Successful Treatment of Widely Disseminated Acanthamoebiasis

Oliva, Stepan; Jantz, Michael A.; Tiernan, Rosemary; Cook, D L; Judson, Marc A.

doi:10.1097/00007611-199901000-00010

Cited by 38 publications

(32 citation statements)

References 7 publications

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“…GAE is almost always fatal, regardless of immune status, with an approximate survival rate of less than 7% (594). Patients with Acanthamoeba-HIV coinfection usually do not survive, particularly patients with disseminated disease (90,323,377,411,477,486,509). In IC patients, Acanthamoeba infections also occur in the skin (386) and bones (512).…”

Section: Free-living Amoebaementioning

confidence: 99%

“…In lung transplant recipients, infections involving the skin, lungs, and brain as well as sinusitis and widely disseminated disease have been reported (176,411,571,580). Acanthamoeba has also been reported to cause disease in kidney and liver transplant recipients (215,536).…”

Section: Free-living Amoebaementioning

confidence: 99%

“…A broad range of drugs have been used to treat Acanthamoeba infections but with various successes. Drugs that show some anti-Acanthamoeba activity include propamidine isethionate, polyhexamethylene biguanide, itraconazole, clotrimazole, pentamidine isethionate, amphotericin B, flucytosine, chlorhexidine gluconate, hydroxystilbamidine, paromomycin, cotrimoxazole, rifampin, polymyxin, sulfadiazine, trimethoprimsulfamethoxazole, azithromycin, dibromopropamidine, hexamidine, and ketoconazole (215,377,401,411,579). In one study, propamidine proved to be the most effective anti-Acanthamoeba agent against 19 corneal isolates (357).…”

Section: Free-living Amoebaementioning

confidence: 99%

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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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Section: Free-living Amoebaementioning

confidence: 99%

Section: Free-living Amoebaementioning

confidence: 99%

Section: Free-living Amoebaementioning

confidence: 99%

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Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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“…While there are reports of infections in immunocompetent individuals (27,28), the majority of cases of GAE have occurred in immunocompromised hosts. Case reports of GAE in patients with human immunodeficiency virus/ AIDS (18,26,33) and patients who have undergone organ transplantation (2,16,29,30) likely reflect an increased incidence of GAE due to a larger population of susceptible individuals. The preponderance of GAE among patients with impaired T-cell immunity, coupled with experimental data showing T-lymphocyte proliferation among healthy volunteers exposed to Acanthamoeba antigens (32), implicates deficits in cell-mediated immunity as an important risk factor for GAE.…”

Section: Case Reportmentioning

confidence: 99%

“…Antimicrobial treatment of GAE is largely empirical, and as yet, there are no standardized treatment recommendations. The rare reports of long-term survivors among patients with GAE (26-28) and disseminated acanthamoebiasis (16,25,29) who are treated with a combination of antibiotic regimens support aggressive therapy. Often, however, the same antibiotic regimens have been used unsuccessfully in other patients, suggesting that early diagnosis, virulence of the agent, infective dose, and host immune factors all play a role in determining the outcome of GAE.…”

Section: Case Reportmentioning

confidence: 99%

Inability To Make a Premortem Diagnosis of Acanthamoeba Species Infection in a Patient with Fatal Granulomatous Amebic Encephalitis

