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Chowdhury M, Prakash PR, Singh A, Jorwal P, Das S, Soneja M. Acanthamoeba meningoencephalitis causing secondary hemophagocytic lymphohistiocytosis in an immunocompetent patient: A first case report. J R Coll Physicians Edinb 2023; 53:23-26. [PMID: 36680356 DOI: 10.1177/14782715221149709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Acanthamoeba is a rare cause of granulomatous amoebic encephalitis (GAE) associated with high mortality. There have been few case reports of Acanthamoeba meningoencephalitis worldwide. Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition caused by abnormally active macrophages and cytotoxic T lymphocytes; its secondary form is due to infections or malignancies. However, HLH is rather an unknown complication of GAE. We describe an unusual and previously unreported case of Acanthamoeba meningoencephalitis in a young immunocompetent female culminating in secondary HLH.
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Affiliation(s)
| | | | | | - Pankaj Jorwal
- Department of Medicine, AIIMS, New Delhi, Delhi, India
| | - Sumanta Das
- Department of Pathology, AIIMS, New Delhi, Delhi, India
| | - Manish Soneja
- Department of Medicine, AIIMS, New Delhi, Delhi, India
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2
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Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease. Front Med 2021; 15:842-866. [PMID: 34825341 DOI: 10.1007/s11684-021-0865-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 10/19/2022]
Abstract
Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which Naegleria fowleri followed by Acanthamoeba spp. and Balamuthia mandrillaris have been successively discovered. As the three dominant genera responsible for infections, Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.
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3
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Öcal Demir S, Besli GE, Bucak A, Boral Ö, Baysal B. Successful Treatment of Acanthamoeba Meningoencephalitis in an Immunocompetent Child. J Trop Pediatr 2021; 67:6276663. [PMID: 33998656 DOI: 10.1093/tropej/fmaa102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acanthamoeba meningoencephalitis is a very rare entity with high mortality rate. Its diagnosis is usually delated, and the optimal approach for its treatment is uncertain. In presented case, early diagnosis was made with direct examination of cerebral spinal fluid, and immediate initiation of accurate treatment with amphotericin B and fluconazole survived patient.
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Affiliation(s)
- Sevliya Öcal Demir
- SB Istanbul Medeniyet University Goztepe Prof Dr Suleyman Yalcın City Hospital, Pediatric Department, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Gülser Esen Besli
- SB Istanbul Medeniyet University Goztepe Prof Dr Suleyman Yalcın City Hospital, Pediatric Department, Division of Pediatric Emergency, Istanbul, Turkey
| | - Abdulmelik Bucak
- SB Istanbul Medeniyet University Goztepe Prof Dr Suleyman Yalcın City Hospital, Pediatric Department, Istanbul, Turkey
| | - Özden Boral
- Istanbul University, Istanbul Medical School, Microbiology and Clinic Microbiology Department, Istanbul, Turkey
| | - Begümhan Baysal
- SB Istanbul Medeniyet University Goztepe Prof Dr Suleyman Yalcın City Hospital, Radiology Department, Istanbul, Turkey
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4
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Alli A, Ortiz JF, Morillo Cox Á, Armas M, Orellana VA. Miltefosine: A Miracle Drug for Meningoencephalitis Caused by Free-Living Amoebas. Cureus 2021; 13:e13698. [PMID: 33833918 PMCID: PMC8020194 DOI: 10.7759/cureus.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
Meningoencephalitis caused by free-living amoebas (FLA) has a high mortality rate, and most treatments are ineffective. FLA includes Naegleria, Fowleri, Acanthamoeba, and Balamuthia mandrillaris (M). We explore the use of miltefosine in the treatment of one of these infections. The concerning mortality of the infection obligates us to look for more effective treatments for meningoencephalitis caused by FLA. During this review, we will consolidate the knowledge of using miltefosine in these three infections. We will investigate the mechanism by which the drug is effective in these infections as well. After this comprehensive review, we should assess if miltefosine improves the mortality and prognosis of the infection with the information collected. We used a Medical Subject Headings (MeSH) search on PubMed. Inclusion criteria included papers written in the English language and human subjects research for the past 25 years. Until today, there are no definitive guidelines to be followed when treating such patients. However, miltefosine has demonstrated promising results. Miltefosine decreases the usual mortality rate in the three infections; however, there are few reports due to the low frequency of these infections. Almost all cases we documented have survived. More information needs to be gathered for the use of miltefosine for these infections.
