A rare case of cutaneous acanthamoebiasis in a renal transplant patient

Winsett, Frank; Dietert, Jessica B.; Tschen, Jaime A.; Swaby, Michael; Bangert, Carolyn A.

doi:10.5070/d3233034292

Cited by 11 publications

(5 citation statements)

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“…The results presented by Hernandez-Jasso et al showed that the skin of Acanthamoeba -infected mice exposed to UV-B radiation is a source of infection from which trophozoites can travel by blood to other organs [ 4 ]. Other results indicated that patient treatment with immunosuppressants after kidney transplantation led to the development of painful nodules on the skin [ 6 ]. This case confirmed that cutaneous acanthamoebiasis is present frequently in patients treated with immunosuppressants.…”

Section: Discussionmentioning

confidence: 99%

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The Immunological Changes in the Skin of BALC/c Mice with Disseminated Acanthamoebiasis

et al. 2023

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Toll-like receptors (TLR) are involved in the recognition of numerous pathogens, including Acanthamoeba spp. Thanks to this, it is possible for immune cells to recognize microorganisms and trigger the body’s innate immune response. The stimulation of TLRs also leads to the activation of specific immunity. The aim of the study was to determine the TLR2 and TLR4 gene expression in the skin of BALC/c mice infected with Acanthamoeba with AM22 strain isolated from a patient. Receptor expression was assessed by real-time polymerase chain reaction (qPCR) in the amoeba-infected host with normal (A) and reduced immunity (AS) as well as in the control host with normal immunity (C) and reduced immunity (CS). Statistical analysis of TLR2 gene expression in A and AS groups compared to C and CS groups, respectively, were statistically insignificant. In the A group, we found statistical upregulation of TLR4 gene expression at 8 dpi compared to the C group. While in AS group, TLR4 gene expression was at a similar level, such as in the CS group. Taking into account the host’s immune status, the TLR4 gene expression was statistically higher in the skin of host from A group than in host from AS group at the beginning of the infection. Increased TLR4 gene expression in hosts with normal immunity infected with Acanthamoeba suggests the involvement of the studied receptor in the course of acanthamoebiasis. The above research results provide new data on the involvement of the studied receptor in the skin in the host’s immune defense triggered during the Acanthamoeba infection.

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Section: Discussionmentioning

confidence: 99%

“…Cutaneous acanthamoebiasis can present variable lesions, including papules, pustules, nodules and skin ulcers that contain Acanthamoeba trophozoites and cysts. Some authors observed that Acanthamoeba inducted skin tissue necrosis [ 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Immunological Changes in the Skin of BALC/c Mice with Disseminated Acanthamoebiasis

et al. 2023

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“…Recent case reports provide anecdotal evidence that miltefosine can be used successfully in combination regimens to treat disseminated Acanthamoeba spp. infections in immunocompromised patients, and that its use has shown a survival advantage in some cases [13][14][15]. Current expert advice suggests using a combination regimen for disseminated acanthamoebiasis of pentamidine, fluconazole, and miltefosine, and the optional addition of cotrimoxazole, metronidazole and azithromycin [16].…”

Section: Discussionmentioning

confidence: 99%

Clinical Improvement of Disseminated Acanthamoeba Infection in a Patient with Advanced HIV Using a Non-Miltefosine-Based Treatment Regimen in a Low-Resource Setting

et al. 2022

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Disseminated Acanthamoeba species infection is likely an underrecognized and underdiagnosed opportunistic infection in patients with advanced human immunodeficiency virus (HIV) disease in South Africa. It presents a unique clinical challenge in that the diagnosis can be difficult to establish and management options are limited in low-resource settings. To our knowledge, there is a paucity of literature to date on the successful use of combination treatment options for patients in low-resource settings without access to miltefosine. We present a case describing the clinical improvement of disseminated Acanthamoeba infection in a patient with advanced HIV using a non-miltefosine-based treatment regimen. The case serves to highlight that Acanthamoeba sp. infection should be considered as a differential diagnosis for nodular and ulcerative cutaneous lesions in patients with advanced HIV in South Africa, and that although there are alternative options for combination treatment in countries without access to miltefosine, efforts should be made to advocate for better access to miltefosine for the treatment of acanthamoebiasis in South Africa.

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“…Winsett et al. reported cutaneous acanthamoebiasis in a renal transplant patient and Salameh et al., reported fetal cases in kidney transplant patients due to granulomatous amoebic encephalitis caused by A. castellanii 36,37 . Duarte et al, in a recent review of the literature, reported five cases of disseminated Acanthamoebiasis in lung or kidney transplant patients 16 .…”

Section: Discussionmentioning

confidence: 99%

“…kidney transplant patients due to granulomatous amoebic encephalitis caused by A. castellanii 36,37. Duarte et al, in a recent review of the literature, reported five cases of disseminated Acanthamoebiasis in lung or kidney transplant patients.…”

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confidence: 99%

Molecular identification of Acanthamoeba genotypes isolated from oral cavity of heart transplant patients in Iran

Arab-Mazar

Niyyati

Javanmard

et al. 2021

Transplant Infectious Dis

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Objective Heart transplant is one of the accepted treatments for some patients with advanced heart failure. Of note, transplant surgeries may cause different infections and complications for patients during the post‐transplant period. A wide variety of opportunistic organisms caused these infections including bacteria, fungi, viruses, and protozoa particularly Free‐living amoebae (FLA). This study aims to study the presence of pathogenic FLA from the oral cavity of post‐heart transplant recipients. Methods Throat swabs were collected from 80 patients who underwent post‐heart transplant surgery. All swabs were immediately cultured in non‐nutrient agar (2%). PCR and sequencing of 18S rRNA gene (DF3 region) of Acanthamoeba isolates were performed using genus‐specific primers. Genetic associations among sequenced genotypes inferred by the 18S rRNA gene obtained by MEGA X and a phylogenetic tree were constructed using the maximum likelihood algorithm and Kimura 2‐parameter model. Results Out of 80 samples collected from post‐heart transplant patients, six (7.5%) samples showed positive outgrowth of Acanthamoeba based on the page key and sequencing of the DF3 region. Sequence similarity of ASA1 by basic local alignment search tool(n) showed that five isolates (ANHT1, ANHT2, ANHT3, ANHT4, and ANHT5) belonged to Acanthamoeba T5 genotype corresponding to A. lenticulata and one strain (ANHT6) belonged to the T4 genotype. Conclusion To the best of our knowledge for the first time, a comprehensive study of Acanthamoeba genotypes isolated from throat samples of heart transplant recipients is described. Heart transplantation patients can be colonized by FLA and are therefore at risk of developing an invasive infection. Physicians' awareness of central nervous system infections related to FLAs and preventive and control measures of patients with compromised immune status due to heart transplant surgery are of utmost importance.

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A rare case of cutaneous acanthamoebiasis in a renal transplant patient

Cited by 11 publications

References 10 publications

The Immunological Changes in the Skin of BALC/c Mice with Disseminated Acanthamoebiasis

The Immunological Changes in the Skin of BALC/c Mice with Disseminated Acanthamoebiasis

Clinical Improvement of Disseminated Acanthamoeba Infection in a Patient with Advanced HIV Using a Non-Miltefosine-Based Treatment Regimen in a Low-Resource Setting

Molecular identification of Acanthamoeba genotypes isolated from oral cavity of heart transplant patients in Iran

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