Cutaneous<i>Acanthamoeba</i>Infection Associated With Acquired Immunodeficiency Syndrome

Park, Choong H.; Iyengar, Vasantha; Hefter, Larry; Pestaner, Joseph P.; Vandel, Nancy M.

doi:10.1093/labmed/25.6.386

Cited by 5 publications

(5 citation statements)

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“…Skin lesions characterized by nodules and ulcerations containing amebic trophozoites and cysts have been reported in a number of cases (41,69,81,87). This is another possible "portal of entry" of the ameba into the body and subsequent spread to other regions of the body by hematogenous route (74,91).…”

Section: Acanthamoeba Spp Dermatitis and Ulcerationsmentioning

confidence: 99%

Free‐living, Amphizoic and Opportunistic Amebas

1997

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Amebas belonging to the genera Naegleria, Acanthamoeba and Balamuthia are free-living, amphizoic and opportunistic protozoa that are ubiquitous in nature. These amebas are found in soil, water and air samples from all over the world. Human infection due to these amebas involving brain, skin, lung and eyes has increased significantly during the last 10 years. The epidemiology, immunology, protozoology, pathology, and clinical features of the infections produced by these protozoa differ strikingly. Infection by the pathogenic Naegleria fowleri is acquired by exposure to polluted water in ponds, swimming pools and man-made lakes. Raised temperatures during the hot summer months or warm water from power plants facilitate the growth of N. fowleri. N. fowleri is a thermophilic ameba that grows well in tropical and subtropical climates. The CNS infection, called Primary Amebic Meningoencephalitis (PAM), produced by N. fowleri is characterized by an acute fulminant meningoencephalitis leading to death 3-7 days after exposure. Victims are healthy, young individuals with a history of recent water-related sport activities. The portal of entry is the olfactory neuroepithelium. The pathologic changes are an acute hemorrhagic necrotizing meningoencephalitis with modest purulent exudate, mainly at the base of the brain, brain-stem and cerebellum. Trophozoites can be seen within the CNS lesions located mainly around blood vessels. Thus far 179 cases have been reported; 81 in the USA alone. Balamuthia mandrillaris and several species of Acanthamoeba are pathogenic "opportunistic" free-living amebas which cause Granulomatous Amebic Encephalitis (GAE) in humans and animals. GAE is an infection, usually seen in debilitated, malnourished individuals, in patients undergoing immunosuppressive therapy for organ transplants and in Acquired Immunodeficiency Syndrome (AIDS). The granulomatous component is negligible, particularly in immunocompromised individuals. Pathologically these amebas produce a patchy, chronic or subacute granulomatous encephalitis with the presence of trophozoites and cysts. The portal of entry is probably through the respiratory tract or an ulceration of the skin reaching the CNS by hematogenous spread. As of October 1, 1996, 166 cases (103 due to Acanthamoeba and 63 due to Balamuthia) of GAE have been reported from around the world. Of these 103 cases due to Acanthamoeba (72 have been reported in the USA alone, > 50 in AIDS). It is well known that several species of Acanthamoeba can also produce, chronic sight threatening ulceration of the cornea called Acanthamoeba keratitis (AK), mostly in contact lens wearers or in individuals with minor corneal abrasions. Hundreds of cases of AK have been documented world wide.

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Section: Acanthamoeba Spp Dermatitis and Ulcerationsmentioning

confidence: 99%

Free‐living, Amphizoic and Opportunistic Amebas

1997

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“…SGD has been the sole manifestation of invasive disease in some patients. [230][231][232][233][234] Reported CD4+ T-cell counts have been less than 250/μL (median, 24/μL) at the time of presentation. Where CD4 counts have not been reported, the histories reveal clinical evidence of late-stage AIDS.…”

Section: Toxoplasmosismentioning

confidence: 99%

“…214 The most common presentation of cerebral disease is that of fever and headache. 214,232 Focal neurologic deficits and profound changes in mental status are also frequent. Neuroradiologic findings mimic those of toxoplasmic encephalitis, with multiple enhancing mass lesions and surrounding edema.…”

Section: Toxoplasmosismentioning

confidence: 99%

“…CSF findings are quite variable. 214,232 A high index of suspicion and tissue or microbiologic diagnosis is key to the antemortem identification of disseminated Acanthamoeba infection. Wet mounts of CSF are occasionally useful.…”

Section: Toxoplasmosismentioning

confidence: 99%

“…214 Acanthamoebae can be isolated by culture on Escherichia coli-seeded nonnutrient agar or in tissue culture medium. 214,232 Identification of species (and even differentiation of Acanthamoeba from Balamuthia) is not possible morphologically. Immunofluorescence techniques can differentiate Acanthamoeba to the group level in tissue section or with cultured organisms.…”

Section: Toxoplasmosismentioning

confidence: 99%

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