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Case Report: First Successful Treatment of Acanthamoeba Brain Abscess with Combination Surgical Excision and Miltefosine-Led Antimicrobial Therapy

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  • 1 Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia;
  • | 2 Department of Infectious Diseases, Cairns Base Hospital, Cairns, Queensland, Australia;
  • | 3 Department of Anatomical Pathology, Townsville University Hospital, Douglas, Townsville, Queensland, Australia

ABSTRACT.

Acanthamoeba brain abscess is very rare and most often fatal. There remains no standardized regimen for its management. We report a case in northern Australia of an immunosuppressed 57-year-old man who presented with diarrhea and weight loss, and was diagnosed with multiple Acanthamoeba brain abscesses after neurological deterioration. This case is the first successful treatment with surgical excision followed by combination antimicrobial therapy including miltefosine. This case was treated initially as nocardiosis or melioidosis, emphasizing the importance of considering differentials such as Acanthamoeba during workup of atypical infection. We present a literature review of the 14 Acanthamoeba brain abscess cases reported in the English literature, of which five were successfully treated. Our review shows a predilection for multiple brain abscesses and an increased mortality rate compared with the general brain abscess population.

Author Notes

Address correspondence to Anson Chan, Department of Neurosurgery, Townsville Hospital, 100 Angus Smith Drive, Douglas, Townsville, Queensland, Australia 4814. E-mail: anson.chan@health.qld.gov.au

Authors’ addresses: Anson Chan and Sarin Kuruvath, Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia, E-mails: anson.chan@health.qld.gov.au and sarin.kuruvath@health.qld.gov.au. Simon Smith, Department of Infectious Diseases, Cairns Base Hospital, Cairns, Queensland, Australia, E-mail: simon.smith2@health.qld.gov.au. Edwin Tan, Department of Anatomical Pathology, Townsville University Hospital, Douglas, Townsville, Queensland, Australia, E-mail: edwin.tan@iqpathology.com.au.

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