Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment

Abstract

Background The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. Case presentation We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. Conclusions The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.

An Unexpected Case of Disseminated Amebiasis with Cerebral Involvement and Successful Recovery in a Non-Endemic Context

“…Amebic brain abscesses are extremely rare and arise almost exclusively alongside amebic lung or liver abscess [ 2 ]. Victoria-Hernández et al reported 133 cases worldwide [ 5 ], with a mortality rate over 95% [ 6 ] due to the difficulty of its diagnosis (CT images of E. histolytica abscesses are indistinguishable from those CT images of abscesses due to other organisms) or due to inadequate treatment, especially if drainage is not performed [ 5 , 6 , 12 , 13 ]. In many published cases of cerebral amebiasis, the diagnosis is made postmortem [ 6 ].…”

“…Brain abscess caused by E. histolytica is an infrequent manifestation of amebiasis infection and is most commonly, although not always, observed in patients with a concomitant liver abscess. Around 133 cases have been reported worldwide [ 5 ]. They are very lethal, exhibiting a mortality rate over 95% [ 6 ] due to the difficulty of its diagnosis and inadequate management.…”

An Overview of Mucosa-Associated Protozoa: Challenges in Chemotherapy and Future Perspectives

“…Similar findings were reported for refractory giardiasis due to MTZ resistance in the parasite in both healthy and immunocompromised individuals ( Morch et al., 2008 ; Nabarro et al., 2015 ; Carter et al., 2018 ; Lalle and Hanevik, 2018 ). So far, there is slight evidence for MTZ resistance in E. histolytica ( Victoria-Hernandez et al., 2020 ), but a decrease in 5-nitroimidazole susceptibility can be induced experimentally ( Wassmann et al., 1999 ; Iyer et al., 2017 ). Notoriously, increased drug resistance leads to higher doses used in the treatment and, therefore, more severe side effects (Hernandez Ceruelos ( Hernandez Ceruelos et al., 2019 ).…”

Panorama general de los protozoos intestinales en México 2000-2020

“…[2,26] En el ámbito clínico, existen múltiples reportes de casos que van desde pancolitis amebiana, absceso hepático y abscesos cerebrales amebianos. [27,28] Por otro lado, G. lamblia representa el protozoo con mayor número de publicaciones en Colima y Jalisco (Tabla 1); sin embargo, la mayor prevalencia se reporta para B. hominis con un 49 % seguido de Cryptosporidium spp. con un 7 %, en este último estado.…”