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3 Acanthamoeba Keratitis
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Acanthamoeba keratitis is a painful, sight-threatening corneal infection It is associated with corneal trauma, most commonly after use of contact lenses and contaminated saline solution Symptoms include severe eye pain, photophobia, tearing, and blurred vision The keratitis progresses slowly, with waxing and waning clinical findings over months, and can progress to blindness Lack of response to antibacterial, antifungal, and antiviral topical treatments and potential use of contaminated contact lens solution are suggestive of the diagnosis Ocular examination shows corneal ring infiltrates, but these can also be caused by other pathogens The diagnosis can be made by examination or culture of corneal scrapings Available diagnostic techniques include examination of a wet preparation for cysts and motile trophozoites, examination of stained specimens, evaluation with immunofluorescent reagents, culture of organisms, and PCR Acanthamoeba keratitis can be cured with local therapy Topical propamidine isethionate (01%), chlorhexidine digluconate (002%), polyhexamethylene biguanide, neomycin-polymyxin B-gramicidin, miconazole, and combinations of these agents have been used successfully Oral itraconazole or ketoconazole can be added for deep keratitis Drug resistance has been reported Use of corticosteroid therapy is controversial In some cases, debridement and penetrating keratoplasty have been performed in addition to medical therapy Corneal grafting can be done after the amebic infection has been eradicated
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Driebe WT Jr Present status of contact lens-induced corneal infections Ophthalmol Clin North Am 2003 Sep;16(3):485 94 [PMID: 14564769] Marciano-Cabral F et al Acanthamoeba spp as agents of disease in humans Clin Microbiol Rev 2003 Apr;16(2):273 307 [PMID: 12692099]
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1 Cryptosporidiosis The incubation period appears to be about 1 14 days In developing countries, disease is seen primarily in children under 5 years of age, where cryptosporidiosis causes 5 10% of cases of childhood diarrhea Presenting symptoms in children include acute watery diarrhea,
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have also been described Disease from microsporidia is seen mainly in immunocompromised persons, particularly those with AIDS Infections in AIDS patients are most commonly with E bieneusi and E intestinalis They cause chronic diarrhea, with anorexia, bloating, weight loss, and wasting, especially in those with advanced immunodeficiency Fever is usually not seen Other illnesses in immunocompromised persons associated with microsporidians (including the genera Enterocytozoon, Encephalitozoon, Brachiola, Vittaforma, Pleistophora, Trachipleistophora, and Microsporidium) include biliary tract disease (AIDS cholangiopathy), genitourinary infection with cystitis, renal disease, hepatitis, peritonitis, myositis, respiratory infections including sinusitis, central nervous system infections including granulomatous encephalitis, and disseminated infections Ocular infections with Encephalitozoon species cause conjunctivitis and keratitis, presenting as redness, photophobia, and loss of visual acuity
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abdominal pain, and cramps, with rapid resolution in most patients; however, symptoms quite commonly persist for 2 weeks or more In developed countries, most patients are adults Diarrhea in immunocompetent individuals typically lasts from 5 to 10 days It is usually watery, with accompanying abdominal pain and cramps, nausea, vomiting, and fever Relapses may follow initial resolution of symptoms Mild illnesses and asymptomatic infection may also be common Cryptosporidiosis is a well-characterized cause of diarrhea in those with AIDS It was common in this population before the advent of highly active antiretroviral therapy, particularly in those with advanced immunosuppression Clinical manifestations are variable, but patients commonly have chronic diarrhea with frequent foul smelling stools, malabsorption, and weight loss Severe, life-threatening watery diarrhea may be seen Cryptosporidiosis also causes extraintestinal disease with AIDS, including pulmonary infiltrates with dyspnea and biliary tract infection with sclerosing cholangitis and AIDS cholangiopathy 2 Isosporiasis The incubation period for I belli is about 1 week In immunocompetent persons, it usually causes a selflimited watery diarrhea lasting 2 3 weeks, with abdominal cramps, anorexia, malaise, and weight loss Fever is unusual Chronic symptoms may persist for months in some patients In immunocompromised patients, isosporiasis more commonly causes severe and chronic diarrhea, with complications including marked dehydration, malnutrition, and hemorrhagic colitis Extraintestinal disease has been reported rarely 3 Cyclosporiasis C cayetanensis oocysts must undergo a period of sporulation of 7 days or more after shedding before they become infectious Therefore, person-to-person spread is unlikely, and spread has typically been due to contaminated food (especially fresh produce) and water The incubation period is 1 11 days Infections can be asymptomatic Cyclosporiasis causes an illness similar to that described for the other pathogens described in this section, with watery diarrhea, abdominal cramps, nausea, fatigue, and anorexia Fever is seen in 25% of cases Symptoms typically continue for 2 weeks or longer and may persist for months Relapses of diarrhea are common Diarrhea may be preceded by a flu-like prodrome and followed by persistent fatigue In immunocompromised patients, cyclosporiasis is typically more severe and prolonged, with chronic fulminant watery diarrhea and weight loss 4 Sarcocystosis Sarcocystis infection may be common in some developing countries, but it is usually asymptomatic Infection appears to most commonly follow the ingestion of undercooked beef or pork, leading to the development of cysts in muscle, with myalgias, fever, bronchospasm, pruritic rash, lymphadenopathy, and subcutaneous nodules Ingestion of fecal sporocysts may lead to gastrointestinal symptoms 5 Microsporidiosis Microsporidia are obligate intracellular protozoans that cause a wide spectrum of diseases Many infections are of zoonotic origin, but human-to-human transmission has been documented Infection is mainly by ingestion of spores, but also by direct inoculation of the eyes In immunocompetent hosts, microsporidian infections most commonly present as self-limited diarrhea Ocular infections
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