Acanthamoeba meningoencephalitis following autologous peripheral stem cell transplantation

Abstract

Summary:Amoebic meningoencephalitis is an unusual complication of bone marrow transplantation. We report a case of Acanthamoeba meningoencephalitis in a patient with non-Hodgkin's lymphoma after autologous stem cell transplantation. Leg weakness, fever and urinary retention developed 69 days following transplantation. The patient then developed fever, generalized tonic clonic seizure, rapid deterioration of mental functions and hypercapneic respiratory failure. Magnetic resonance imaging demonstrated a ring enhancing lesion at the level of the thoracic spines 11 and 12. Examination of the cerebrospinal fluid revealed pleocytosis. Despite empiric therapy with broad-spectrum antimicrobial agents, the patient's condition worsened and she died 11 days following admission. Autopsy findings revealed a subacute meningoencephalitis secondary to Acanthamoeba culbertsoni. Keywords: Acanthamoeba; meningoencephalitis; stem cell transplantation Infections are a major cause of morbidity and mortality following autologous peripheral blood stem cell transplantation (PBSCT). However, amoebic infections have rarely been identified in this group of patients. Only two cases of Acanthamoeba meningoencephalitis have been reported following autologous bone marrow transplantation. 1 They presented 9 and 6 months, respectively, following transplantation for leukemia with fever and pulmonary infiltrates, and later developed rapid mental status deterioration and seizures. The patients died 25 and 18 days after hospitalization despite aggressive treatment with broad-spectrum antibiotics, metronidazole, doxycycline, amphotericin B, fluconazole and trimethoprim-sulfamethaxazole. Acanthamoeba meningoencephalitis was diagnosed only at autopsy. Free-living amoeba of the genus Acanthamoeba are ubiquitous and can be isolated from fresh water, soil, sew- Case reportA 47-year-old female was diagnosed with monocytoid B cell lymphoma, in August 1994. The patient received 24 courses of cyclophosphamide, vincristine and prednisone (CVP) following which she was found to have residual disease. She then received six courses of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) and was subsequently referred to our center for high-dose chemotherapy and autologous stem cell rescue. The patient received three courses of tumor debulking and stem cell mobilization chemotherapy with etoposide 60 mg/kg, cyclophosphamide 3 g/m 2 and paclitaxel 200 mg/m 2 administered at monthly intervals, following which she received pre-transplant conditioning regimen consisting of busulfan 16 mg/kg, etoposide 60 mg/kg and cyclophosphamide 90 mg/kg followed by stem cell infusion (day 0). Ciprofloxacin 500 mg orally twice a day as prophylaxis was administered day −10 to day +6. Prophylactic amphotericin B (10 mg/day from day +2 to day +12, and subsequently 30 mg/week) was also administered. Trimethoprim-sulfamethaxasole was given twice a day 2 days a week from day −8 until day −1 prior to transplant and restarted following engraftment beginning on day +8. On day +6,...

Acanthamoebaspp. as Agents of Disease in Humans

“…Table 2 summarizes differences in terms of disease, portal of entry, clinical signs, pathology, and diagnosis for free-living amebae causing human infections. GAE is generally associated with individuals who already have underlying diseases such as malignancies (133), systemic lupus erythematosus (163,230), diabetes (172), renal failure, cirrhosis, tuberculosis, skin ulcers, human immunodeficiency virus (HIV) infection or Hodgkin's disease (201,277,286,426,477). Predisposing factors include alcoholism, drug abuse, steroid treatment, cancer chemotherapy, radiotherapy, and organ transplantation (14,282,408).…”

Ante mortem diagnosis of amoebic encephalitis in a haematopoietic stem cell transplanted patient

“…Recently, cases of amoebic meningoencephalitis have been found in healthy persons [7] and in haematopoietic stem cell transplanted patients [2,5,9,13]. It seems that recipients of HSCT may be at increased risk for life-threatening amoebic infections as well as the difficulty in making an ante mortem diagnosis of GAE.…”

In vitro amoebicidal activities of Satureja cuneifolia and Melissa officinalis on Acanthamoeba castellanii cysts and trophozoites

“…In particular, these protozoa have been associated with corneal infections (amoebic keratitis, AK), especially in contact lens wearers, chronic but fatal granulomatous amoebic meningoencephalitis (GAE), and skin nodules and abscesses Marciano-Cabral et al 2000;Driebe 2003;Khan 2003;Seal 2003). More recently, Acanthamoeba have been recognized to be opportunistic pathogens of humans and other animals, and they are known to cause a spectrum of infections in immunocompromised individuals, including patients with AIDS (Feingold et al 1998;Rosenberg and Morgan 2001;Marciano-Cabral and Cabral 2003;Carter et al 2004). Eradication of these protozoa from the infection sites is difficult because, under adverse conditions, the amoebas encyst and the medical therapy is often less effective against cysts than against trophozoites (Lloyd et al 2001).…”