An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment

Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections. Les amibes à vie libre du genre Acanthamoeba sont les agents causant une infection sévère de la cornée, dangereuse pour la vue, appelée kératite à Acanthamoeba. De plus, le nombre de cas signalés à travers le monde est en augmentation année après année, principalement chez les porteurs de lentilles de contact, bien que des cas de kératite à Acanthamoeba aient également été signalés chez les non-porteurs de lentilles. Fait intéressant, la kératite à Acanthamoeba est restée significative, en dépit de nos progrès dans la chimiothérapie antimicrobienne et les soins de soutien. En partie, cela est dû à une compréhension incomplète de la pathogenèse et la physiopathologie de la maladie, aux retards du diagnostic et aux problèmes associés aux interventions chimiothérapeutiques. Compte tenu de la nature dévastatrice de cette maladie, nous présentons ici notre compréhension actuelle de la kératite à Acanthamoeba et des mécanismes moléculaires ass