A case of successful treatment of cutaneous <i>Acanthamoeba</i> infection in a lung transplant recipient

Walia, Rajat; Montoya, José G.; Visvesvera, G.S.; Booton, Gregory C.; Doyle, Ramona L.

doi:10.1111/j.1399-3062.2006.00159.x

Cited by 70 publications

(46 citation statements)

References 13 publications

(16 reference statements)

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“…We evaluated the polyene macrolide corifungin versus Acanthamoeba because an earlier study showed that it effectively killed another free-living ameba, Naegleria fowleri, with better efficacy than amphotericin B (24). Previous studies reported that a combination of amphotericin B and a second drug was effective in eradicating a skin infection and GAE caused by Acanthamoeba (25,26). Amphotericin B has significant toxicity and is a hydrophobic molecule with negligible solubility in aqueous solution (27).…”

Section: Discussionmentioning

confidence: 99%

In Vitro Efficacy of Corifungin against Acanthamoeba castellanii Trophozoites and Cysts

Debnath

Tunac²,

Silva-Olivares

et al. 2014

Antimicrob Agents Chemother

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cPainful 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, electrondense 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. Free-living Acanthamoeba spp. cause keratitis, a serious eye infection that can occur in healthy individuals wearing contact lenses, as well as chronic granulomatous amebic encephalitis (GAE) leading to death in immunocompromised persons. Acanthamoeba has a worldwide distribution and is the most common ameba found in the environment. Coincident with the number of Acanthamoeba keratitis cases in the United States has been an increase in developing countries. Wearing of contact lenses is now recognized as the leading risk factor for keratitis (1-3). In the United States, the estimated number of keratitis cases is 1.36 per million contact lens wearers (4, 5). GAE is a relatively rare disease. Approximately 150 cases have been reported worldwide (5). GAE results from inhalation of amebae through the nasal cavities and lungs, or introduction through skin lesions followed by access to the central nervous system by hematogenous spread or through the olfactory neuroepithelium (6). Clinical manifestations include headache, fever, nausea, vomiting, behavioral changes, stiff neck, lethargy, increased intracranial pressure, and, in the later stage, loss of consciousness, seizures, coma, and death (7-9).The drugs recommended for the treatment of Acanthamoeba keratitis include polyhexamethylene biguanide (0.02%) or chlorhexidine (0.02%) along with a diamidine (either 0.1% propamidine or 0.1% hexamidine) (10). Corticosteroids are applied topically to control corneal inflammation, pain, and scleritis, particularly following keratoplasty (11). While this antimicrobial treatment can kill the trophozoites, the resistance of Acanthamoeba cysts to antimicrobials can lead to the recurrence of keratitis. For GAE, combination therapies were found more successful than single-drug therapies, a...

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Section: Discussionmentioning

confidence: 99%

In Vitro Efficacy of Corifungin against Acanthamoeba castellanii Trophozoites and Cysts

Debnath

Tunac²,

Silva-Olivares

et al. 2014

Antimicrob Agents Chemother

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“…More recently, PCR assays have been used. Treatment includes application of chlorhexidine gluconate and ketoconazole cream with one of the following: pentamidine isethionate, sulfadiazine, flucytosine, fluconazole or itraconazole [11,58]. The majority of patients with GAE due to Balamuthia exhibit skin ulcerations that may be several centimeters wide and appear on the face, trunk, hands and feet of patients [31].…”

Section: Eye Infections -Acanthamoeba Keratitis (Ak)mentioning

confidence: 99%

“…Characteristic lesions are nodules, pustules, papules and skin ulcerations that contain Acanthamoebatrophozoites and cysts. The most frequently lesion affected sites are the face, trunk and extremities [58]. Diagnosis of Acanthamoeba skin infection includes tissue histology, staining the smears of tissue, immunofuorescence assays, culture on non-nutrient agar plates seeded with bacteria as food source or tissue culture.…”

Section: Eye Infections -Acanthamoeba Keratitis (Ak)mentioning

confidence: 99%

Human infections caused by free-living amoebae

Król-Turmińska¹,

Olender²

2017

Ann Agric Environ Med.

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Introduction. Among free-living amoebae that are widely distributed in nature only four genera/species are known as agents of human infections: Acanthamoeba spp., Naegleriafowleri, Balamuthia mandrillaris and Sappiniapedata. These amoebae are not well adapted to parasitism, and could exist in the human environment without the need for a host. Infections due to these amoebae, despite low morbidity, are characterized by relatively high mortality rate and pose serious clinical problems. Objectve. This review study presents and summarizes current knowledge about infections due to pathogenic and opportunistic free-living amoebae focused on epidemiology, clinical manifestations, diagnosis and treatment based on global literature. State of knowledge. All four genera have been recognized as etiologic factors of fatal central nervous system infections and other serious diseases in humans. N. fowleri causes an acute fulminating meningoencephalitis in children and young adults. Acanthamoeba spp. and B.mandrillaris are opportunistic pathogens causing granulomatous amoebic encephalitis and disseminated or localized infections which could affect the skin, sinuses, lungs, adrenals and/or bones. Acanthamoeba spp. is also the main agent of acute eye infection -Acanthamoeba keratitis, mostly in contact lens wearers. However, there is only one recognized case of encephalitis caused by S. pedata. Conclusions. Amoebic diseases are difficult to diagnose which leads to delayed treatment, and result in a high mortality rate. Considering those issues, there is an urgent need to draw more attention to this type of diseases.

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“…are ubiquitous, free-living amoebae that infect humans opportunistically. These organisms are the etiological agent of fatal granulomatous amoebic encephalitis (GAE), usually associated with IC individuals (511,593,594). Acanthamoeba exists in a range of environments, including soil, air, freshwater, salt water, and sewage (320).…”

Section: Free-living Amoebaementioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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SUMMARY There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

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A case of successful treatment of cutaneous Acanthamoeba infection in a lung transplant recipient

Cited by 70 publications

References 13 publications

In Vitro Efficacy of Corifungin against Acanthamoeba castellanii Trophozoites and Cysts

In Vitro Efficacy of Corifungin against Acanthamoeba castellanii Trophozoites and Cysts

Human infections caused by free-living amoebae

Importance of Nonenteric Protozoan Infections in Immunocompromised People

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