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      National Outbreak of Acanthamoeba Keratitis Associated with Use of a Contact Lens Solution, United States

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          Abstract

          Premarket standardized testing for Acanthamoeba spp. is warranted.

          Abstract

          An outbreak of Acanthamoeba keratitis, a rare, potentially blinding, corneal infection, was detected in the United States in 2007; cases had been increasing since 2004. A case–control study was conducted to investigate the outbreak. We interviewed 105 case-patients from 30 states and 184 controls matched geographically and by contact lens use. Available contact lenses, cases, solutions, and corneal specimens from case-patients were cultured and tested by molecular methods. In multivariate analyses, case-patients had significantly greater odds of having used Advanced Medical Optics Complete Moisture Plus (AMOCMP) solution (odds ratio 16.9, 95% confidence interval 4.8–59.5). AMOCMP manufacturing lot information was available for 22 case-patients, but none of the lots were identical. Three unopened bottles of AMOCMP tested negative for Acanthamoeba spp. Our findings suggest that the solution was not intrinsically contaminated and that its anti- Acanthamoeba efficacy was insufficient. Premarket standardized testing of contact lens solutions for activity against Acanthamoeba spp. is warranted.

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          Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution.

          Scott K. Fridkin, Arjun Srinivasan, Jeffrey M. Jacobson … (2006)
          Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. Keratitis infection with Fusarium species. As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.
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            The epidemiology of Acanthamoeba keratitis in the United States.

            John Green, G Visvesvara, Sean T. Bailey (1989)
            We surveyed members of the Ocular Microbiology and Immunology Group and reviewed laboratory requests at the Centers for Disease Control to determine better the epidemiology of Acanthamoeba keratitis in the United States. A total of 208 cases of Acanthamoeba keratitis were identified. The number of cases increased gradually between 1981 and 1984, with a dramatic increase beginning in 1985. Males and females were equally affected. Of the 208 patients, 85 (41%) resided in California, Texas, Florida, or Pennsylvania. Of 189 patients, 160 (85%) wore contact lenses, predominantly daily-wear or extended-wear soft lenses. Of the 138 patients who wore contact lenses and for whom information was available, 88 (64%) used saline prepared by dissolving salt tablets in distilled water. Patients aged 50 years and older were more likely to have had a history of trauma than younger patients, and males were more likely to have a history of trauma than females.
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              18S ribosomal DNA typing and tracking of Acanthamoeba species isolates from corneal scrape specimens, contact lenses, lens cases, and home water supplies of Acanthamoeba keratitis patients in Hong Kong.

              E Houang, Ruby Lam, Joshua Byers … (2002)
              We examined partial 18S ribosomal DNA (Rns) sequences of Acanthamoeba isolates cultured in a study of microbial keratitis in Hong Kong. Sequence differences were sufficient to distinguish closely related strains and were used to examine links between strains obtained from corneal scrape specimens, contact lenses, lens cases, lens case solutions, and home water-supply faucets of patients with Acanthamoeba. We also looked for evidence of mixed infections. Identification of Acanthamoeba Rns genotypes was based on sequences of approximately 113 bp within the genus-specific amplicon ASA.S1. This permitted genotype identification by using nonaxenic cultures. Of 13 specimens obtained from corneal scrapes, contact lenses, lens cases, or lens case solutions, 12 were Rns genotype T4 and the remaining one was Rns genotype T3. The sequences of corneal scrape specimens of two patients also were the same as those obtained from their contact lenses or lens case specimens. A possible triple-strain infection was indicated by three different T4 sequences in cultures from one patient's lenses. Although faucet water used by patients to clean their lenses is a possible source of infections, specimens isolated from the faucets at two Acanthamoeba keratitis patients' homes differed from their corneal scrape or lens specimens. The overall results demonstrate the potential of this Rns region for tracking Acanthamoeba keratitis strains in infections and for distinguishing single-strain and closely related multiple-strain infections even when other microorganisms might be present with the cultured specimens. They also confirm the predominance of Rns genotype T4 strains in Acanthamoeba keratitis infections.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): August 2009
                Volume: 15
                Issue: 8
                Pages: 1236-1242
                Affiliations
                [1]Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.R. Verani, S.A. Lorick, J.S. Yoder, M.J. Beach, C.R. Braden, J.M. Roberts, D.C. Chang, B.J. Park, G.S. Visvesvara, S.L. Roy)
                [2]Illinois Department of Public Health, Chicago, Illinois, USA (C.S. Conover)
                [3]California Department of Public Health, Sacramento, California, USA (S. Chen)
                [4]Florida Department of Health, Tallahassee, Florida, USA (K.A. McConnell); and Baylor College of Medicine, Houston, Texas, USA (D.B. Jones)
                Author notes
                Address for correspondence: Jennifer R. Verani, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop C23, Atlanta, GA 30333, USA; email: jverani@ 123456cdc.gov
                Article
                Publisher ID: 09-0225
                DOI: 10.3201/eid1508.090225
                PMC ID: 2815976
                PubMed ID: 19751585
                SO-VID: 3c8d1266-5947-4441-8d92-3ce897819e33
                History
                Categories
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: parasites,united states,cornea,contact lenses,disease outbreak,contact lens solution,acanthamoeba,research,keratitis,protozoa
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: parasites, united states, cornea, contact lenses, disease outbreak, contact lens solution, acanthamoeba, research, keratitis, protozoa

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