Instituto de Investigaciones para la Industria Química (INIQUI, CONICET - Universidad Nacional de Salta), Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ingeniería, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina; Facultad de Ciencias de la Salud, Universidad Nacional de Salta, Av. Bolivia 5150, 4400, Salta, Argentina.
Unidad de Investigación y Desarrollo en Tecnología Farmacéutica (UNITEFA, CONICET - Departamento de Ciencias Farmacéuticas, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba), Ciudad Universitaria, 5000, Córdoba, Argentina.
Cont Lens Anterior Eye. 2018 Jun;41(3):245-251. doi: 10.1016/j.clae.2017.12.017. Epub 2017 Dec 19.
Acanthamoeba spp. is a free living protozoan in the environment, but can cause serious diseases. Acanthamoeba keratitis (AK), a severe and painful eye infection, must be treated as soon as possible to prevent ulceration of the cornea, loss of visual acuity, and eventually blindness or enucleation. Although the disease affects principally contact lens (CLs) wearers, it is recognized nowadays as a cause of keratitis also in non-CLs wearers. Although the number of infections caused by these amoebae is low, AK is an emerging disease presenting an extended number of cases each year worldwide mostly due to the increasing use of CLs, but also to better diagnostic methods and awareness. There are two principal causes that lead to severe outcomes: misdiagnosis or late diagnosis of the causal agent, and lack of a fully effective therapy due to the existence of a highly resistant cyst stage of Acanthamoeba. Recent studies have reported different genotypes that have not been previously associated with this disease. In addition, Acanthamoeba can act as a reservoir for phylogenetically diverse microorganisms. In this regard, recently giant viruses called Pandoravirus have been found within genotypes producing keratitis. What potential risk this poses is not yet known. This review focuses on an overview of the present status and future prospects of this re-emerging pathology, including features of the parasite, epidemiology, clinical aspects, diagnosis, and treatment.
棘阿米巴属是一种自由生活的原生动物,存在于环境中,但可引起严重疾病。棘阿米巴角膜炎(AK)是一种严重且疼痛的眼部感染,必须尽快治疗,以防止角膜溃疡、视力丧失,最终导致失明或眼球摘除。尽管这种疾病主要影响隐形眼镜(CLs)佩戴者,但现在已经认识到,它也是非 CLs 佩戴者角膜炎的一个原因。尽管这些阿米巴引起的感染数量较少,但由于 CLs 的使用增加,以及更好的诊断方法和认识,AK 作为一种新兴疾病,每年在全球都呈现出更多的病例。导致严重后果的主要原因有两个:对病原体的误诊或延迟诊断,以及由于棘阿米巴存在高度耐药的囊泡阶段,缺乏完全有效的治疗方法。最近的研究报告了不同的基因型,这些基因型以前与这种疾病无关。此外,棘阿米巴可作为进化上多样化的微生物的储主。在这方面,最近在引起角膜炎的基因型中发现了一种称为潘多拉病毒的巨型病毒。目前尚不清楚这会带来什么潜在风险。这篇综述重点介绍了这种重新出现的病理学的现状和未来前景,包括寄生虫的特征、流行病学、临床方面、诊断和治疗。