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Jiang Q, Zhang Z, Cai Y, Chen L, Deng L, Xiong Y. Disseminated Acanthamoeba castellanii infection in a patient with AIDS: a case report and literature review. Front Med (Lausanne) 2024; 11:1377302. [PMID: 38952864 PMCID: PMC11215114 DOI: 10.3389/fmed.2024.1377302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/27/2024] [Indexed: 07/03/2024] Open
Abstract
Background Acanthamoeba castellanii infection is a rare condition primarily occurring in immunocompromised patients with extremely high mortality. Currently, there is no standard treatment for this condition, and successful treatment reports are scarce. Case presentation We present a case of Acanthamoeba castellanii infection in a 63-year-old female patient with AIDS, who was admitted to our hospital with symptoms of fever, skin ulcers, subcutaneous nodules, and food regurgitation from the nose while eating. After initial empirical treatment failed, a biopsy of the subcutaneous nodule was performed, and metagenomic next-generation sequencing (mNGS) technology was used to detect pathogenic microorganisms in both the biopsy specimen and blood samples. The results revealed Acanthamoeba castellanii infection. Additionally, histopathological examination of the biopsy specimen and cytological examination of the secretions from the ulcer surface also confirmed this pathogenic infection. The patient's symptoms significantly improved upon discharge after adjusting the treatment regimen to a combination of anti-amebic therapy. Conclusion Immunocompromised patients presenting with unexplained fever and skin or sinus lesions should be evaluated for Acanthamoeba castellanii infection. Multi-drug combination therapy is required for this organism infection, and a standard treatment protocol still needs further research. Metagenomic next-generation sequencing is a valuable tool for early diagnosis of unknown pathogen infections.
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Affiliation(s)
- Qunqun Jiang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhongwei Zhang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuxiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liangjun Chen
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liping Deng
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong Xiong
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, Wuhan, China
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2
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Chan A, Smith S, Tan E, Kuruvath S. Case Report: First Successful Treatment of Acanthamoeba Brain Abscess with Combination Surgical Excision and Miltefosine-Led Antimicrobial Therapy. Am J Trop Med Hyg 2022; 106:861-866. [PMID: 35026730 PMCID: PMC8922513 DOI: 10.4269/ajtmh.21-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/13/2021] [Indexed: 11/07/2022] Open
Abstract
Acanthamoeba brain abscess is very rare and most often fatal. There remains no standardized regimen for its management. We report a case in northern Australia of an immunosuppressed 57-year-old man who presented with diarrhea and weight loss, and was diagnosed with multiple Acanthamoeba brain abscesses after neurological deterioration. This case is the first successful treatment with surgical excision followed by combination antimicrobial therapy including miltefosine. This case was treated initially as nocardiosis or melioidosis, emphasizing the importance of considering differentials such as Acanthamoeba during workup of atypical infection. We present a literature review of the 14 Acanthamoeba brain abscess cases reported in the English literature, of which five were successfully treated. Our review shows a predilection for multiple brain abscesses and an increased mortality rate compared with the general brain abscess population.
