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Lakhani DA, Deng F, Lin DDM. Infectious Diseases of the Brain and Spine: Parasitic and Other Atypical Transmissible Diseases. Magn Reson Imaging Clin N Am 2024; 32:347-361. [PMID: 38555145 DOI: 10.1016/j.mric.2024.02.002] [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: 04/02/2024]
Abstract
Atypical infections of the brain and spine caused by parasites occur in immunocompetent and immunosuppressed hosts, related to exposure and more prevalently in endemic regions. In the United States, the most common parasitic infections that lead to central nervous system manifestations include cysticercosis, echinococcosis, and toxoplasmosis, with toxoplasmosis being the most common opportunistic infection affecting patients with advanced HIV/AIDS. Another rare but devastating transmittable disease is prion disease, which causes rapidly progressive spongiform encephalopathies. Familiarity and understanding of various infectious agents are a crucial aspect of diagnostic neuroradiology, and recognition of unique features can aid timely diagnosis and treatment.
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Affiliation(s)
- Dhairya A Lakhani
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francis Deng
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Qin L, Xiang Y, Wu Z, Zhang H, Wu X, Chen Q. Metagenomic next-generation sequencing for diagnosis of fatal Balamuthia amoebic encephalitis. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 119:105570. [PMID: 38382768 DOI: 10.1016/j.meegid.2024.105570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Balamuthia amoebic encephalitis (BAE), caused by Balamuthia mandrillaris, is a rare and life-threatening infectious disease with no specific and effective treatments available. The diagnosis of BAE at an early stage is difficult because of the non-specific clinical manifestations and neuroimaging. CASE DESCRIPTION A 52-year-old male patient, who had no previous history of skin lesions, presented to the emergency department with an acute headache, walking difficulties, and disturbance of consciousness. The patient underwent a series of examinations, including regular cerebrospinal fluid (CSF) studies and magnetic resonance imaging, and tuberculous meningoencephalitis was suspected. Despite being treated with anti-TB drugs, no clinical improvement was observed in the patient. Following corticosteroid therapy, the patient developed a rapid deterioration in consciousness with dilated pupils. Metagenomic next-generation sequencing (mNGS) revealed an unexpected central nervous system (CNS) amoebic infection, and the patient died soon after the confirmed diagnosis. CONCLUSION This study highlights the application of mNGS for the diagnosis of patients with suspected encephalitis or meningitis, especially those caused by rare opportunistic infections.
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Affiliation(s)
- Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziwei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaomei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qihua Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Zamli KM, Hashim F, Razali SA, Yusoff HM, Mohamad H, Abdullah F, Asari A. Synthesis, anti-amoebic activity and molecular docking simulation of eugenol derivatives against Acanthamoeba sp. Saudi Pharm J 2023; 31:101703. [PMID: 37546528 PMCID: PMC10400915 DOI: 10.1016/j.jsps.2023.101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Amoebae of the genus Acanthamoeba can cause diseases such as amoebic keratitis and granulomatous amoebic encephalitis. Until now, treatment options for these diseases have not been fully effective and have several drawbacks. Therefore, research into new drugs is needed for more effective treatment of Acanthamoeba infections. Eugenol, a phenolic aromatic compound mainly derived from cloves, has a variety of pharmaceutical properties. In this study, nine eugenol derivatives (K1-K9), consisting of five new and four known compounds, were synthesized and screened for their antiamoebic properties against Acanthamoeba sp. The structure of these compounds was characterized spectroscopically by Fourier transform infrared (FTIR), Ultraviolet-Visible (UV-Vis), 1H and 13C Nuclear Magnetic Resonance (NMR) and mass spectrometer (MS). The derived molecules were screened for antiamoebic activity by determining IC50 values based on 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and observation of amoeba morphological changes by light and fluorescence microscopy. Most of the tested compounds possessed strong to moderate cytotoxic effects against trophozoite cells with IC50 values ranging from 0.61 to 24.83 μg/mL. Observation of amoebae morphology by light microscopy showed that the compounds caused the transformed cells to be roundish and reduced in size. Furthermore, fluorescence microscopy observation using acridine orange (AO) and propidium iodide (PI) (AO/PI) staining showed that the cells have damaged membranes by displaying a green cytoplasm with orange-stained lysosomes. Acidification of the lysosomal structure indicated disruption of the internal structure of Acanthamoeba cells when treated with eugenol derivatives. The observed biological results were also confirmed by interaction simulations based on molecular docking between eugenol derivatives and Acanthamoeba profilin. These interactions could affect the actin-binding ability of the protein, disrupting the shape and mobility of Acanthamoeba. The overall results of this study demonstrate that eugenol derivatives can be considered as potential drugs against infections caused by Acanthamoeba.
