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Gonçalves DDS, Ferreira MDS, Guimarães AJ. Extracellular Vesicles from the Protozoa Acanthamoeba castellanii: Their Role in Pathogenesis, Environmental Adaptation and Potential Applications. Bioengineering (Basel) 2019; 6:bioengineering6010013. [PMID: 30717103 PMCID: PMC6466093 DOI: 10.3390/bioengineering6010013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 12/11/2022] Open
Abstract
Extracellular vesicles (EVs) are membranous compartments of distinct cellular origin and biogenesis, displaying different sizes and include exosomes, microvesicles, and apoptotic bodies. The EVs have been described in almost every living organism, from simple unicellular to higher evolutionary scale multicellular organisms, such as mammals. Several functions have been attributed to these structures, including roles in energy acquisition, cell-to-cell communication, gene expression modulation and pathogenesis. In this review, we described several aspects of the recently characterized EVs of the protozoa Acanthamoeba castellanii, a free-living amoeba (FLA) of emerging epidemiological importance, and compare their features to other parasites' EVs. These A. castellanii EVs are comprised of small microvesicles and exosomes and carry a wide range of molecules involved in many biological processes like cell signaling, carbohydrate metabolism and proteolytic activity, such as kinases, glucanases, and proteases, respectively. Several biomedical applications of these EVs have been proposed lately, including their use in vaccination, biofuel production, and the pharmaceutical industry, such as platforms for drug delivery.
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Affiliation(s)
- Diego de Souza Gonçalves
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Rio de Janeiro 24210-130, Brazil.
| | - Marina da Silva Ferreira
- Departamento de Imunologia, Instituto de Microbiologia Professor Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-970, Brazil.
| | - Allan J Guimarães
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Rio de Janeiro 24210-130, Brazil.
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Nehete LS, Kumar A, Chavali P, A. R. P, Devi BI. Fulminant acanthamoebic meningoencephalitis in immunocompetent patients: an uncommon entity. Br J Neurosurg 2018; 36:98-101. [DOI: 10.1080/02688697.2018.1485873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Lokesh Suresh Nehete
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Anil Kumar
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Pooja Chavali
- Department of Neuropathology, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Prabhuraj A. R.
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
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Basher MHA, Ithoi I, Mahmud R, Abdulsalam AM, Foead AI, Dawaki S, Atroosh WMM, Nissapatorn V, Abdullah WO. Occurrence of Acanthamoeba genotypes in Central West Malaysian environments. Acta Trop 2018; 178:219-228. [PMID: 29203378 DOI: 10.1016/j.actatropica.2017.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
Acanthamoeba species are ubiquitous free-living protozoa that can be found worldwide. Occasionally, it can become parasitic and the causative agent of acanthamoebic keratitis (AK) and Granulomatous Amoebic Encephalitis (GAE) in man. A total of 160 environmental samples and 225 naturally-infected animal corneal swabs were collected for Acanthamoeba cultivation. Acanthamoeba was found to be high in samples collected from environments (85%, 136/160) compared to infected animal corneas (24.89%, 56/225) by microscopic examination. Analysis of nucleotide sequence of 18S rRNA gene of all the 192 cultivable Acanthamoeba isolates revealed 4 genotypes (T3, T4. T5 and T15) with T4 as the most prevalent (69.27%, 133/192) followed by T5 (20.31%), T15 (9.90%) and T3 (0.52%). Genotype T4 was from the strain of A. castellanii U07401 (44.27%), A. castellanii U07409 (20.83%) and A. polyphagaAY026243 (4.17%), but interestingly, only A. castellanii U07401 was detected in naturally infected corneal samples. In environmental samples, T4 was commonly detected in all samples including dry soil, dust, wet debris, wet soil and water. Among the T4, A. castellanii (U07409) strains were detected high occurrence in dry (45%) followed by aquatic (32.50%) and moist (22.50%) samples but however A. castellanii (U07401) strains were dominant in dry samples of soil and dust (93.10%). Subsequently, genotype T5 of A. lenticulata (U94741) strains were dominant in samples collected from aquatic environments (58.97%). In summary, A. castellanii (U07401) strains were found dominant in both environmental and corneal swab samples. Therefore, these strains are possibly the most virulent and dry soil or dusts are the most possible source of Acanthamoeba infection in cats and dogs corneas.
