Acridine orange staining for rapid diagnosis of Acanthamoeba keratitis

Acanthamoeba keratitis is uncommon, but one of the most severe infectious diseases of the cornea. Delayed diagnosis or misdiagnosis as bacterial or herpes simplex keratitis leads to extensive corneal inflammation and profound visual loss. Therefore, accurate and rapid diagnosis of Acanthamoeba keratitis is essential for successful treatment and good prognosis. We evaluated the usefulness of acridine orange staining from corneal scrapings and contact lens solutions for the rapid diagnosis of four consecutive cases of Acanthamoeba keratitis. Gram stain and culture on nonnutrient agar plates with Escherichia coli overlay were also made. Corneal scrapings stained with acridine orange revealed yellow-to-orange polygonal, cystic structures consistent with the appearance of Acanthamoeba among inflammatory cells and the corneal epithelial cells. The contact lens case solutions of two patients also showed numerous cysts with double wall. Some organisms from the third patient were identified as Acanthamoeba castellani and others as Acanthamoeba lugdunensis. Based on the acridine orange staining results in four cases of Acanthamoeba keratitis, this stain is recommended as a simple and reliable method for the rapid diagnosis of this disease.