Amebic keratitis in a wearer of disposable contact lenses due to a mixed Vahlkampfia and Hartmannella infection.

PURPOSE: To support the hypothesis that Acanthamoeba is not a unique cause of amebic keratitis, we report a case of amebic keratitis in which viable Acanthamoeba could not be isolated from corneal tissue. Vahlkampfia and Hartmannella, two other genera of free-living ameba, were isolated, however, using prolonged culture. METHODS: A 24-year-old wearer of soft contact lenses had keratitis. Extensive histologic and microbiologic investigations were performed on corneal scrape, biopsy, and keratoplasty tissue. Contact lenses, storage case, and the home water supply, where contact lens hygiene was practiced, were examined for the presence of micro-organisms. RESULTS: No viruses, pathogenic bacteria, or fungi were detected from corneal tissue samples. Amebae were observed using light and electron microscopy, but these could not be unequivocally classified using immunocytochemical staining. Viable Vahlkampfia and Hartmannella, but no Acanthamoeba, were isolated from the corneal biopsy sample. Indirect immunofluorescence with a range of polyclonal rabbit antisera raised against axenically cultivated stains of the three amebal genera was unhelpful because of cross-reactivity. A diverse range of micro-organisms was present within the storage case, including the three amebal species. Amebic cysts also were associated with the contact lens. CONCLUSION: A mixed non-Acanthamoeba amebic keratitis has been identified in a wearer of soft contact lenses where lack of storage case hygiene provided the opportunity for the free-living protozoa Vahlkampfia and Hartmannella to be introduced to the ocular surface. When Acanthamoeba-like keratitis occurs, but where Acanthamoeba cannot be isolated using conventional laboratory culture methods, alternate means should be used to identify other amebae that may be present. Polyclonal immunofluorescent antibody staining was unreliable for generic identification of pathogenic free-living amebae in corneal tissue.

Identification of antigens of pathogenic free-living amoebae by protein immunoblotting with rabbit immune and human sera.

Prominent antigens of pathogenic and nonpathogenic free-living amoebae were identified by using polyclonal rabbit immune sera in immunoblot assays. The intent was to determine if prominent epitopes identified with rabbit immune sera could also be recognized by human sera. With rabbit sera, the development of immunoreactive bands was restricted to molecular masses of greater than 18.5 kDa for Naegleria, Hartmannella, and Vahlkampfia antigens. Two or more broad bands of less than 18.5 kDa were prominent features in three different Acanthamoeba species. Few cross-reactive antibodies could be detected between representative species of the three different subgroups of Acanthamoeba. Naegleria antigen was likewise serologically distinct, as were Hartmannella and Vahlkampfia antigens. The relative lack of cross-reacting antibodies between the pathogenic amoebae suggested that i would be desirable to use a panel of amoebic antigens to represent the range of serologically distinct antigens for assessing reactive antibodies in human sera. In pooled human sera (10 serum specimens per pool), the appearance of minimally reactive bands ranging from 32.5 to 106 kDa was a common feature of all six antigens. A prominent band of less than 18.5 kDa was identified in the Acanthamoeba culbertsoni antigen lane in 2 of the 10 human serum specimen pools. When sera from each of the two groups were tested individually by immunoblotting, the reaction with A. culbertsoni antigen could be associated with one individual. By using a panel of amoebic antigens, this method could prove useful in recognizing undiagnosed amoebic infections by revealing specific reactive antibodies.

Retrospective identification of Acanthamoeba culbertsoni in a case of amoebic meningoencephalitis.

Acanthamoeba culbertsoni was identified retrospectively in a case of amoebic meningoencephalitis, previously reported by Jager and Stamm (Lancet, 2, 1343, 1972). This is the second report of this species causing secondary infection in man. Positive results were obtained only with anti-A. culbertsoni sera when the brain sections were stained by the indirect immunofluorescence antibody test with various antisera produced against different Acanthamoeba species. Antiserum raised against purified plasma membranes of A. culbertsoni showed once more its highly specific diagnostic value.

Comparative studies on related free-living and pathogenic amebae with special reference to Acanthamoeba.

Comparative studies were conducted on the structure, nutrition, protein composition, immunology, and effect on cell cultures of Acanthamoeba sp. (Lilly A-1 strain), A. castellanii (Singh and Neff strains), A. astronyxis, A. comandoni, A. polyphaga, A. terricola, Hartmannella vermiformis, and Naegleria gruberi. Lilly A-1 strain of Acanthamoeba received special attention owing to its pathogenicity for experimental animals. Distinct differences were noted in structure, nutrition, and antigenic composition of Acanthamoeba spp. and Hartmannella, and it was concluded that their recognition as separate genera is justified. With the exception of A. terricola, all species of Acanthamoeba could be differentiated by cyst structure. Cysts of A. terricola closely resembled those of A. castellanii Singh strain, and close antigenic relationships between these 2 species were demonstrated by gel diffusion and immunoelectrophoresis (IEP); it was concluded that the 2 amebae belong in the same species. The pathogenic Acanthamoeba sp, Lilly strain differed from the nonpathogenic A. castellanii Singh strain (a) cyst structure; (b) protein distribution patterns (on disc electrophoresis);(c)soluble and particulate antigens (on gel diffusion, IEP, complement fixation, and immobilization tests); (d) capacity to induce cell-free plaques and other cytopathic effect (CPE) in mammalian monlayer cell cultures; (e) elimination of a phospholipase, responsible for some of the CPE, into the culture medium. Acanthamoeba sp. Lilly strain, which liberated more phospholipase, produced more CPE. Acanthamoeba sp. Lilly strain differed also from other species of this genus in cyst structure and antigenic composition. It was concluded, therefore, that, following the recommendation of Singh & Das, it ought to be placed in a separate species, Acanthamoeba culbertsoni.

Soil ameba infection. Specific indirect immunoenzymatic (peroxidase) staining of formalin-fixed paraffin sections.

This report describes the use of the immunoenzymatic (peroxidase) method to identify the species and to stain distinctively the amebas in formalin-fixed paraffin-mounted sections. This permits the use of hematoxylin and eosin counterstaining. The method, now well developed by others for many purposes, is an alternative to immunofluorescence and seems to offer a number of advantages and a lesser number of disadvantages.