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Abstract
For the past several decades, there has been little improvement in the morbidity and mortality associated with Acanthamoeba keratitis and Acanthamoeba encephalitis, respectively. The discovery of a plethora of antiacanthamoebic compounds has not yielded effective marketed chemotherapeutics. The rate of development of novel antiacanthamoebic chemotherapies of translational value and the lack of interest of the pharmaceutical industry in developing such chemotherapies have been disappointing. On the other hand, the market for contact lenses/contact lens disinfectants is a multi-billion-dollar industry and has been successful and profitable. A better understanding of drugs, their targets, and mechanisms of action will facilitate the development of more-effective chemotherapies. Here, we review the progress toward phenotypic drug discovery, emphasizing the shortcomings of useable therapies.
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Khalife GE, Pambuccian SE, Visvesvara GS, Horten B. Disseminated Acanthamoeba Infection Masquerading as Bacillary Angiomatosis in a Patient With AIDS. Int J Surg Pathol 2016. [DOI: 10.1177/106689699400200103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disseminated Acanthamoeba infections and bacillary angiomatosis are among the un usual opportunistic infections encountered in patients with AIDS. We report a fatal case of disseminated Acanthamoeba palestinensis infection involving the skin, palate, brain, lungs, and testes in a patient with AIDS in whom the mucocutaneous lesions were initially interpreted clinically and pathologically as bacillary angiomatosis. Int J Surg Pathol 2(1):11-16, 1994
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Webster D, Umar I, Umar I, Kolyvas G, Bilbao J, Guiot MC, Duplisea K, Qvarnstrom Y, Visvesvara GS. Treatment of granulomatous amoebic encephalitis with voriconazole and miltefosine in an immunocompetent soldier. Am J Trop Med Hyg 2012; 87:715-8. [PMID: 22869634 DOI: 10.4269/ajtmh.2012.12-0100] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 38-year-old male immunocompetent soldier developed generalized seizures. He underwent surgical debulking and a progressive demyelinating pseudotumor was identified. Serology and molecular testing confirmed a diagnosis of granulomatous amoebic encephalitis caused by Acanthamoeba sp. in this immunocompetent male. The patient was treated with oral voriconazole and miltefosine with Acanthamoeba titers returning to control levels and serial imaging demonstrating resolution of the residual lesion.
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Affiliation(s)
- Duncan Webster
- Department of Internal Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada.
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Siddiqui R, Khan NA. Biology and pathogenesis of Acanthamoeba. Parasit Vectors 2012; 5:6. [PMID: 22229971 PMCID: PMC3284432 DOI: 10.1186/1756-3305-5-6] [Citation(s) in RCA: 356] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/10/2012] [Indexed: 12/18/2022] Open
Abstract
Acanthamoeba is a free-living protist pathogen, capable of causing a blinding keratitis and fatal granulomatous encephalitis. The factors that contribute to Acanthamoeba infections include parasite biology, genetic diversity, environmental spread and host susceptibility, and are highlighted together with potential therapeutic and preventative measures. The use of Acanthamoeba in the study of cellular differentiation mechanisms, motility and phagocytosis, bacterial pathogenesis and evolutionary processes makes it an attractive model organism. There is a significant emphasis on Acanthamoeba as a Trojan horse of other microbes including viral, bacterial, protists and yeast pathogens.
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Reddy R, Vijayasaradhi M, Uppin MS, Challa S, Jabeen A, Borghain R. Acanthamoeba meningoencephalitis in an immunocompetent patient: an autopsy case report. Neuropathology 2011; 31:183-7. [PMID: 20667014 DOI: 10.1111/j.1440-1789.2010.01151.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic granulomatous CNS infections may be caused by tuberculosis, fungi and rarely by free-living amoeba, especially in immunocompromised individuals. We report a rare, fatal case of granulomatous amoebic encephalitis in an immunocompetent patient mimicking CNS tuberculosis, and review the imageological features and diagnostic tests.