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Affiliation(s)
- Khairunisa Mohd Zamli
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Fatimah Hashim
- Biological Security and Sustainability Research Group, Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Siti Aisyah Razali
- Biological Security and Sustainability Research Group, Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Hanis Mohd Yusoff
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
- Advanced Nano Materials (ANoMa) Research Group, Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Habsah Mohamad
- Institute of Biotechnology Marine, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
| | - Fauziah Abdullah
- Phytochemistry Programme, Natural Products Division, Forest Research Institute of Malaysia, 52109 Kepong, Selangor, Malaysia
| | - Asnuzilawati Asari
- Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
- Advanced Nano Materials (ANoMa) Research Group, Faculty of Science and Marine Environment, Universiti Malaysia Terengganu, 21030 Kuala Nerus, Terengganu, Malaysia
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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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Omaña-Molina M, Sanchez-Rocha R, Hernandez-Martinez D, Romero Grijalva M, Salinas-Lara C, Rodriguez-Sosa M, Juarez-Avelar I, Salazar-Villatoro L, Gonzalez-Robles A, Mendez-Cruz AR, Aley-Medina P, Espinosa-Villanueva J, Castelan-Ramirez I, Lorenzo-Morales J. Type 2 diabetes mellitus BALB/c mice are more susceptible to granulomatous amoebic encephalitis: Immunohistochemical study. Exp Parasitol 2017; 183:150-159. [PMID: 28917708 DOI: 10.1016/j.exppara.2017.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
Granulomatous amoebic encephalitis (GAE) is a chronic, difficult to resolve infection caused by amphizoic amoebae of the genus Acanthamoeba, which in most cases occurs in immunosuppressed persons or with chronic diseases such as diabetes. In this study, we describe the early events of A. culbertsoni infection of GAE in diabetic mice model. Diabetes was induced in male BALB/c mice, with a dose of streptozotocin (130 mg/kg). Healthy and diabetic mice were inoculated via intranasal with 1 × 106 trophozoites of A. culbertsoni. Then were sacrificed and fixed by perfusion at 24, 48, 72 and 96 h post-inoculation, the brains and nasopharyngeal meatus were processed to immunohistochemical analysis. Invasion of trophozoites in diabetic mice was significantly greater with respect to inoculated healthy mice. Trophozoites and scarce cysts were immunolocalized in respiratory epithelial adjacent bone tissue, olfactory nerve packets, Schwann cells and the epineurium base since early 24 h post-inoculation. After 48 h, trophozoites were observed in the respiratory epithelium, white matter of the brain, subcortical central cortex and nasopharyngeal associated lymphoid tissue (NALT). At 72 h, cysts and trophozoites were immunolocalized in the olfactory bulb with the presence of a low inflammatory infiltrate characterized by polymorphonuclear cells. Scarce amoebae were observed in the granular layer of the cerebellum without evidence of inflammation or tissue damage. No amoebas were observed at 96 h after inoculation, suggesting penetration to other tissues at this time. In line with this, no inflammatory infiltrate was observed in the surrounding tissues where the amoebae were immunolocalized, which could contribute to the rapid spread of infection, particularly in diabetic mice. All data suggest that trophozoites invade the tissues by separating the superficial cells, penetrating between the junctions without causing cytolytic effect in the adjacent cells and subsequently reaching the CNS, importantly, diabetes increases the susceptibility to amoebae infection, which could favor the GAE development.
