Multidrug-resistant Acanthamoeba keratitis caused by the T4 Genotype: A case report

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Acanthamoeba keratitis (AK) is a serious microbial infection of the cornea.
• Contact lens wear is a significant risk factor for AK.
• The T4 genotype of Acanthamoeba is associated with severe and refractory cases.

Purpose of the Study:

• To report a case of aggressive Acanthamoeba keratitis caused by the T4 genotype.
• To highlight the challenges in managing refractory AK.
• To emphasize the importance of early diagnosis and treatment.

Main Methods:

• Clinical case presentation of a 28-year-old female contact lens wearer.
• Ophthalmic examination including in vivo confocal microscopy.
• Microbiological culture, PCR, and sequencing for Acanthamoeba identification and genotyping.
• Assessment of response to intensive medical and surgical treatments.

Main Results:

• The patient presented with severe ocular pain and photophobia.
• In vivo confocal microscopy revealed characteristic Acanthamoeba cysts.
• Acanthamoeba T4 genotype was confirmed.
• Despite aggressive multi-modal therapy including topical agents, oral medication, and keratoplasty, the infection progressed to stromal necrosis and phthisis bulbi.
• Permanent vision loss occurred.

Conclusions:

• Acanthamoeba keratitis due to the T4 genotype can be aggressive and lead to poor visual outcomes.
• Refractory cases necessitate vigilant monitoring and timely surgical intervention.
• Early diagnosis and prompt, appropriate treatment are critical for managing AK.