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Affiliation(s)
- Rajesh Reddy
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India
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Akpek G, Uslu A, Huebner T, Taner A, Rapoport A, Gojo I, Akpolat Y, Ioffe O, Kleinberg M, Baer M. Granulomatous amebic encephalitis: an under-recognized cause of infectious mortality after hematopoietic stem cell transplantation. Transpl Infect Dis 2011; 13:366-73. [DOI: 10.1111/j.1399-3062.2011.00612.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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YAMASAKI K, SUGIMOTO T, FUTAMI M, MORIYAMA T, UEHARA H, TAKESHIMA H, MORIGUCHI S, MARUTSUKA K, ASADA Y. Granulomatous Amoebic Encephalitis Caused by Balamuthia Mandrillaris -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:667-70. [DOI: 10.2176/nmc.51.667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kouji YAMASAKI
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Tetsuaki SUGIMOTO
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Munetomo FUTAMI
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Takuzo MORIYAMA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Hisao UEHARA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Hideo TAKESHIMA
- Department of Neurosurgery, Faculty of Medicine, University of Miyazaki
| | - Sayaka MORIGUCHI
- Department of Pathology, Faculty of Medicine, University of Miyazaki
| | - Kousuke MARUTSUKA
- Department of Pathology, Faculty of Medicine, University of Miyazaki
| | - Yujiro ASADA
- Department of Pathology, Faculty of Medicine, University of Miyazaki
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Granulomatous amebic encephalitis in a child with acute lymphoblastic leukemia successfully treated with multimodal antimicrobial therapy and hyperbaric oxygen. J Clin Microbiol 2010; 49:446-8. [PMID: 21084511 DOI: 10.1128/jcm.01456-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acanthamoeba is the causative agent of granulomatous amebic encephalitis, a rare and usually fatal disease. We report a child with acute lymphoblastic leukemia who developed brain abscesses caused by Acanthamoeba during induction therapy. Multimodal antimicrobial chemotherapy and hyperbaric oxygen therapy resulted in complete resolution of symptoms and of pathology as seen by magnetic resonance imaging.
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Protozoa. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00182-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Saxena A, Mittal S, Burman P, Garg P. Acanthameba meningitis with successful outcome. Indian J Pediatr 2009; 76:1063-4. [PMID: 19907944 DOI: 10.1007/s12098-009-0205-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 08/26/2008] [Indexed: 11/24/2022]
Abstract
We report a rare cause of sub acute meningitis in a 15-yr-old immunocompetent female child with successful outcome. The etiological agent was Acanthamoeba. The child was successfully treat with combination of Ketoconazole. Rifampicin, cotrimoxa zole and for a period of 9 month.
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Affiliation(s)
- Ajit Saxena
- Department of Pediatrics and Microbiology, Fortis Hospital, Sita Ram Bhartia Institute of Science and Research, New Delhi, India
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Diagnosis of infections caused by pathogenic free-living amoebae. Interdiscip Perspect Infect Dis 2009; 2009:251406. [PMID: 19657454 PMCID: PMC2719787 DOI: 10.1155/2009/251406] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 06/05/2009] [Indexed: 11/23/2022] Open
Abstract
Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, and Sappinia sp. are pathogenic free-living amoebae. N. fowleri causes Primary Amoebic Meningoencephalitis, a rapidly fatal disease of the central nervous system, while Acanthamoeba spp. and B. mandrillaris cause chronic granulomatous encephalitis. Acanthamoeba spp. also can cause cutaneous lesions and Amoebic Keratitis, a sight-threatening infection of the cornea that is associated with contact lens use or corneal trauma. Sappinia pedata has been identified as the cause of a nonlethal case of amoebic encephalitis. In view of the potential health consequences due to infection with these amoebae, rapid diagnosis is critical for early treatment. Microscopic examination and culture of biopsy specimens, cerebral spinal fluid (CSF), and corneal scrapings have been used in the clinical laboratory. For amoebic keratitis, confocal microscopy has been used to successfully identify amoebae in corneal tissue. More recently, conventional and real-time PCR assays have been developed that are sensitive and specific for the amoebae. In addition, multiplex PCR assays are available for the rapid identification of these pathogens in biopsy tissue, CSF, and corneal specimens.
