Coexistent Acanthamoeba Keratitis and Herpetic Keratitis

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Abstract
Objective: To describe a series of patients with proved herpes simplex virus keratitis (herpetic keratitis) who also had documentedAcanthamoebakeratitis. Methods: Herpetic keratitis was documented with viral cultures, immunologic stains, or histopathologic examination for multinucleated giant cells in the corneal epithelium.Acanthamoebaorganisms were identified using confocal microscopy and epithelial biopsy with hematoxylin-eosin staining. Biopsy of the stroma and epithelium was used to identifyAcanthamoebaorganisms in 1 case. Results: Cultures for herpes simplex virus were positive in 6 of the 9 cases. Immunologic stains were positive in an additional 2 cases, and in 1 case multinucleated giant cells were present in the epithelium consistent with the diagnosis of herpes simplex virus keratitis. Tandem scanning confocal microscopic findings were positive forAcanthamoebain 8 of the 9 cases, and all of them demonstratedAcanthamoebaorganisms in epithelial scrape biopsy specimens. In 1 case, which was not evaluated with confocal microscopy,Acanthamoebawas detected using a stromal and epithelial biopsy. Two of the 9 patients had a history of contact lens use. Conclusion: Acanthamoebakeratitis may be present as a secondary or opportunistic infection in patients with herpetic keratitis.