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National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States.

Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL, AcanthamoebaKeratitis Investigation Te - Emerging Infect. Dis. (2009)

Bottom Line: 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).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 likely insufficient.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jverani@cdc.gov

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 likely insufficient. Premarket standardized testing of contact lens solutions for activity against Acanthamoeba spp. is warranted.

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Related in: MedlinePlus

Symptom onset of cases of Acanthamoeba keratitis, by month and year, United States, 2005–2007 (N = 105).
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Related In: Results  -  Collection


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Figure 2: Symptom onset of cases of Acanthamoeba keratitis, by month and year, United States, 2005–2007 (N = 105).

Mentions: Times of symptom onset (Figure 2) did not show any obvious trends or a single period of peak exposure. The 105 case-patients were predominantly female (67 [64%]) with a median age of 29 years (range 12–76 years) (Table 1). Of these case-patients, 93 (89%) wore contact lenses (82 [88%] used soft contact lenses), and 87 (94%) reported using some type of cleaning or disinfecting solution (78 [90%]) used a multipurpose solution). Of the 6 contact lens users who did not report use of any cleaning or disinfecting solution, 1 used daily disposable lenses, 1 used extended-wear lenses that were replaced with no cleaning, 2 used only saline solution, 1 used saline solution and rewetting drops, and 1 did not recall which types or brands of solutions were used.


National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States.

Verani JR, Lorick SA, Yoder JS, Beach MJ, Braden CR, Roberts JM, Conover CS, Chen S, McConnell KA, Chang DC, Park BJ, Jones DB, Visvesvara GS, Roy SL, AcanthamoebaKeratitis Investigation Te - Emerging Infect. Dis. (2009)

Symptom onset of cases of Acanthamoeba keratitis, by month and year, United States, 2005–2007 (N = 105).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2815976&req=5

Figure 2: Symptom onset of cases of Acanthamoeba keratitis, by month and year, United States, 2005–2007 (N = 105).
Mentions: Times of symptom onset (Figure 2) did not show any obvious trends or a single period of peak exposure. The 105 case-patients were predominantly female (67 [64%]) with a median age of 29 years (range 12–76 years) (Table 1). Of these case-patients, 93 (89%) wore contact lenses (82 [88%] used soft contact lenses), and 87 (94%) reported using some type of cleaning or disinfecting solution (78 [90%]) used a multipurpose solution). Of the 6 contact lens users who did not report use of any cleaning or disinfecting solution, 1 used daily disposable lenses, 1 used extended-wear lenses that were replaced with no cleaning, 2 used only saline solution, 1 used saline solution and rewetting drops, and 1 did not recall which types or brands of solutions were used.

Bottom Line: 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).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 likely insufficient.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jverani@cdc.gov

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 likely insufficient. Premarket standardized testing of contact lens solutions for activity against Acanthamoeba spp. is warranted.

Show MeSH
Related in: MedlinePlus