Praneetha Thulasi1, Hajirah N Saeed2, Christopher J Rapuano3, Joshua H Hou4, Alpheus B Appenheimer5, James Chodosh2, Joann J Kang6, Amber M Morrill7, Neil Vyas8, Michael E Zegans7, Richard Zuckerman9, Elmer Y Tu10. 1. Emory Eye Center, Emory University, Atlanta, Georgia, USA. 2. Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA. 3. Wills Eye Hospital, Philadelphia, Pennsylvania, USA. 4. Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA. 5. Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, Iowa, USA. 6. Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York, USA. 7. Department of Surgery (Ophthalmology), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA. 8. Kaiser Permanente, Panorama City Medical Center, Panorama City, California, USA. 9. Department of Infectious Disease and International Health, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA. 10. Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address: etu@uic.edu.
Abstract
PURPOSE: To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy. DESIGN: Descriptive, retrospective multicenter case series. METHODS: We reviewed 15 patients with AK unresponsive to therapy who were subsequently given adjuvant systemic miltefosine between 2011 and 2017. The main outcome measures were resolution of infection, final visual acuity, tolerance of miltefosine, and clinical course of disease. RESULTS: All patients were treated with biguanides and/or diamidines or azoles without resolution of disease before starting miltefosine. Eleven of 15 patients retained count fingers or better vision, and all were considered disease free at last follow-up. Eleven of 15 patients had worsening inflammation with miltefosine, with 10 of them improving with steroids. Six patients received multiple courses of miltefosine. Most tolerated oral miltefosine well, with mild gastrointestinal symptoms as the most common systemic side effect. CONCLUSIONS: Oral miltefosine is a generally well-tolerated treatment adjuvant in patients with refractory AK. The clinician should be prepared for a steroid-responsive inflammatory response frequently encountered during the treatment course.
PURPOSE: To report a case series of patients with treatment-resistant Acanthamoeba keratitis (AK) using oral miltefosine, often as salvage therapy. DESIGN: Descriptive, retrospective multicenter case series. METHODS: We reviewed 15 patients with AK unresponsive to therapy who were subsequently given adjuvant systemic miltefosine between 2011 and 2017. The main outcome measures were resolution of infection, final visual acuity, tolerance of miltefosine, and clinical course of disease. RESULTS: All patients were treated with biguanides and/or diamidines or azoles without resolution of disease before starting miltefosine. Eleven of 15 patients retained count fingers or better vision, and all were considered disease free at last follow-up. Eleven of 15 patients had worsening inflammation with miltefosine, with 10 of them improving with steroids. Six patients received multiple courses of miltefosine. Most tolerated oral miltefosine well, with mild gastrointestinal symptoms as the most common systemic side effect. CONCLUSIONS: Oral miltefosine is a generally well-tolerated treatment adjuvant in patients with refractory AK. The clinician should be prepared for a steroid-responsive inflammatory response frequently encountered during the treatment course.
Authors: Vithusan Muthukumar; Lei Shi; Ning Chai; Achim Langenbucher; Sören L Becker; Berthold Seitz; Erika Orosz; Tanja Stachon; Albrecht F Kiderlen; Markus Bischoff; Nóra Szentmáry Journal: Microorganisms Date: 2022-08-13