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Affiliation(s)
- Anson Chan
- Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia;,Address correspondence to Anson Chan, Department of Neurosurgery, Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, Queensland, Australia 4814. E-mail:
| | - Simon Smith
- Department of Infectious Diseases, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Edwin Tan
- Department of Anatomical Pathology, Townsville University Hospital, Douglas, Townsville, Queensland, Australia
| | - Sarin Kuruvath
- Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia
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3
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Damhorst GL, Watts A, Hernandez-Romieu A, Mel N, Palmore M, Ali IKM, Neill SG, Kalapila A, Cope JR. Acanthamoeba castellanii encephalitis in a patient with AIDS: a case report and literature review. THE LANCET. INFECTIOUS DISEASES 2022; 22:e59-e65. [PMID: 34461057 PMCID: PMC10910629 DOI: 10.1016/s1473-3099(20)30933-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
Amoebic encephalitis is a rare cause of CNS infection for which mortality exceeds 90%. We present the case of a 27-year-old man with AIDS who presented to a hospital in Atlanta (Georgia, USA) with tonic-clonic seizures and headache. His clinical condition deteriorated over several days. Brain biopsy revealed lymphohistiocytic inflammation and necrosis with trophozoites and encysted forms of amoebae. Immunohistochemical and PCR testing confirmed Acanthamoeba castellanii encephalitis, typically described as granulomatous amoebic encephalitis (GAE). No proven therapy for GAE is available, although both surgical and multiagent antimicrobial treatment strategies are often used. Most recently, these include the antileishmanial agent miltefosine. Here we review all cases of GAE due to Acanthamoeba spp in people with HIV/AIDS identified in the literature and reported to the Centers for Disease Control and Prevention. We describe this case as a reminder to the clinician to consider protozoal infections, especially free-living amoeba, in the immunocompromised host with a CNS infection refractory to traditional antimicrobial therapy.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Abigail Watts
- Division of Pulmonary Critical Care & Sleep Medicine and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Nonglin Mel
- Family Medicine, Broward Health, Fort Lauderdale, FL, USA
| | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Ibne Karim M Ali
- Free-Living and Intestinal Amebas (FLIA) Laboratory, Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stewart G Neill
- Department of Pathology & Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jennifer R Cope
- Domestic Water, Sanitation, and Hygiene Epidemiology Team, Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Mungroo MR, Khan NA, Maciver S, Siddiqui R. Opportunistic free-living amoebal pathogens. Pathog Glob Health 2021; 116:70-84. [PMID: 34602025 DOI: 10.1080/20477724.2021.1985892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Pathogenic free-living amoebae affecting the central nervous system are known to cause granulomatous amoebic encephalitis (GAE) or primary amoebic meningoencephalitis (PAM). Although hosts with impaired immunity are generally at a higher risk of severe disease, amoebae such as Naegleria fowleri and Balamuthia mandrillaris can instigate disease in otherwise immunocompetent individuals, whereas Acanthamoeba species mostly infect immunocompromised people. Acanthamoeba also cause a sight-threatening eye infection, mostly in contact lens wearers. Although infections due to pathogenic amoebae are considered rare, recently, these deadly amoebae were detected in water supplies in the USA. This is of particular concern, especially with global warming further exacerbating the problem. Herein, we describe the epidemiology, presentation, diagnosis, and management of free-living amoeba infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates.,Research Institute of Health and Medical Sciences, University of Sharjah, Sharjah, UAE
| | - Sutherland Maciver
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, Sharjah, UAE
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5
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High oxygen concentrations inhibit Acanthamoeba spp. Parasitol Res 2021; 120:3001-3005. [DOI: 10.1007/s00436-021-07219-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
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6
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Aparicio DV, Bejarano JIC, de Los Santos AM, Ramírez-Cortinas S, de la O Cavazos M. Case Report: Granulomatous Amebic Encephalitis due to Acanthamoeba spp. in an Immunocompetent Pediatric Patient. Am J Trop Med Hyg 2021; 105:167-170. [PMID: 33970886 DOI: 10.4269/ajtmh.21-0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/08/2021] [Indexed: 11/07/2022] Open
Abstract
Granulomatous amebic encephalitis (GAE) caused by Acanthamoeba is a rare infection with central nervous system (CNS) involvement usually with fatal consequences. Currently, information regarding GAE in children is scarce and is limited only to case reports and case series. A 13-year-old immunocompetent male patient with a 6-month history of progressive and intermittent headaches presented to our institution. One week before hospital admission, the patient showed signs of CNS involvement. Magnetic resonance imaging revealed multiple lesions with supra- and infratentorial cerebral abscesses. An empiric treatment with combined antibiotics was given, but the patient died after 20 days of hospital stay. A postmortem diagnosis confirmed GAE. Although it is a rare disease in pediatric patients, GAE should be considered in children with a chronic history of fever, headache, and vomiting with CNS involvement.
