Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review

Abstract

Acanthamoeba is the most common cause of granulomatous amebic encephalitis, a typically fatal condition that is classically described as indolent and slowly progressive. We report a case of Acanthamoeba encephalitis in a kidney transplant recipient that progressed to death within 3 days of symptom onset and was diagnosed at autopsy. We also review clinical characteristics, treatments, and outcomes of all published cases of Acanthamoeba encephalitis in solid organ transplant (SOT) recipients. Ten cases were identified, and the infection was fatal in 9 of these cases. In 6 patients, Acanthamoeba presented in a fulminant manner and death occurred within 2 weeks after the onset of neurologic symptoms. These acute presentations are likely related to immunodeficiencies associated with solid organ transplantation that result in an inability to control Acanthamoeba proliferation. Skin lesions may predate neurologic involvement and provide an opportunity for early diagnosis and treatment. Acanthamoeba is an under-recognized cause of encephalitis in SOT recipients and often presents in a fulminant manner in this population. Increased awareness of this disease and its clinical manifestations is essential to attain an early diagnosis and provide the best chance of cure.

Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine‐containing regimen: Case report and review of the literature

“…Acanthamoeba are free-living amoebae found in soil, air, and numerous aquatic environments, including drinking water, seawater, and swimming pools (3). Human infection is most common in immunocompromised hosts and is transmitted by inhalation of Acanthamoeba cysts or inoculation by direct contact with skin or mucosal surfaces.…”

“…Human infection is most common in immunocompromised hosts and is transmitted by inhalation of Acanthamoeba cysts or inoculation by direct contact with skin or mucosal surfaces. This protozoan has been reported to cause cutaneous lesions, nasopharyngeal infections, pneumonia, pyelonephritis, and granulomatous amoebic encephalitis (GAE), which is fatal in 90% of cases (3–6). Acanthamoeba osteomyelitis is extremely rare, and has only been reported in one other solid organ transplant (SOT) patient (7).…”

“…Although no cases of donor-derived Acanthamoeba infection have ever been reported, the California Transplant Donor Network was contacted because transplant-related transmission of another amoeba, Balamuthia, has been reported (1–3). The donor network concluded that no other infection or illness consistent with free-living amoeba infection had been reported in other organ recipients, and archived donor serum was negative for Acanthamoeba serology.…”

The Neurology of Solid Organ Transplantation

“…The risk of toxoplasmosis has been reduced with trimethoprim-sulfometoxazole prophylaxis which also prevents listeriosis and nocardiosis. In contrast, amebic meningoencephalitis is rare after SOT, but it carries very poor prognosis [46].…”

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

“…The pseudotumoral pattern commonly demonstrates a superficial gyriform pattern of enhancement, which could probably aid in demystifying the diagnosis (Fig 29). 72,73 …”