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Affiliation(s)
- Ammar Alli
- Internal Medicine, Tishreen University Faculty of Medicine, Lattakia, SYR
- Internal Medicine, Universitat de Barcelona, Barcelona, ESP
| | - Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU
- Neurology, Larkin Community Hospital, Miami, USA
| | | | - Maria Armas
- Surgery, Pontificia Universidad Catolica del Ecuador, Quito, ECU
| | - Victor A Orellana
- Obstetrics and Gynecology, Pontifica Universidad Católica del Ecuador, Quito, ECU
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5
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Kot K, Łanocha-Arendarczyk N, Kosik-Bogacka D. Immunopathogenicity of Acanthamoeba spp. in the Brain and Lungs. Int J Mol Sci 2021; 22:1261. [PMID: 33514026 PMCID: PMC7865479 DOI: 10.3390/ijms22031261] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Free-living amoebas, including Acanthamoeba spp., are widely distributed in soil, water, and air. They are capable of causing granulomatous amebic encephalitis, Acanthamoeba pneumonia, Acanthamoeba keratitis, and disseminated acanthamoebiasis. Despite low occurrence worldwide, the mortality rate of Acanthamoeba spp. infections is very high, especially in immunosuppressed hosts. Acanthamoeba infections are a medical problem, owing to limited improvement in diagnostics and treatment, which is associated with incomplete knowledge of pathophysiology, pathogenesis, and the host immune response against Acanthamoeba spp. infection. The aim of this review is to present the biochemical and molecular mechanisms of Acanthamoeba spp.-host interactions, including the expression of Toll-like receptors, mechanisms of an immune response, the activity of metalloproteinases, the secretion of antioxidant enzymes, and the expression and activity of cyclooxygenases. We show the relationship between Acanthamoeba spp. and the host at the cellular level and host defense reactions that lead to changes in the selected host's organs.
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Affiliation(s)
- Karolina Kot
- Department of Biology and Medical Parasitology, Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.K.); (N.Ł.-A.)
| | - Natalia Łanocha-Arendarczyk
- Department of Biology and Medical Parasitology, Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (K.K.); (N.Ł.-A.)
| | - Danuta Kosik-Bogacka
- Independent Laboratory of Pharmaceutical Botany, Faculty of Pharmacy, Medical Biotechnology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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6
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Identification of T3 and T4 Genotypes of Acanthamoeba sp. in Dust Samples Isolated from Air Conditioning Equipment of Public Hospital of Ituiutaba-MG. Curr Microbiol 2020; 77:890-895. [PMID: 31960093 DOI: 10.1007/s00284-019-01869-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
The free-living amoebae are currently considered an emerging parasitic infection. The infection by this protozoan can generate serious infection and even cause death. Due to their amphizoic and opportunistic characters of these microorganisms, one should give more attention, not only in swimming pools but also where there are immunologically susceptible patients such as those found in intensive care units and surgical centers. Due to their difficult diagnosis often postmortem, because they are considered to be an emerging parasitic infection and their diagnosis is difficult, often performed post mortem. This study aimed to evaluate the safety of these protozoa in air conditioners by taking samples of dust from both the surgical center and the intensive therapy unit. We analyzed 48 dust samples that were collected from six air conditioners equipment located in the Intensive Care Unit (ICU) and Surgical Center (SC) of a public hospital. We found 10.4% of the samples collected in the SC, and 75% of the samples collected in the ICU presented free-living amoeba cysts by light microscopy analysis. In total, 35.4% (17/48) of the air conditioning samples of the hospital were positive and, by PCR, were identified to belong to the genus Acanthamoeba spp and Balamuthia mandrillaris species. By DNA sequencing analysis, it was possible to classify the Acanthamoeba samples as belonging to the T3 and T4 genotypes. These genotypes are the main cause of keratitis in humans, and Balamuthia may cause amoebic encephalitis, and together are emerging parasitic infections. Our results show the presence of the two most important amoebas Acanthamoeba (T3 and T4 genotypes) and Balamuthia in the SC and the ICU, and these necessary precautions these sites could be propagating cysts of these amoebas and patients during their stay or discharge could present ocular and NSC alterations without perhaps arriving to the diagnosis of free-living amoeba infection.