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Affiliation(s)
- Denisse Vaquera Aparicio
- 1Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - José Iván Castillo Bejarano
- 1Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Abiel Mascareñas de Los Santos
- 1Department of Pediatrics/Infectious Diseases Service, Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Sergio Ramírez-Cortinas
- 2Department of Pediatrics, Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | - Manuel de la O Cavazos
- 2Department of Pediatrics, Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León, Monterrey, Mexico
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7
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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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8
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Kulkarni G, R. Taallapalli A, Nashi S, Alladi S, Chickabasaviah Y. Granulomatous amebic encephalitis presenting like a tumor-chasing a diagnostic conundrum. Ann Indian Acad Neurol 2021; 24:968-970. [PMID: 35359565 PMCID: PMC8965954 DOI: 10.4103/aian.aian_994_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 11/23/2022] Open
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9
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Fakae LB, Stevenson CW, Zhu XQ, Elsheikha HM. In vitro activity of Camellia sinensis (green tea) against trophozoites and cysts of Acanthamoeba castellanii. Int J Parasitol Drugs Drug Resist 2020; 13:59-72. [PMID: 32512260 PMCID: PMC7281304 DOI: 10.1016/j.ijpddr.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 01/06/2023]
Abstract
The effect of Camellia sinensis (green tea) on the growth of Acanthamoeba castellanii trophozoites was examined using a microplate based-Sulforhodamine B (SRB) assay. C. sinensis hot and cold brews at 75% and 100% concentrations significantly inhibited the growth of trophozoites. We also examined the structural alterations in C. sinensis-treated trophozoites using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). This analysis showed that C. sinensis compromised the cell membrane integrity and caused progressive destruction of trophozoites. C. sinensis also significantly inhibited the parasite's ability to form cysts in a dose-dependent manner and reduced the rate of excystation from cysts to trophozoites. C. sinensis exhibited low cytotoxic effects on primary corneal stromal cells. However, cytotoxicity was more pronounced in SV40-immortalized corneal epithelial cells. Chromatographic analysis showed that both hot and cold C. sinensis brews contained the same number and type of chemical compounds. This work demonstrated that C. sinensis has anti-acanthamoebic activity against trophozoite and cystic forms of A. castellanii. Further studies are warranted to identify the exact substances in C. sinensis that have the most potent anti-acanthamoebic effect.
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Affiliation(s)
- Lenu B Fakae
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK; School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK; Rivers State University, Nkpolu - Oroworukwo P.M.B 5080, Port Harcourt, Rivers State, Nigeria
| | - Carl W Stevenson
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, 730046, China
| | - Hany M Elsheikha
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.
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10
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Baig AM. Innovative Methodology in the Discovery of Novel Drug Targets in the Free-Living Amoebae. Curr Drug Targets 2020; 20:60-69. [PMID: 29697029 DOI: 10.2174/1389450119666180426100452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/03/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022]
Abstract
Despite advances in drug discovery and modifications in the chemotherapeutic regimens, human infections caused by free-living amoebae (FLA) have high mortality rates (~95%). The FLA that cause fatal human cerebral infections include Naegleria fowleri, Balamuthia mandrillaris and Acanthamoeba spp. Novel drug-target discovery remains the only viable option to tackle these central nervous system (CNS) infection in order to lower the mortality rates caused by the FLA. Of these FLA, N. fowleri causes primary amoebic meningoencephalitis (PAM), while the A. castellanii and B. Mandrillaris are known to cause granulomatous amoebic encephalitis (GAE). The infections caused by the FLA have been treated with drugs like Rifampin, Fluconazole, Amphotericin-B and Miltefosine. Miltefosine is an anti-leishmanial agent and an experimental anti-cancer drug. With only rare incidences of success, these drugs have remained unsuccessful to lower the mortality rates of the cerebral infection caused by FLA. Recently, with the help of bioinformatic computational tools and the discovered genomic data of the FLA, discovery of newer drug targets has become possible. These cellular targets are proteins that are either unique to the FLA or shared between the humans and these unicellular eukaryotes. The latter group of proteins has shown to be targets of some FDA approved drugs prescribed in non-infectious diseases. This review out-lines the bioinformatics methodologies that can be used in the discovery of such novel drug-targets, their chronicle by in-vitro assays done in the past and the translational value of such target discoveries in human diseases caused by FLA.