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Aichelburg AC, Walochnik J, Assadian O, Prosch H, Steuer A, Perneczky G, Visvesvara GS, Aspöck H, Vetter N. Successful treatment of disseminated Acanthamoeba sp. infection with miltefosine. Emerg Infect Dis 2009; 14:1743-6. [PMID: 18976559 PMCID: PMC2630722 DOI: 10.3201/eid1411.070854] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous amoebic encephalitis, and underlying miliary tuberculosis and tuberculous meningitis. The patient responded favorably to treatment with miltefosine, an alkylphosphocholine. The patient remained well with no signs of infection 2 years after treatment cessation.
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Mattana A, Biancu G, Alberti L, Accardo A, Delogu G, Fiori PL, Cappuccinelli P. In vitro evaluation of the effectiveness of the macrolide rokitamycin and chlorpromazine against Acanthamoeba castellanii. Antimicrob Agents Chemother 2004; 48:4520-7. [PMID: 15561820 PMCID: PMC529218 DOI: 10.1128/aac.48.12.4520-4527.2004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 06/03/2004] [Accepted: 07/27/2004] [Indexed: 11/20/2022] Open
Abstract
The present study demonstrates the in vitro effectiveness of the macrolide rokitamycin and the phenothiazine compound chlorpromazine against Acanthamoeba castellanii. Growth curve evaluations revealed that both drugs inhibit trophozoite growth in dose- and time-dependent ways. The effects of both drugs when they were used at the MICs at which 100% of isolates are inhibited were amoebistatic, but at higher doses they were amoebicidal as well as cysticidal. Experiments showed that when rokitamycin was associated with chlorpromazine or amphotericin B, rokitamycin enhanced their activities. Furthermore, low doses of rokitamycin and chlorpromazine, alone or in combination, blocked the cytopathic effect of A. castellanii against WKD cells derived from the human cornea. These results may have important significance in the development of new anti-Acanthamoeba compounds.
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Affiliation(s)
- A Mattana
- Department of Pharmaceutical Sciences, University of Sassari, Sassari, Italy.
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Nwachuku N, Gerba CP. Health effects of Acanthamoeba spp. and its potential for waterborne transmission. REVIEWS OF ENVIRONMENTAL CONTAMINATION AND TOXICOLOGY 2004; 180:93-131. [PMID: 14561077 DOI: 10.1007/0-387-21729-0_2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Risk from Acanthamoeba keratitis is complex, depending upon the virulence of the particular strain, exposure, trauma, or other stress to the eye, and host immune response. Bacterial endosymbionts may also play a factor in the pathogenicity of Acanthamoeba. Which factor(s) may be the most important is not clear. The ability of the host to produce IgA antibodies in tears may be a significant factor. The immune response of the host is a significant risk factor for GAE infection. If so, then a certain subpopulation with an inability to produce IgA in the tears may be at greatest risk. There was no sufficient data on the occurrence or types of Acanthamoeba in tapwater in the U.S. Published work on amoebal presence in tapwater does not provide information on the type of treatment the water received or the level of residual chlorine. Assessment of the pathogenicity by cell culture and molecular methods of Acanthamoeba in tapwater would also be useful in the risk assessment process for drinking water. The possibility that Acanthamoeba spp. might serve as vectors for bacterial infections from water sources also should be explored. The bacterial endosymbionts include an interesting array of pathogens such as Vibrio cholerae and Legionella pneumophila, both of which are well recognized waterborne/water-based pathogens. Work is needed to determine if control of Acanthamoeba spp. is needed to control water-based pathogens in water supplies.
