[Acanthamoeba keratitis: about the first two Tunisian cases].

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Acanthamoeba keratitis is a severe corneal infection often leading to vision loss.
• Contact lens wear is a significant risk factor for Acanthamoeba keratitis.
• This report marks the first documented case of Acanthamoeba keratitis in Tunisia.

Observation:

• Two young myopic women wearing soft contact lenses presented with severe bilateral keratitis and decreased visual acuity.
• Microscopic examination revealed Acanthamoeba trophozoites and cysts, with one case co-infected with Fusarium oxysporum.
• Initial antibiotic and antifungal treatments were ineffective.

Findings:

• Corneal scraping and contact lens solution analysis confirmed Acanthamoeba presence.
• Treatment with polyhexamethylene biguanide (PHMB), voriconazole, and surgical intervention (keratoplasty) showed partial recovery in one patient.
• Prompt treatment with Désomédine improved vision in the second patient, though residual opacity remained.

Implications:

• Highlights the importance of considering Acanthamoeba in contact lens-related keratitis, especially in regions where it's not commonly reported.
• Suggests that a combination therapy including PHMB, voriconazole, and potentially keratoplasty may be effective for severe cases.
• Emphasizes the need for prompt diagnosis and appropriate management to prevent irreversible vision loss from Acanthamoeba keratitis.