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11
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Peixoto D, Prestes DP. Parasitic Infections of the Stem Cell Transplant Recipient and the Hematologic Malignancy Patient, Including Toxoplasmosis and Strongyloidiasis. Infect Dis Clin North Am 2019; 33:567-591. [PMID: 31005139 DOI: 10.1016/j.idc.2019.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) recipients may infrequently develop parasitic infections at the time of the procedure via contamination from allograft tissue or blood products, and in the post-transplantation period through the traditional route of infection or as a reactivation caused by immunosuppression related to the transplant. To reduce risk, efforts should be directed at performing a comprehensive history, maintaining a high index of suspicion, and adhering to preventive measures. Additional strategies for the prevention, screening and careful follow-up, identification, and pre-emptive treatment of parasitic infections are required to reduce morbidity and mortality in HSCT patients.
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Affiliation(s)
- Driele Peixoto
- São Paulo State Cancer Institute (ICESP), Hospital das Clínicas, Av. Dr. Arnaldo, 251, São Paulo CEP: 01246-000, Brazil.
| | - Daniel P Prestes
- A. C. Camargo Cancer Center, Rua Professor Antonio Prudente, 211, Sao Paulo CEP: 01509-010, Brazil; Emilio Ribas Infectious Diseases Institute, Av. Doutor Arnaldo, 165, Sao Paulo CEP: 01246-900, Brazil
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12
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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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13
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Mungroo MR, Anwar A, Khan NA, Siddiqui R. Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy. Mini Rev Med Chem 2019; 19:980-987. [PMID: 30868950 DOI: 10.2174/1389557519666190313161854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 12/22/2022]
Abstract
Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as "brain-eating amoebae". The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Ayaz Anwar
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Naveed Ahmed Khan
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Ruqaiyyah Siddiqui
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
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14
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Tang J, Zhu H, Cai L, Tang T, Tang J, Sun Y, Liu M, Dai K, Qiao Z, Yu C. Postoperative infection caused by Acinetobacter baumannii misdiagnosed as a free-living amoeba species in a humeral head hemiarthroplasty patient: a case report. Infect Dis Poverty 2018; 7:33. [PMID: 29631621 PMCID: PMC5890356 DOI: 10.1186/s40249-018-0408-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 03/19/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is ubiquitous, facultative intracellular, and opportunistic bacterial pathogen. Its unique abilities allow it to survive in a diverse range of environments, including health care settings, leading to nosocomial infections. And its exceptional ability to develop resistance to multiple antibiotics leaves few drug options for treatment. It has been recognized as a leading cause of nosocomial pneumonia and bacteremia over the world. CASE PRESENTATION In this case, a 73-year-old woman presented with a Neer Group VI proximal humeral fracture. Six hours after a successfully performed hemiarthroplasty, she developed continuous fever. Clinical examination revealed that the vitals were regular. Laboratory and radiographic examinations revealed only elevated procalcitonin levels. Blood culture revealed no bacterial or fungal growth. Cooling treatment and empirical broad-spectrum antibiotic therapy showed no apparent effect. CONCLUSIONS We report a postoperative infection caused by Acinetobacter baumannii. The infectious pathogen was identified via molecular DNA sequencing and was initially misidentified as a free-living amoeba species upon microscopic examinations. The patient was mistreated with antiamebic combination therapy. Her symptoms persisted for over 4 months and were eventually followed by her death.