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7
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Lee DC, Fiester SE, Madeline LA, Fulcher JW, Ward ME, Schammel CMG, Hakimi RK. Acanthamoeba spp. and Balamuthia mandrillaris leading to fatal granulomatous amebic encephalitis. Forensic Sci Med Pathol 2019; 16:171-176. [PMID: 31773473 DOI: 10.1007/s12024-019-00202-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
Acanthamoeba spp. and Balamuthia mandrillaris are free-living amebae known to cause disseminated and fatal central nervous system dysfunction which manifests as granulomatous amebic encephalitis (GAE) with exceedingly rare frequency. We report two lethal cases of infection with free-living amebae: an acute case of Acanthamoeba spp. infection in an immunocompromised female and a subacute case of B. mandrillaris in a Hispanic male. The Acanthamoeba spp. infection presented with an atypical lesion in the thalamus that caused rapid deterioration of the patient while the case of B. mandrillaris had a prolonged clinical course with multifocal lesions beginning in the frontal lobe. Cerebrospinal fluid results were non-specific in both cases, however, post-mortem histology demonstrated the presence of trophozoites along a perivascular distribution of necrosis and infiltrate composed primarily of neutrophils. In addition to detailing the clinical presentations of these infrequent amebic infections, we offer insight into the difficulties surrounding their diagnoses in order to aid the clinician in accurate and timely identification.
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Affiliation(s)
- Daniel C Lee
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA
| | - Steven E Fiester
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA. .,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.
| | - Lee A Madeline
- Department of Radiology, Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - James W Fulcher
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Office of the Medical Examiner, Greenville County, SC, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Michael E Ward
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Office of the Medical Examiner, Greenville County, SC, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Christine Marie-Gilligan Schammel
- Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Ryan K Hakimi
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Medicine, Neurology Division, Prisma Health - Upstate, Greenville, SC, 29605, USA
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8
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Kalra SK, Sharma P, Shyam K, Tejan N, Ghoshal U. Acanthamoeba and its pathogenic role in granulomatous amebic encephalitis. Exp Parasitol 2019; 208:107788. [PMID: 31647916 DOI: 10.1016/j.exppara.2019.107788] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/11/2019] [Accepted: 10/19/2019] [Indexed: 01/13/2023]
Abstract
Acanthamoeba is a free-living amoeba that is widely distributed in the environment. It is an opportunist protist, which is known to cause rare yet fatal infection of the central nervous system (CNS), granulomatous amebic encephalitis (GAE) in humans. GAE cases are increasingly been reported among immunocompromised patients, with few cases in immunocompetent hosts. Diagnosis of GAE primarily includes neuroimaging, microscopy, cerebrospinal fluid (CSF) culture, histopathology, serology and molecular techniques. Early diagnosis is vital for proper management of infected patients. Combination therapeutic approach has been tried in various GAE cases reported worldwide. We tried to present a comprehensive review, which summarizes on the epidemiology of GAE caused by Acanthamoeba along with the associated clinical symptoms, risk factors, diagnosis and treatment of GAE among infected patients.
