Coexistent Acanthamoeba keratitis and herpetic keratitis
W. D. Mathers, M. A. Goldberg, J. E. Sutphin, J. W. Ditkoff and R. Folberg
Department of Ophthalmology, University of Iowa, Iowa City, USA.
OBJECTIVE: To describe a series of patients with proved herpes simplex
virus keratitis (herpetic keratitis) who also had documented Acanthamoeba
keratitis. METHODS: Herpetic keratitis was documented with viral cultures,
immunologic stains, or histopathologic examination for multinucleated giant
cells in the corneal epithelium. Acanthamoeba organisms were identified
using confocal microscopy and epithelial biopsy with hematoxylin-eosin
staining. Biopsy of the stroma and epithelium was used to identify
Acanthamoeba organisms in 1 case. RESULTS: Cultures for herpes simplex
virus were positive in 6 of the 9 cases. Immunologic stains were positive
in an additional 2 cases, and in 1 case multinucleated giant cells were
present in the epithelium consistent with the diagnosis of herpes simplex
virus keratitis. Tandem scanning confocal microscopic findings were
positive for Acanthamoeba in 8 of the 9 cases, and all of them demonstrated
Acanthamoeba organisms in epithelial scrape biopsy specimens. In 1 case,
which was not evaluated with confocal microscopy, Acanthamoeba was detected
using a stromal and epithelial biopsy. Two of the 9 patients had a history
of contact lens use. CONCLUSION: Acanthamoeba keratitis may be present as a
secondary or opportunistic infection in patients with herpetic keratitis.