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Affiliation(s)
- Maritza Omaña-Molina
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico.
| | - Raquel Sanchez-Rocha
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Dolores Hernandez-Martinez
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Miriam Romero Grijalva
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Citlaltepetl Salinas-Lara
- Laboratory of Histology and Pathology, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Miriam Rodriguez-Sosa
- Laboratory of Innate Immunity, UBIMED, Faculty of Superior Studies, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Imelda Juarez-Avelar
- Laboratory of Innate Immunity, UBIMED, Faculty of Superior Studies, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Lizbeth Salazar-Villatoro
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies, Mexico City, Mexico
| | - Arturo Gonzalez-Robles
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies, Mexico City, Mexico
| | - Adolfo Rene Mendez-Cruz
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Patricia Aley-Medina
- Neuromorphology Laboratory, Faculty of Superior Studies, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Jesus Espinosa-Villanueva
- Neuromorphology Laboratory, Faculty of Superior Studies, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Ismael Castelan-Ramirez
- Laboratory of Amphizoic Amoebae, Faculty of Superior Studies, Medicine, UNAM, Iztacala, Tlalnepantla, State of Mexico, Mexico
| | - Jacob Lorenzo-Morales
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, La Laguna, Tenerife, Canary Islands, Spain
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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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An Autopsy Case of Fulminant Amebic Colitis in a Patient with a History of Rheumatoid Arthritis. Case Rep Rheumatol 2016; 2016:8470867. [PMID: 27382497 PMCID: PMC4921145 DOI: 10.1155/2016/8470867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
Generally, amebic colitis is localized around the mucosal membrane and often accompanied by diarrhea and abdominal pain. We describe a patient with a history of rheumatoid arthritis who had received prolonged steroid therapy. The patient complained of breathing difficulties because of rheumatoid lung disease. Although the patient was given antibacterial agent, the symptoms did not improve until death. We did an autopsy and found that he had fulminant amebic colitis, although the patient was not previously examined. Histochemical analysis revealed severe inflammation and full-thickness necrosis of the colon by ameba, suggesting the involvement of ameba in the progression of the overall condition.
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Shih RY, Koeller KK. Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives. Radiographics 2015; 35:1141-69. [PMID: 26065933 DOI: 10.1148/rg.2015140317] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite remarkable progress in prevention and treatment, infectious diseases affecting the central nervous system remain an important source of morbidity and mortality, particularly in less-developed countries and in immunocompromised persons. Bacterial, fungal, and parasitic pathogens are derived from living organisms and affect the brain, spinal cord, or meninges. Infections due to these pathogens are associated with a variety of neuroimaging patterns that can be appreciated at magnetic resonance imaging in most cases. Bacterial infections, most often due to Streptococcus, Haemophilus, and Neisseria species, cause significant meningitis, whereas the less common cerebritis and subsequent abscess formation have well-documented progression, with increasingly prominent altered signal intensity and corresponding contrast enhancement. Atypical bacterial infections are characterized by the development of a granulomatous response, classically seen in tuberculosis, in which the tuberculoma is the most common parenchymal form of the disease; spirochetal and rickettsial diseases are less common. Fungal infections predominate in immunocompromised hosts and are caused by yeasts, molds, and dimorphic fungi. Cryptococcal meningitis is the most common fungal infection, whereas candidiasis is the most common nosocomial infection. Mucormycosis and aspergillosis are characterized by angioinvasiveness and are associated with high morbidity and mortality among immunocompromised patients. In terms of potential exposure in the worldwide population, parasitic infections, including neurocysticercosis, toxoplasmosis, echinococcosis, malaria, and schistosomiasis, are the greatest threat. Rare amebic infections are noteworthy for their extreme virulence and high mortality. The objective of this article is to highlight the characteristic neuroimaging manifestations of bacterial, fungal, and parasitic diseases, with emphasis on radiologic-pathologic correlation and historical perspectives.
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Affiliation(s)
- Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.Y.S., K.K.K.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
| | - Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (R.Y.S., K.K.K.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, Rochester, Minn (K.K.K.)
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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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Alkhunaizi AM, Dawamneh MF, Banda RW, Daabil RA, Al-Tawfiq JA, Akkad SA, Boukhamseen AH. Acanthamoeba encephalitis in a patient with systemic lupus treated with rituximab. Diagn Microbiol Infect Dis 2013; 75:192-4. [DOI: 10.1016/j.diagmicrobio.2012.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 10/30/2012] [Accepted: 11/04/2012] [Indexed: 11/15/2022]
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