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Affiliation(s)
- Sonali K Kalra
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Bajhol, Distt. Solan, 173229, HP, India.
| | - Palvi Sharma
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Bajhol, Distt. Solan, 173229, HP, India
| | - Kirti Shyam
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, Bajhol, Distt. Solan, 173229, HP, India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareili Road, Lucknow, 226014, UP, India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareili Road, Lucknow, 226014, UP, India
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9
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Kum SJ, Lee HW, Jung HR, Choe M, Kim SP. Amoebic Encephalitis Caused by Balamuthia mandrillaris. J Pathol Transl Med 2019; 53:327-331. [PMID: 31121998 PMCID: PMC6755651 DOI: 10.4132/jptm.2019.05.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/14/2019] [Indexed: 11/17/2022] Open
Abstract
We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthiamandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthiamandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.
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Affiliation(s)
- Su Jung Kum
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Won Lee
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Ra Jung
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Misun Choe
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Pyo Kim
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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10
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Coven SL, Song E, Steward S, Pierson CR, Cope JR, Ali IK, Ardura MI, Hall MW, Chung MG, Bajwa RPS. Acanthamoeba granulomatous amoebic encephalitis after pediatric hematopoietic stem cell transplant. Pediatr Transplant 2017; 21. [PMID: 28921764 DOI: 10.1111/petr.13060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2017] [Indexed: 11/27/2022]
Abstract
Acanthamoeba encephalitis is a rare, often fatal condition, particularly after HSCT, with 9 reported cases to date in the world literature. Our case was originally diagnosed with ALL at age 3 years, and after several relapses underwent HSCT at age 9 years. At 17 years of age, he was diagnosed with secondary AML for which he underwent a second allogeneic HSCT. He presented with acute-onset worsening neurological deficits on day +226 after the second transplant and a post-mortem diagnosis of Acanthamoeba encephalitis was established, with the aid of the CDC.
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Affiliation(s)
- Scott L Coven
- Department of Pediatrics, Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Eunkyung Song
- Department of Pediatrics, Division of Infectious Diseases, Host Defense Program, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Sarah Steward
- Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pathology and the Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jennifer R Cope
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Ibne K Ali
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Monica I Ardura
- Department of Pediatrics, Division of Infectious Diseases, Host Defense Program, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark W Hall
- Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Melissa G Chung
- Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.,Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Rajinder P S Bajwa
- Department of Pediatrics, Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
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Acanthamoeba castellanii Genotype T4 Stimulates the Production of Interleukin-10 as Well as Proinflammatory Cytokines in THP-1 Cells, Human Peripheral Blood Mononuclear Cells, and Human Monocyte-Derived Macrophages. Infect Immun 2016; 84:2953-62. [PMID: 27481240 PMCID: PMC5038060 DOI: 10.1128/iai.00345-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/24/2016] [Indexed: 12/11/2022] Open
Abstract
Free-living amoebae of the genus Acanthamoeba can cause severe and chronic infections in humans, mainly localized in immune privileged sites, such as the brain and the eye. Monocytes/macrophages are thought to be involved in Acanthamoeba infections, but little is known about how these facultative parasites influence their functions. The aim of this work was to investigate the effects of Acanthamoeba on human monocytes/macrophages during the early phase of infection. Here, THP-1 cells, primary human monocytes isolated from peripheral blood, and human monocyte-derived macrophages were either coincubated with trophozoites of a clinical isolate of Acanthamoeba (genotype T4) or stimulated with amoeba-derived cell-free conditioned medium. Production of proinflammatory cytokines (tumor necrosis factor alpha [TNF-α], interleukin-6 [IL-6], and IL-12), anti-inflammatory cytokine (IL-10), and chemokine (IL-8) was evaluated at specific hours poststimulation (ranging from 1.5 h to 23 h). We showed that both Acanthamoeba trophozoites and soluble amoebic products induce an early anti-inflammatory monocyte-macrophage phenotype, characterized by significant production of IL-10; furthermore, challenge with either trophozoites or their soluble metabolites stimulate both proinflammatory cytokines and chemokine production, suggesting that this protozoan infection results from the early induction of coexisting, opposed immune responses. Results reported in this paper confirm that the production of proinflammatory cytokines and chemokines by monocytes and macrophages can play a role in the development of the inflammatory response during Acanthamoeba infections. Furthermore, we demonstrate for the first time that Acanthamoeba stimulates IL-10 production in human innate immune cells, which might both promote the immune evasion of Acanthamoeba and limit the induced inflammatory response.