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Affiliation(s)
- Jiaxin Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Huaimin Zhu
- Department of Microbiology and Parasitology, Second Military Medical University, Shanghai, 200433, China
| | - Li Cai
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, 200336, China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jian Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuehua Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ming Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Zhiguang Qiao
- Medical 3D Printing Innovation Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200125, China. .,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, 200030, China.
| | - Chao Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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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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16
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Samuels MA, Gonzalez RG, Makadzange AT, Hedley-Whyte ET. Case 3-2017. A 62-Year-Old Man with Cardiac Sarcoidosis and New Diplopia and Weakness. N Engl J Med 2017; 376:368-379. [PMID: 28121502 DOI: 10.1056/nejmcpc1610713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Martin A Samuels
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - R Gilberto Gonzalez
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - Azure T Makadzange
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
| | - E Tessa Hedley-Whyte
- From the Department of Neurology (M.A.S.), Brigham and Women's Hospital, the Departments of Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H.-W.), Massachusetts General Hospital, and the Departments of Neurology (M.A.S.), Radiology (R.G.G.), Medicine (A.T.M.), and Pathology (E.T.H-W.), Harvard Medical School - all in Boston
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17
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Lukies MW, Watanabe Y, Maeda T, Kusakabe S, Arita H, Tomiyama N. Amoebic encephalitis: case report and literature review of neuroimaging findings. BJR Case Rep 2016; 2:20150499. [PMID: 30459996 PMCID: PMC6243338 DOI: 10.1259/bjrcr.20150499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/07/2016] [Accepted: 02/12/2016] [Indexed: 11/05/2022] Open
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Doan N, Rozansky G, Nguyen HS, Gelsomino M, Shabani S, Mueller W, Johnson V. Granulomatous amebic encephalitis following hematopoietic stem cell transplantation. Surg Neurol Int 2015; 6:S459-62. [PMID: 26539322 PMCID: PMC4604647 DOI: 10.4103/2152-7806.166788] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/03/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Granulomatous amebic encephalitis (GAE) is rare, but often fatal. The infection has been documented predominantly among the immunocompromised population or among those with chronic disease. To date, however, there have only been eight cases regarding the infection following hematopoietic stem cell transplantation (HSCT). CASE DESCRIPTION A 62-year-old female with a history of relapsed diffuse large B-cell lymphoma, recently underwent peripheral blood autologous stem cell transplant after BEAM conditioning (day 0). On day +15, she began to exhibit worsening fatigue, generalized weakness, and fever. Symptoms progressed to nausea, emesis, somnolence, confusion, and frontal headaches over the next few days. Imaging demonstrated multifocal ill-defined vasogenic edema with patchy enhancement. The patient was started on broad antibiotics, antifungals, and seizure prophylaxis. Evaluation for bacterial, fungal, mycobacterial, and viral etiologies was fruitless. Her mental status progressively deteriorated. On day +22, she exhibited severe lethargy and went into pulseless electrical activity arrest, requiring chest compressions. The episode lasted <2 min and her pulse was restored. She was taken to the operating room for a brain biopsy. Postoperatively, her right pupil began to dilate compared to the left; she demonstrated extensor posturing in her upper extremities and withdrawal in her lower extremities. Repeat computed tomography demonstrated progressive edema. Given poor prognosis and poor neurological examination, the family opted for withdrawal of care. Final pathology was consistent with Acanthamoeba GAE. CONCLUSION The authors report the third case of GAE after autologous stem cell transplant, and the ninth case overall after HSCT. This case is unusual due to its rapid clinical presentation after HSCT compared to prior literature. The case highlights the need for high suspicion of Acanthamoeba infection in this patient population.
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Affiliation(s)
- Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Gregory Rozansky
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Vijay Johnson
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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19
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Walochnik J, Scheikl U, Haller-Schober EM. Twenty years of acanthamoeba diagnostics in Austria. J Eukaryot Microbiol 2015; 62:3-11. [PMID: 25047131 PMCID: PMC4342769 DOI: 10.1111/jeu.12149] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/03/2014] [Accepted: 06/17/2014] [Indexed: 11/27/2022]
Abstract
Acanthamoebae are the causative agents of an often seriously progressing keratitis (AK) occurring predominantly in contact lens wearers and can cause several disseminating infections potentially resulting in granulomatous amoebic encephalitis (GAE) in the immunocompromised host. Our institution is the Austrian reference laboratory for Acanthamoeba diagnostics and the aim of this study was to give an overview of proven cases of Acanthamoeba infections in Austria during the past 20 yr. All samples of patients with suspected AK or GAE were screened for Acanthamoeba spp. by culture and/or PCR and the detected amoebae were genotyped. Altogether, 154 cases of AK and three cases of GAE were diagnosed. Age of the AK patients ranged from 8 to 82 yr (mean 37.8) and 58% of the patients were female. Approximately 89% of the AK patients were contact lens wearers, almost all cases were unilateral and 19% of the patients required a keratoplasty. Age of the GAE patients ranged from 2 to 25 yr (mean 14.7), all were HIV-negative, but two were severely immunosuppressed at the time of diagnosis. The predominant genotype in the AK cases was T4, other genotypes found were T3, T5, T6, T10 and T11. The three GAE cases involved genotypes T2, T4 and T5.