Bloch

Schuster

2005

J Clin Microbiol

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Granulomatous amebic encephalitis (GAE), an infection of immunocompromised hosts, is almost uniformly fatal. A case of GAE in a patient who failed to mount a serologic response to Acanthamoeba polyphaga is presented. Although Acanthamoeba polyphaga that is sensitive to multiple antimicrobials grew from brain tissue, an inability to make a premortem diagnosis precluded therapy. CASE REPORTA 70-year-old female presented for medical attention with lethargy and seizures. Symptoms began 36 days earlier when she was hospitalized with syncope. An evaluation at that time included magnetic resonance imaging (MRI), revealing a focal area of edema in the right temporal lobe consistent with an acute infarction, and she was discharged to a rehabilitation facility with a diagnosis of cerebrovascular accident. She was readmitted with worsening ataxia, lethargy, and generalized seizures. Her past medical history included chronic neutropenia secondary to myelodysplastic syndrome, hypogammaglobulinemia treated with monthly intravenous gamma globulin, asplenia, steroid-dependent discoid lupus (prednisone, 20 mg twice a day), and diabetes mellitus.On exam, the patient was afebrile and hemodynamically stable. An ocular exam did not reveal papilledema. Her neck was supple. She was oriented only to person. A neurological examination was otherwise nonfocal. Laboratory studies included a platelet count of 355 ϫ 10 9 /liter, a hematocrit of 32.8%, and a white blood cell count of 2.8 ϫ 10 9 /liter, which was unchanged from her baseline leukopenia. A lumbar puncture (Table 1) was significant for lymphocytic pleocytosis and hypoglycorrhacia. A repeat MRI revealed intense contrast enhancement of the right posterior temporal lobe, with two new contrast-enhancing areas in the medial temporal lobe. A stereotactic biopsy of the right temporal lobe performed on day 42 was nondiagnostic, with results showing a reactive gliosis with lymphocytic infiltrate in the leptomeninges, but no amebae or granulomas, and negative bacterial, fungal, and mycobacterial cultures.The patient's hospital course was significant for progressive obtundation, requiring intubation for airway protection. The results of repeat lumbar punctures are provided in Table 1. Serial MRI revealed persistent abnormal signal intensity in the temporal lobes, with new areas of uptake in the right basal ganglia, pons, and left occiput. Extensive diagnostic evaluation was unrevealing except for a stable elevation in titers of antibodies to Mycoplasma pneumoniae (1.425 in the acute phase and 1.645 in the convalescent phase) and Ehrlichia chaffeensis (1:128 in the acute phase and 1:128 in the convalescent phase) and evidence of prior Epstein-Barr virus infection (viral capsid antigen immunoglobulin G titer of Ͼ10, viral capsid antigen immunoglobulin M titer of Ͻ10, and EBNA titer of Ͼ10). Despite empirical treatment with acyclovir, decadron, and plasmaphoresis, the patient died 100 days after her initial presentation.Hematoxylin and eosin-stained sections of the patient's brain obtained at ...

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Molecular identification and genotyping of Acanthamoeba spp., in bronchoalveolar lavage fluid from immunocompetent patients with chronic respiratory disorders (CRD)

et al. 2022

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This study aimed to investigate the presence and genotyping of Acanthamoeba spp., in the bronchoalveolar lavage fluid (BALF) of immunocompetent patients with chronic respiratory disorders (CRD). In this study, 211 BALF samples were collected from patients with CRD during the COVID-19 pandemic who were candidates for fiberoptic bronchoscopy (FOB) at Imam Khomeini Hospital, Sari, Mazandaran Province, northern Iran and investigated for Acanthamoeba spp., by PCR. A total of 211 FBAL samples were examined; 5 (5/211; 2.36%) were positive by using the PCR test for Acanthamoeba spp. According to sequence analysis, three strains belonged to the T4 genotype and one strain to the T2 genotype. Our data demonstrate that the presence of Acanthamoeba (T4 and T2) in BALF specimens of patients with respiratory infections. However, it is important to note that these findings may be merely accidental. Our findings suggest further investigation to fully understand the role of Acanthamoeba spp. in the pathogenesis of lung infections.

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Successful Treatment of Widely Disseminated Acanthamoebiasis

Cited by 38 publications

References 7 publications

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Inability To Make a Premortem Diagnosis of Acanthamoeba Species Infection in a Patient with Fatal Granulomatous Amebic Encephalitis

Molecular identification and genotyping of Acanthamoeba spp., in bronchoalveolar lavage fluid from immunocompetent patients with chronic respiratory disorders (CRD)

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