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Affiliation(s)
- Nena Nwachuku
- Office of Science and Technology, Office of Water, U.S. Environmental Protection Agency, 1200 Pennsylvania Ave. N.W., Mc 4304T, Washington, DC 20460, USA
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Abstract
The authors present the case of a previously healthy 26-year-old man who presented with cerebrospinal acanthamebic granulomas, and they review the literature on acanthamebic granulomas of the central nervous system (CNS). The appearance of the lesion on imaging studies suggested the presence of tuberculous granulomas, which are common in India, and antituberculosis treatment was started. Despite surgical excision of a granuloma located in the right temporoparietal region and an intramedullary granuloma at T7-8, the disease progressed and resulted in death. Unlike other cases, this patient was not immunocompromised, had no history of engaging in water activities, and had no ulcers on his body, leaving in question the mode of entry used by the ameba. Acanthamebic granulomas can cause severe infections in healthy patients as well as in sick ones. This disease should be considered in the differential diagnosis when treating infective granulomas of the CNS.
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Affiliation(s)
- Vernon Velho
- Department of Neurosurgery, Grant Medical College and Sir J. J. Group of Hospitals, Byculla, Mumbai, India.
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Abstract
Acanthamoeba spp. are free-living amebae that inhabit a variety of air, soil, and water environments. However, these amebae can also act as opportunistic as well as nonopportunistic pathogens. They are the causative agents of granulomatous amebic encephalitis and amebic keratitis and have been associated with cutaneous lesions and sinusitis. Immuno compromised individuals, including AIDS patients, are particularly susceptible to infections with Acanthamoeba. The immune defense mechanisms that operate against Acanthamoeba have not been well characterized, but it has been proposed that both innate and acquired immunity play a role. The ameba's life cycle includes an active feeding trophozoite stage and a dormant cyst stage. Trophozoites feed on bacteria, yeast, and algae. However, both trophozoites and cysts can retain viable bacteria and may serve as reservoirs for bacteria with human pathogenic potential. Diagnosis of infection includes direct microscopy of wet mounts of cerebrospinal fluid or stained smears of cerebrospinal fluid sediment, light or electron microscopy of tissues, in vitro cultivation of Acanthamoeba, and histological assessment of frozen or paraffin-embedded sections of brain or cutaneous lesion biopsy material. Immunocytochemistry, chemifluorescent dye staining, PCR, and analysis of DNA sequence variation also have been employed for laboratory diagnosis. Treatment of Acanthamoeba infections has met with mixed results. However, chlorhexidine gluconate, alone or in combination with propamidene isethionate, is effective in some patients. Furthermore, effective treatment is complicated since patients may present with underlying disease and Acanthamoeba infection may not be recognized. Since an increase in the number of cases of Acanthamoeba infections has occurred worldwide, these protozoa have become increasingly important as agents of human disease.
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Affiliation(s)
- Francine Marciano-Cabral
- Department of Microbiology and Immunology, Virginia Commonwealth University, Richmond, Virginia 23298-0678, USA.
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Walochnik J, Duchêne M, Seifert K, Obwaller A, Hottkowitz T, Wiedermann G, Eibl H, Aspöck H. Cytotoxic activities of alkylphosphocholines against clinical isolates of Acanthamoeba spp. Antimicrob Agents Chemother 2002; 46:695-701. [PMID: 11850250 PMCID: PMC127497 DOI: 10.1128/aac.46.3.695-701.2002] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Free-living amoebae of the genus Acanthamoeba are causing serious chronic conditions such as destructive keratitis in contact lens wearers or granulomatous amoebic encephalitis in individuals with compromised immune systems. Both are characterized by the lack of availability of sufficiently effective and uncomplicated, manageable treatments. Hexadecylphosphocholine (miltefosine) is licensed for use as a topical antineoplastic agent, but it is also active in vitro against several protozoan parasites, and it was applied very successfully for the treatment of human visceral leishmaniasis. The aim of our study was to evaluate the efficacy of hexadecylphosphocholine and other alkylphosphocholines (APCs) against Acanthamoeba spp. The in vitro activities of eight different APCs against three Acanthamoeba strains of various pathogenicities were determined. All substances showed at least amoebostatic effects, and some of them disrupted the amoebae, as shown by the release of cytoplasmic enzyme activity. Hexadecylphosphocholine exhibited the highest degree of cytotoxicity against trophozoites, resulting in complete cell death at a concentration as low as 40 microM, and also displayed significant cysticidal activity. Hexadecylphosphocholine may be a promising new candidate for the topical treatment of Acanthamoeba keratitis and, conceivably, even for the oral treatment of granulomatous amoebic encephalitis.