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Affiliation(s)
- Julia Walochnik
- Molecular Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Centre for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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20
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Acanthamoeba encephalitis: isolation of genotype T1 in mycobacterial liquid culture medium. J Clin Microbiol 2014; 53:735-9. [PMID: 25502534 DOI: 10.1128/jcm.02887-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We report a case of Acanthamoeba encephalitis diagnosed from an antemortem brain biopsy specimen, where the organism was first isolated in mycobacterial liquid medium and first identified by using a sequence generated by a commercial panfungal sequencing assay. We correlate susceptibility results with clinical outcome.
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21
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Zamora A, Henderson H, Swiatlo E. Acanthamoeba encephalitis: A Case Report and Review of Therapy. Surg Neurol Int 2014; 5:68. [PMID: 24991471 PMCID: PMC4078452 DOI: 10.4103/2152-7806.132239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background: Acanthamoeba is a rare cause of encephalitis yet is associated with high mortality. Treatment protocols vary greatly and generally include combination therapy across a wide spectrum of antiinfective classes. Case Description: A 63-year-old male who underwent renal transplantation presented 6 months after transplantation with depressed level of consciousness. Imaging of the head with computerized tomography showed an enhancing lesion suspicious for brain abscess. Biopsy of the lesion showed Acanthamoeba cysts. The patient was treated with sulfadiazine, fluconazole, flucytosine, azithromycin, and miltefosine but without success. We review recently published cases of Acanthamoeba encephalitis with an emphasis on treatment protocols and outcomes. Conclusion: Free-living protozoans such as Acanthamoeba are ubiquitous in the environment and should be suspected in immunosuppressed persons who present with central nervous system findings and brain abscess. Biopsy is critical to establish the etiology so that appropriate combination therapy can be deployed.
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Affiliation(s)
- A Zamora
- Department of Medicine, University of Mississippi Medical Center, MS USA
| | - H Henderson
- Department of Medicine, University of Mississippi Medical Center, MS USA
| | - E Swiatlo
- Department of Medicine, University of Mississippi Medical Center, MS USA ; G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS USA
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22
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In vitro efficacy of corifungin against Acanthamoeba castellanii trophozoites and cysts. Antimicrob Agents Chemother 2013; 58:1523-8. [PMID: 24366747 DOI: 10.1128/aac.02254-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Painful blinding keratitis and fatal granulomatous amebic encephalitis are caused by the free-living amebae Acanthamoeba spp. Several prescription eye medications are used to treat Acanthamoeba keratitis, but the infection can be difficult to control because of recurrence of infection. For the treatment of encephalitis, no single drug was found useful, and in spite of the use of a combination of multiple drugs, the mortality rate remains high. Therefore, efficient, novel drugs are urgently needed for the treatment of amebic keratitis and granulomatous amebic encephalitis. In this study, we identified corifungin, a water-soluble polyene macrolide, as amebicidal. In vitro, it was effective against both the trophozoites and the cysts. Transmission electron microscopy of Acanthamoeba castellanii incubated with corifungin showed the presence of swollen mitochondria, electron-dense granules, degeneration of cytoplasm architecture, and loss of nuclear chromatin structure. These changes were followed by lysis of amebae. Corifungin also induced the encystment process of A. castellanii. There were alterations in the cyst cell wall followed by lysis of the cysts. Corifungin is a promising therapeutic option for keratitis and granulomatous amebic encephalitis.
