1921
Volume 70, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

We present a case of 23-year-old man with acute meningoencephalitis, accompanied by inflammation of a nasal ulcer. He had been healthy until six months prior to admission to the hospital when he had a motorcycle accident. A star-shaped wound at his nose was incurred after falling into a swamp. A computed tomogram of the brain showed two nonenhancing hypodense lesions at the left caudate nucleus and the right parietal lobe, ependymitis and leptomeningeal enhancement. A skin biopsy showed chronic noncaseous granulomatous inflammation without demonstrated microorganisms. The patient did not respond to the empirical treatment with cloxacillin, ceftriaxone, and amphotericin B, and eventually died on the thirteenth day of hospitalization. At autopsy, hematoxylin and eosin–stained brain sections showed a chronic necrotizing inflammation with numerous amebic trophozoites and rare cysts. Definitive identification of was made by fluorescent immunohistochemical analysis. There were 10 primary amebic meningoencephalitis, eight a granulomatous amebic encephalitis, and three meningitis in Thailand. To our knowledge, this case is the first reported case of in Southeast Asia.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2004.70.666
2004-06-01
2017-09-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/70/6/0700666.html?itemId=/content/journals/10.4269/ajtmh.2004.70.666&mimeType=html&fmt=ahah

References

  1. Ma P, Visvesvara GS, Martinez AJ, Theodore FH, Daggett PM, Sawyer TK, 1990. Naegleria and acanthamoeba infections: review. Rev Infect Dis 12 : 490–513.
  2. Sison JP, Kemper CA, Loveless M, McShane D, Visvesvara GS, Deresinski SC, 1995. Disseminated Acanthamoeba infections in patients with AIDS: case reports and review. Clin Infect Dis 20 : 1207–1216.
  3. Fowler M, Carter RF, 1965. Acute pyogenic meningitis probably due to Acanthamoeba sp.: a preliminary report. BMJ 5464 : 740–742.
  4. Butt CG, 1966. Primary amebic meningoencephalitis. N Engl J Med 274 : 1473–1476.
  5. Visvesvara GS, Martinez AJ, Schuster FL, Leitch GJ, Wallace SV, Sawyer TK, Anderson M, 1990. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol 28 : 2750–2756.
  6. Rowen JL, Doerr CA, Vogel H, Baker CJ, 1995. Balamuthia mandrillaris: a newly recognized agent for amebic meningoencephalitis. Pediatr Infect Dis J 14 : 705–710.
  7. Denney CF, Iragui VJ, Uber-Zak LD, Karpinski NC, Ziegler EJ, Visvesvara GS, Reed SL, 1997. Amebic meningoencephalitis caused by Balamuthia mandrillaris: case report and review. Clin Infect Dis 25 : 1354–1358.
  8. Gordon SM, Steinberg JP, DuPuis MH, Kozarsky PE, Nickerson JF, Visvesvara GS, 1992. Culture isolation of Acanthamoeba species and leptomyxid amebas from patients with amebic meningoencephalitis, including two patients with AIDS. Clin Infect Dis 15 : 1024–1030.
  9. Booton GC, Carmichael JR, Visvesvara GS, Byers TJ, Fuerst PA, 2003. Genotyping of Balamuthia mandrillaris based on nuclear 18S and mitochondrial 16S rRNA genes. Am J Trop Med Hyg 68 : 65–69.
  10. Martinez AJ, Visvesvara GS, 1991. Laboratory diagnosis of pathogenic free-living amoebas: Naegleria, Acanthamoeba, and Leptomyxid. Clin Lab Med 11 : 861–877.
  11. Sithinamsuwan P, Sangruchi T, Chiewvit P, Poungvarin N, 2001. Free-living ameba infections of the central nervous system in Thailand. Report of two patients and review of the literature. Intern Med J Thai 17 : 350–360.
  12. Martinez AJ, Visvesvara GS, 2001. Balamuthia mandrillaris infection. J Med Microbiol 50 : 205–207.
  13. Recavarren-Arce S, Velarde C, Gotuzzo E, Cabrera J, 1999. Amoeba angeitic lesions of the central nervous system in Balamuthia mandrillaris amoebiasis. Human Pathol 30 : 269–273.
  14. Deol I, Robledo L, Meza A, Visvesvara GS, Andrew RJ, 2000. Encephalitis due to a free-living amoeba (Balamuthia mandrillaris): case report with literature review. Surg Neurol 53 : 611–616.
  15. Popek EJ, Neafie RC, 1992. Granulomatous meningoencephalitis due to leptomyxid amoeba. Pediatr Pathol 12 : 871–881.
  16. Katz JD, Ropper AH, Adelman L, Worthington M, Wade P, 2000. A case of Balamuthia mandrillaris meningoencephalitis. Arch Neurol 57 : 1210–1212.
  17. Schuster FL, Visvesvara GS, 1996. Axenic growth and drug sensitivity studies of Balamuthia mandrillaris, an agent of amebic meningoencephalitis in humans and other animals. J Clin Microbiol 34 : 385–388.
  18. Schuster FL, 2002. Cultivation of pathogenic and opportunistic free-living amoebas. Clin Microbiol Rev 15 : 342–354.
  19. Janitschke K, Martinez AJ, Visvesvara GS, Schuster FL, 1996. Animal model Balamuthia mandrillaris infection: contrast and comparison in immunodeficient and immunocompetent mice: a murine model of “granulomatous” amebic encephalitis. J Neuropathol Exp Neurol 55 : 815–821.
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2004.70.666
Loading
/content/journals/10.4269/ajtmh.2004.70.666
Loading

Data & Media loading...

  • Received : 27 Aug 2003
  • Accepted : 30 Oct 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error