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Affiliation(s)
- Julia Walochnik
- Department of Medical Parasitology, Clinical Institute of Hygiene, University of Vienna, Vienna, Austria
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Singhal T, Bajpai A, Kalra V, Kabra SK, Samantaray JC, Satpathy G, Gupta AK. Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials. Pediatr Infect Dis J 2001; 20:623-7. [PMID: 11419508 DOI: 10.1097/00006454-200106000-00016] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acanthamoeba was implicated as the causative agent of chronic meningitis in three apparently immunocompetent children. Diagnosis was established by cerebrospinal fluid wet mount examination and culture. Two children improved rapidly with combination oral therapy composed of trimethoprim-sulfamethoxazole, rifampin and ketoconazole.
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Affiliation(s)
- T Singhal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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Deol I, Robledo L, Meza A, Visvesvara GS, Andrews RJ. Encephalitis due to a free-living amoeba (Balamuthia mandrillaris): case report with literature review. SURGICAL NEUROLOGY 2000; 53:611-6. [PMID: 10940434 DOI: 10.1016/s0090-3019(00)00232-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Amebic infections can spread to the central nervous system with a lengthy but usually fatal course. A typical case is presented to raise awareness of this increasingly reported infectious process that may have a more favorable outcome if diagnosed in its early stages. CASE DESCRIPTION A 38-year-old male presented with an ulcerating 10 x 8 cm mass on his thigh and smaller skin nodules. In less than 6 months seizures developed due to granulomatous lesions of the brain. Biopsies/excisions of the thigh lesion, a subcutaneous nodule, and a brain lesion were performed. He failed to respond to broad spectrum antibiotics and antineoplastic agents, and died within 6 weeks of the initial MRI scan of the brain. Rare amebic trophozoites were appreciated in the biopsy specimens on post-mortem review, and Balamuthia mandrillaris confirmed as the infecting agent on immunofluorescence studies. CONCLUSIONS Granulomatous amebic encephalitis is a parasitic infection with a lengthy clinical course before rapid deterioration due to extensive brain lesions is noted. Either early treatment with antimicrobials or-in rare cases-excision of the brain lesion(s) may offer the chance of a cure.
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Affiliation(s)
- I Deol
- Department of Pathology, Texas Tech University Health Sciences Center, El Paso 79905, USA
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Lowichik A, Siegel JD. Parasitic infections of the central nervous system in children. Part I: Congenital infections and meningoencephalitis. J Child Neurol 1995; 10:4-17. [PMID: 7769177 DOI: 10.1177/088307389501000102] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This review article presents the epidemiology, pathogenesis, clinical presentation, laboratory and radiologic findings, and treatment of parasitic infections of the central nervous system in children. Some obscure parasitic infections are included. To assist the clinician faced with a specific case, infections are categorized first by predominant clinical manifestations: congenital disease, meningoencephalitis, focal lesions, and disseminated multisystem disease. Within the clinical categories, parasites are grouped according to the geographic area where most human infections occur. Congenital infections and those that present most frequently as meningoencephalitis are discussed in this part of the review.