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23
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Satlin MJ, Graham JK, Visvesvara GS, Mena H, Marks KM, Saal SD, Soave R. Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review. Transpl Infect Dis 2013; 15:619-26. [PMID: 24010955 DOI: 10.1111/tid.12131] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/27/2013] [Indexed: 11/28/2022]
Abstract
Acanthamoeba is the most common cause of granulomatous amebic encephalitis, a typically fatal condition that is classically described as indolent and slowly progressive. We report a case of Acanthamoeba encephalitis in a kidney transplant recipient that progressed to death within 3 days of symptom onset and was diagnosed at autopsy. We also review clinical characteristics, treatments, and outcomes of all published cases of Acanthamoeba encephalitis in solid organ transplant (SOT) recipients. Ten cases were identified, and the infection was fatal in 9 of these cases. In 6 patients, Acanthamoeba presented in a fulminant manner and death occurred within 2 weeks after the onset of neurologic symptoms. These acute presentations are likely related to immunodeficiencies associated with solid organ transplantation that result in an inability to control Acanthamoeba proliferation. Skin lesions may predate neurologic involvement and provide an opportunity for early diagnosis and treatment. Acanthamoeba is an under-recognized cause of encephalitis in SOT recipients and often presents in a fulminant manner in this population. Increased awareness of this disease and its clinical manifestations is essential to attain an early diagnosis and provide the best chance of cure.
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Affiliation(s)
- M J Satlin
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Transplantation-Oncology Infectious Diseases Program, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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24
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In vitro efficacies of clinically available drugs against growth and viability of an Acanthamoeba castellanii keratitis isolate belonging to the T4 genotype. Antimicrob Agents Chemother 2013; 57:3561-7. [PMID: 23669391 DOI: 10.1128/aac.00299-13] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The effects of clinically available drugs targeting muscarinic cholinergic, adrenergic, dopaminergic, and serotonergic receptors; intracellular calcium levels and/or the function of calcium-dependent biochemical pathways; ion channels; and cellular pumps were tested against a keratitis isolate of Acanthamoeba castellanii belonging to the T4 genotype. In vitro growth inhibition (amoebistatic) assays were performed by incubating A. castellanii with various concentrations of drugs in the growth medium for 48 h at 30°C. To determine amoebicidal effects, amoebae were incubated with drugs in phosphate-buffered saline for 24 h, and viability was determined using trypan blue exclusion staining. For controls, amoebae were incubated with the solvent alone. Of the eight drugs tested, amlodipine, prochlorperazine, and loperamide showed potent amoebicidal effects, as no viable trophozoites were observed (>95% kill rate), while amiodarone, procyclidine, digoxin, and apomorphine exhibited up to 50% amoebicidal effects. In contrast, haloperidol did not affect viability, but all the drugs tested inhibited A. castellanii growth. Importantly, amlodipine, prochlorperazine, and loperamide showed compelling cysticidal effects. The cysticidal effects were irreversible, as cysts treated with the aforementioned drugs did not reemerge as viable amoebae upon inoculation in the growth medium. Except for apomorphine and haloperidol, all the tested drugs blocked trophozoite differentiation into cysts in encystation assays. Given the limited availability of effective drugs to treat amoebal infections, the clinically available drugs tested in this study represent potential agents for managing keratitis and granulomatous amoebic encephalitis caused by Acanthamoeba spp. and possibly against other meningoencephalitis-causing amoebae, such as Balamuthia mandrillaris and Naegleria fowleri.