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12
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Abstract
The list of emerging and reemerging pathogens that cause neurologic disease is expanding. Various factors, including population growth and a rise in international travel, have contributed to the spread of pathogens to previously nonendemic regions. Recent advances in diagnostic methods have led to the identification of novel pathogens responsible for infections of the central nervous system. Furthermore, new issues have arisen surrounding established infections, particularly in an increasingly immunocompromised population due to advances in the treatment of rheumatologic disease and in transplant medicine.
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Affiliation(s)
- Felicia C Chow
- Division of Infectious Diseases, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Carol A Glaser
- Division of Infectious Diseases, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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13
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Tan SK, Gajurel K, Tung C, Albers G, Deresinski S, Montoya JG, Sheikh AY, Banerjee D, Ha R. Fatal acanthamoeba encephalitis in a patient with a total artificial heart (syncardia) device. Open Forum Infect Dis 2014; 1:ofu057. [PMID: 25734127 PMCID: PMC4281817 DOI: 10.1093/ofid/ofu057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 06/13/2014] [Indexed: 11/13/2022] Open
Abstract
Acanthamoeba encephalitis is an uncommon but often fatal infection complication. Here we report the first case of Acanthamoeba encephalitis in a patient with a Total Artificial Heart device.
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Affiliation(s)
- Susanna K Tan
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine
| | - Kiran Gajurel
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine
| | - Christie Tung
- Department of Neurology & Neurological Sciences , Stanford University School of Medicine
| | - Gregory Albers
- Department of Neurology & Neurological Sciences , Stanford University School of Medicine
| | - Stan Deresinski
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine
| | - Jose G Montoya
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine , Stanford University School of Medicine
| | - Ahmad Y Sheikh
- Department of Cardiothoracic Surgery , Stanford University School of Medicine
| | - Dipanjan Banerjee
- Department of Medicine, Division of Cardiovascular Medicine , Stanford University School of Medicine , California
| | - Richard Ha
- Department of Cardiothoracic Surgery , Stanford University School of Medicine
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14
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Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection. J Clin Microbiol 2011; 50:1128-31. [PMID: 22170911 DOI: 10.1128/jcm.06252-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a patient with advanced HIV infection and Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with Toxoplasma gondii coinfection. A multidisciplinary effort and state-of-the-art diagnostic techniques were required for diagnosis. Our patient is the first reported case of an HIV-infected person with dual Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection.
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15
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Lakshmi V, Umabala P, Anuradha K, Padmaja K, Padmasree C, Rajesh A, Purohit AK. Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:583139. [PMID: 22191080 PMCID: PMC3236371 DOI: 10.4061/2011/583139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 09/15/2011] [Indexed: 02/01/2023]
Abstract
Intracranial abscesses are life-threatening infections that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Materials and Methods. This is a retrospective analysis of 352 samples from 1987 to 2010 analyzed at a tertiary care hospital in South India from 1987 to 2010, to document the changing trends with time. Results. The age of the patients ranged from 2 to 80 years, a larger number of males being affected. Otogenic infections were the most common cause while cryptogenic abscesses were 20%. Gram stain and culture positivity were 78% each. Gram-positive and negative facultative aerobes and obligate anaerobes were also on the rise. Unusual organisms, like Burkholderia pseudomallei, Salmonella typhi, Nocardia species, Cladosporium bantiana, Fonsecaea pedrosoi, Entamoeba histolytica, and Acanthamoeba were also isolated and/or detected from the brain abscesses aspirate or resected tissue. Summary. New and emerging pathogens associated with brain abscess, especially in immunosuppressed individuals, have renewed the necessity of an early detection, and it will be of great value in appropriate management of patients with brain abscess.
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Affiliation(s)
- V Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh 500082, India
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