Acute Granulomatous Acanthamoeba Encephalitis in an Immunocompetent Patient

Lackner, Peter; Beer, Ronny; Broessner, Gregor; Helbok, Raimund; Pfausler, Bettina; Brenneis, Christian; Auer, Herbert; Walochnik, Julia; Schmutzhard, Erich

doi:10.1007/s12028-009-9291-z

Cited by 54 publications

(26 citation statements)

References 8 publications

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“…Most published cases have used multiple drug combinations with varying success. [12468910111213151617182023] A review of the English language literature for cases of CNS infection with Acanthamoeba diagnosed antemortem since 2000 and which described treatment protocols is summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba encephalitis: A Case Report and Review of Therapy

Zamora¹,

Henderson²,

Swiatlo³

2014

Surg Neurol Int

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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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Section: Discussionmentioning

confidence: 99%

Acanthamoeba encephalitis: A Case Report and Review of Therapy

Zamora¹,

Henderson²,

Swiatlo³

2014

Surg Neurol Int

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“…A PUBMED search for "Acanthamoeba meningoencephalitis in an immunocompetent patient" revealed reports of 11 such patients. [3][4][5][7][8][9][10][11][12] The details of these patients are given in Table 1. It was seen to occur at all age groups and more in female patients.…”

Section: Discussionmentioning

confidence: 99%

Acanthamoeba meningoencephalitis in an immunocompetent patient: An autopsy case report

Reddy¹,

Vijayasaradhi²,

Uppin³

et al. 2011

Neuropathology

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“…Acanthamoeba and Balamuthia species cause granulomatous amebic encephalitis usually in immunocompromised patients, including those receiving monoclonal antibody therapy, but may rarely occur in immunocompetent hosts (99)(100)(101)(102). Disseminated granulomatous amebic disease and amebic keratitis are other forms of the disease (100).…”

Section: Granulomatous Amebic Encephalitismentioning

confidence: 99%

Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives:From the Radiologic Pathology Archives

Shih¹,

Koeller²

2015

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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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Acute Granulomatous Acanthamoeba Encephalitis in an Immunocompetent Patient

Abstract: This case report demonstrates successful treatment of usually lethal GAE in an immunocompetent patient with high dose meropenem, linezolid, moxifloxacin and fluconazole followed by a partially adapted antimicrobial combination therapy.

Cited by 54 publications

References 8 publications

Acanthamoeba encephalitis: A Case Report and Review of Therapy

Acanthamoeba encephalitis: A Case Report and Review of Therapy

Acanthamoeba meningoencephalitis in an immunocompetent patient: An autopsy case report

Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives:From the Radiologic Pathology Archives

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