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25
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Abstract
AbstractCerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. Parasites that have been described to affect the central nervous system (CNS), either as the dominant or as a collateral feature, include cestodes (Taenia solium (neurocysticerciasis), Echinococcus granulosus (cerebral cystic echinococcosis), E. multilocularis (cerebral alveolar echinococcosis), Spirometra mansoni (neurosparganosis)), nematodes (Toxocara canis and T. cati (neurotoxocariasis), Trichinella spiralis (neurotrichinelliasis), Angiostrongylus cantonensis and A. costaricensis (neuroangiostrongyliasis), Gnathostoma spinigerum (gnathostomiasis)), trematodes (Schistosoma mansoni (cerebral bilharziosis), Paragonimus westermani (neuroparagonimiasis)), or protozoa (Toxoplasma gondii (neurotoxoplasmosis), Acanthamoeba spp. or Balamuthia mandrillaris (granulomatous amoebic encephalitis), Naegleria (primary amoebic meningo-encephalitis), Entamoeba histolytica (brain abscess), Plasmodium falciparum (cerebral malaria), Trypanosoma brucei gambiense/rhodesiense (sleeping sickness) or Trypanosoma cruzi (cerebral Chagas disease)). Adults or larvae of helminths or protozoa enter the CNS and cause meningitis, encephalitis, ventriculitis, myelitis, ischaemic stroke, bleeding, venous thrombosis or cerebral abscess, clinically manifesting as headache, epilepsy, weakness, cognitive decline, impaired consciousness, confusion, coma or focal neurological deficits. Diagnosis of cerebral parasitoses is dependent on the causative agent. Available diagnostic tools include clinical presentation, blood tests (eosinophilia, plasmodia in blood smear, antibodies against the parasite), cerebrospinal fluid (CSF) investigations, imaging findings and occasionally cerebral biopsy. Treatment relies on drugs and sometimes surgery. Outcome of cerebral parasitoses is highly variable, depending on the effect of drugs, whether they are self-limiting (e.g. Angiostrongylus costaricensis) or whether they remain undetected or asymptomatic, like 25% of neurocysticerciasis cases.
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Webster D, Umar I, Umar I, Kolyvas G, Bilbao J, Guiot MC, Duplisea K, Qvarnstrom Y, Visvesvara GS. Treatment of granulomatous amoebic encephalitis with voriconazole and miltefosine in an immunocompetent soldier. Am J Trop Med Hyg 2012; 87:715-8. [PMID: 22869634 DOI: 10.4269/ajtmh.2012.12-0100] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 38-year-old male immunocompetent soldier developed generalized seizures. He underwent surgical debulking and a progressive demyelinating pseudotumor was identified. Serology and molecular testing confirmed a diagnosis of granulomatous amoebic encephalitis caused by Acanthamoeba sp. in this immunocompetent male. The patient was treated with oral voriconazole and miltefosine with Acanthamoeba titers returning to control levels and serial imaging demonstrating resolution of the residual lesion.
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Affiliation(s)
- Duncan Webster
- Department of Internal Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
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27
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Alves DDSMM, Moraes AS, Nitz N, de Oliveira MGC, Hecht MM, Gurgel-Gonçalves R, Cuba CAC. Occurrence and characterization of Acanthamoeba similar to genotypes T4, T5, and T2/T6 isolated from environmental sources in Brasília, Federal District, Brazil. Exp Parasitol 2012; 131:239-44. [PMID: 22546341 DOI: 10.1016/j.exppara.2012.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 04/08/2012] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
Species of Acanthamoeba can cause keratitis and brain infections. The characterization of environmental isolates is necessary to analyze the risk of human infection. We aimed at identifying and genotyping Acanthamoeba isolates from soil, swimming pools, and water features in Brasília, Federal District, Brazil, as well as determining their physiological characteristics and pathogenic potential. Among the 18 isolates studied, eight were similar to genotype T5, five to T4, and one to T2/T6, classified by the sequence analysis of 18S rDNA. Genotypes of four isolates were not determined. Ten isolates (55%) grew at 37 °C and seven (39%) grew in media with 1.5M mannitol, which are the physiological parameters associated with pathogenic Acanthamoeba; also, four isolates from swimming pools presented high pathogenic potential. Our results indicate a widespread distribution of potentially pathogenic Acanthamoeba T4, T5, and T2/T6 in different environmental sources in Brasília, revealing the potential risk of human infection and the need of preventive measures.
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Affiliation(s)
- Daniella de Sousa Mendes Moreira Alves
- Laboratório de Parasitologia Médica e Biologia de Vetores, Faculdade de Medicina, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil.
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28
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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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