TRATAS 1 AMEBA
development of ascoring system for the diagnosis ofamoebic keratitis
DOI:
https://doi.org/10.70313/2718.7446.v18.n2.422Keywords:
amoebic keratitis, Acanthamoeba, infectious keratitisAbstract
Objective: To develop a scoring system to establish a presumptive diagnosis of amoebic keratitis, considering the risk factors identified by scientific publications to date.
Methods: A literature search on amoebic keratitis and risk factors was performed, including systematic reviews and narratives from the years 2024 and 2025. Clinical, epidemiologic studies not mentioned in the reviews, published since 2000, were also included. All major risk factors were identified and a scoring system was used, based on the number of papers mentioning each risk factor, also considering the potential prevalences reported.
Results: Five studies from 2024 and 2025 (systematic reviews and narrative) and eleven studies published between 2006 and 2023 were included. Thirty-two different risk factors were identified, where 18 were related to history or epidemiological characteristics and 14 were risk factors associated with clinical characteristics. The total score accounting for the 32 risk factors was 72. The history segment accounted for the majority of the score (61.1%), led by the use of contact lenses.
Conclusion: A clinical scoring system was developed to establish a presumptive diagnosis of amoebic keratitis, based on the clinical evidence published to date. The clinical history of contact lens use is one of the main factors and from its clinical aspect, the ring infiltrate is the one that gives the highest score to suspect this pathology.
Downloads
References
1. Zhang Y, Xu X, Wei Z, Cao K, Zhang Z, Liang Q. The global epidemiology and clinical diagnosis of Acanthamoeba keratitis. J Infect Public Health 2023; 16(6): 841-852. doi:10.1016/j.jiph.2023.03.020.
2. Stapleton F. The epidemiology of infectious keratitis. Ocul Surf 2023; 28: 351-363. doi:10.1016/j.jtos.2021.08.007.
3. Ren K, Xue Y, Rønn R et al. Dynamics and determinants of amoeba community, occurrence and abundance in subtropical reservoirs and rivers. Water Res 2018; 146: 177-186. doi:10.1016/j.watres.2018.09.011.
4. Maycock NJ, Jayaswal R. Update on Acanthamoeba keratitis: diagnosis, treatment, and outcomes. Cornea 2016; 35(5): 713-720. doi:10.1097/ICO.0000000000000804.
5. Przybek-Skrzypecka J, Skrzypecki J, Suh L, Szaflik JP. Corneal ring infiltrate: far more than Acanthamoeba keratitis: review of pathophysiology, morphology, differential diagnosis and management. J Ophthalmic Inflamm Infect 2023; 13(1): 55. doi:10.1186/s12348-023-00379-6.
6. Szentmáry N, Daas L, Shi L et al. Acanthamoeba keratitis: clinical signs, differential diagnosis and treatment. J Curr Ophthalmol 2018; 31(1): 16-23. doi:10.1016/j.joco.2018.09.008.
7. Aiello F, Gallo Afflitto G, Ceccarelli F et al. Perspectives on the incidence of Acanthamoeba keratitis: a systematic review and meta-analysis. Ophthalmology 2025; 132(2): 206-218. doi:10.1016/j.ophtha.2024.08.003.
8. Marques-Couto P, Monteiro M, Ferreira AM, Pinheiro-Costa J, Vilares-Morgado R. Acanthamoeba keratitis management and prognostic factors: a systematic review. J Clin Med 2025; 14(7): 2528. doi:10.3390/jcm14072528.
9. Papa V, Bodicoat DH, Duarte AA, Dart JKG, De Francesco M. The natural history of acanthamoeba keratitis: a systematic literature review. Ophthalmol Ther. Published online May 5, 2025. doi:10.1007/s40123-025-01152-9.
10. Petrillo F, Tortori A, Vallino V et al. Understanding Acanthamoeba keratitis: an in-depth review of a sight-threatening eye infection. Microorganisms 2024; 12(4): 758. doi:10.3390/microorganisms12040758.
11. Raghavan A, Rammohan R. Acanthamoeba keratitis: a review. Indian J Ophthalmol 2024; 72(4): 473-482. doi:10.4103/IJO.IJO_2627_23.
12. Parmar DN, Awwad ST, Petroll WM, Bowman RW, McCulley JP, Cavanagh HD. Tandem scanning confocal corneal microscopy in the diagnosis of suspected acanthamoeba keratitis. Ophthalmology 2006; 113(4): 538-547. doi:10.1016/j.ophtha.2005.12.022.
13. Awwad ST, Petroll WM, McCulley JP, Cavanagh HD. Updates in Acanthamoeba keratitis. Eye Contact Lens 2007; 33(1): 1-8. doi:10.1097/ICL.0b013e31802b64c1.
14. Tu EY, Joslin CE, Sugar J, Shoff ME, Booton GC. Prognostic factors affecting visual outcome in Acanthamoeba keratitis. Ophthalmology 2008; 115(11): 1998-2003. doi:10.1016/j.ophtha.2008.04.038.
15. Boggild AK, Martin DS, Lee TY, Yu B, Low DE. Laboratory diagnosis of amoebic keratitis: comparison of four diagnostic methods for different types of clinical specimens. J Clin Microbiol 2009; 47(5): 1314-1318. doi:10.1128/JCM.00173-09.
16. Lorenzo-Morales J, Khan NA, Walochnik J. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment. Parasite 2015; 22: 10. doi:10.1051/parasite/2015010.
17. Carnt N, Robaei D, Minassian DC, Dart JKG. Acanthamoeba keratitis in 194 patients: risk factors for bad outcomes and severe inflammatory complications. Br J Ophthalmol 2018; 102(10): 1431-1435. doi:10.1136/bjophthalmol-2017-310806.
18. Fanselow N, Sirajuddin N, Yin XT, Huang AJW, Stuart PM. Acanthamoeba keratitis, pathology, diagnosis and treatment. Pathogens 2021; 10(3): 323. doi:10.3390/pathogens10030323.
19. Shareef O, Shareef S, Saeed HN. New frontiers in Acanthamoeba keratitis diagnosis and management. Biology (Basel) 2023; 12(12): 1489. doi:10.3390/biology12121489.
20. Posarelli M, Passaro ML, Avolio FC, Costagliola C, Semeraro F, Romano V. The incidence of severe complications in acanthamoeba keratitis: qualitative and quantitative systematic assessment. Surv Ophthalmol 2024; 69(5): 769-778. doi:10.1016/j.survophthal.2024.06.001.
21. Nicola F. Queratitis infecciosa no viral: factores predisponentes, agentes etiológicos y diagnóstico de laboratorio. Rev Argent Microbiol 2005; 37(4): 229-239.
22. Juárez MM, Tártara LI, Cid AG et al. Acanthamoeba in the eye, can the parasite hide even more? Latest developments on the disease. Cont Lens Anterior Eye 2018; 41(3): 245-251. doi:10.1016/j.clae.2017.12.017.
23. Desio D, Banegas J, Albera P, Nashiro C, Minervini P, Hope S, Apestey N, Pellegrino F. Estudio retrospectivo de queratitis infecciosas durante la pandemia del coronavirus. Oftalmol Clin Exp 2022; 15(4): e442-e454. doi:10.70313/2718.7446.v15.n04.193
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Consejo Argentino de Oftalmología
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Con esta licencia no se permite un uso comercial de la obra original, ni la generación de obras derivadas. Las licencias Creative Commons permiten a los autores compartir y liberar sus obras en forma legal y segura.
How to Cite
