RESUMEN
PURPOSE: To report a cluster of postoperative Acanthamoeba endophthalmitis after routine cataract surgeries. METHODS: A brief summary of sentinel events leading to the referral of 4 patients of postoperative endophthalmitis to our hospital is followed by clinical descriptions and the various diagnostic approaches and interventions used. Genotyping and phylogenetic analysis are also discussed. RESULTS: Four cases of postoperative cluster endophthalmitis, presumed to be bacterial and treated as such, were referred to our hospital. The presence of an atypical ring infiltrate in the first case facilitated the diagnosis of Acanthamoeba endophthalmitis. All patients had vitritis, corneal involvement, and scleral inflammation. Multiple diagnostic methods, such as corneal scrapings, confocal microscopy, aqueous and vitreous taps, scleral abscess drainage, histopathological studies, polymerase chain reaction, and genotyping and phylogenetic analyses of isolated Acanthamoeba, were used to confirm the diagnosis of endophthalmitis and to establish the extent of ocular involvement. Various medical and therapeutic interventions used to control the infections were also documented. The isolated Acanthamoeba were confirmed as belonging to the T10 genotype, an environmentally and clinically rare variety. CONCLUSIONS: This is the first report of a cluster of postoperative T10 genotype Acanthamoeba endophthalmitis, occurring after routine cataract surgery in immunocompetent individuals. Contrary to current perceptions, a rapidly evolving infection can occur with Acanthamoeba.
Asunto(s)
Acanthamoeba/genética , Amebiasis/parasitología , Endoftalmitis/parasitología , Infecciones Parasitarias del Ojo/parasitología , Complicaciones Posoperatorias/parasitología , Acanthamoeba/aislamiento & purificación , Amebiasis/diagnóstico , Amebiasis/tratamiento farmacológico , Antiprotozoarios/uso terapéutico , Humor Acuoso/parasitología , Extracción de Catarata , Córnea/parasitología , ADN Protozoario/genética , ADN Ribosómico/genética , Punto Alto de Contagio de Enfermedades , Endoftalmitis/diagnóstico , Endoftalmitis/tratamiento farmacológico , Infecciones Parasitarias del Ojo/diagnóstico , Infecciones Parasitarias del Ojo/tratamiento farmacológico , Femenino , Técnicas de Genotipaje , Humanos , Masculino , Microscopía Confocal , Filogenia , Reacción en Cadena de la Polimerasa , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , ARN Ribosómico 18S/genéticaRESUMEN
PURPOSE: To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery. METHODS: Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis. RESULTS: Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology. CONCLUSIONS: Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.