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Affiliation(s)
- A Lowichik
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA
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Slater CA, Sickel JZ, Visvesvara GS, Pabico RC, Gaspari AA. Brief report: successful treatment of disseminated acanthamoeba infection in an immunocompromised patient. N Engl J Med 1994; 331:85-7. [PMID: 8208270 DOI: 10.1056/nejm199407143310204] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- C A Slater
- Department of Dermatology, University of Rochester Medical Center, N.Y. 14642
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Martínez AJ, Guerra AE, García-Tamayo J, Céspedes G, González-Alfonzo JE, Visvesvara GS. Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela. Acta Neuropathol 1994; 87:430-4. [PMID: 8017178 DOI: 10.1007/bf00313614] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Granulomatous amebic encephalitis (GAE), or meningoencephalitis due to Acanthamoeba spp. and leptomyxid ameba are uncommon CNS infections that generally occur in immunocompromised hosts. We describe a case of GAE caused by Balamuthia mandrillaris previously designated as a leptomyxid ameba, in an apparently healthy 14-year-old Venezuelan boy. This case was characterized by sudden onset of seizures, focal neurologic signs and by a prolonged clinical course (from November 1992 to March 1993). Neuroimaging studies showed cerebral hypodense lesions in cerebral hemispheres, brain stem and cerebellum. Microscopically, we found a chronic granulomatous inflammatory reaction with necrotizing angiitis, large numbers of amebic trophozoites and few cysts in perivascular spaces and within necrotic CNS tissue. The amebas were identified as B. mandrillaris based on their immunofluorescence reactivity with the anti-B. mandrillaris serum. So far, 30 cases of GAE due to B. mandrillaris have been recognized in humans, two in AIDS patients. No visceral involvement by free-living amebas or any other significant abnormality was observed. This patient developed "spontaneous" GAE, but it remains possible that an undiagnosed abnormality in cell-mediated immunity or a deficient humoral immune response may explain the susceptibility of this patient to this opportunistic infection.
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Affiliation(s)
- A J Martínez
- Department of Pathology, University of Pittsburgh School of Medicine, PA
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26
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Moura H, Wallace S, Visvesvara GS. Acanthamoeba healyi n. sp. and the isoenzyme and immunoblot profiles of Acanthamoeba spp., groups 1 and 3. THE JOURNAL OF PROTOZOOLOGY 1992; 39:573-83. [PMID: 1522539 PMCID: PMC7194289 DOI: 10.1111/j.1550-7408.1992.tb04853.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two strains of Acanthamoeba isolated from human brain tissue and a strain of Acanthamoeba isolated from a fish were compared with 10 species of Acanthamoeba belonging to groups 1, 2 and 3 based on their isoenzyme profiles and antigenic characteristics. A total of 12 enzymes were studied. The isoenzymes and antigens were electrophoretically separated on polyacrylamide gradient gels, and the patterns obtained were compared after appropriate staining for particular enzymes and reactivities with homologous and heterologous rabbit anti-Acanthamoeba antisera. One of the human strains (CDC:1283:V013) was identified as A. healyi n. sp. because of its unique isoenzyme profiles for 11 of the 12 enzymes tested. The other human isolate was reidentified as A. culbertsoni because its isoenzyme profiles for 10 of 12 enzymes resembled those of A. culbertsoni, Lilly A-1 strain. Since the isoenzyme profiles and the antigenic patterns of the fish isolate as well were remarkably similar to those of A. royreba, it was considered as a strain of A. royreba. Polyacrylamide gradient gel electrophoresis appears to be a powerful technique for the study of isoenzymes and antigens of Acanthamoeba.
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Affiliation(s)
- H Moura
- Parasitic Diseases Branch, Centers for Disease Control, Atlanta, Georgia 30333
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Visvesvara GS, Martinez AJ, Schuster FL, Leitch GJ, Wallace SV, Sawyer TK, Anderson M. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol 1990; 28:2750-6. [PMID: 2280005 PMCID: PMC268267 DOI: 10.1128/jcm.28.12.2750-2756.1990] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Amebae belonging to the order Leptomyxida are regarded as innocuous soil organisms incapable of infecting mammals. We report here the isolation of a leptomyxid ameba from the brain of a pregnant baboon (Papio sphinx) that died of meningoencephalitis at the San Diego Zoo Wild Animal Park. By using rabbit anti-leptomyxid serum in the immunofluorescence assay, we have identified the leptomyxid ameba in the brain sections of a number of human encephalitic cases from around the world as well as a few cases of meningoencephalitis in animals in the United States, which suggests that the leptomyxid amebae are potential etiologic agents of fatal meningoencephalitis in humans and animals.
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Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections. THE JOURNAL OF PROTOZOOLOGY 1990; 37:25S-33S. [PMID: 2258827 DOI: 10.1111/j.1550-7408.1990.tb01142.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Small free-living amebas belonging to the genera Acanthamoeba and Naegleria occur world-wide. They have been isolated from a variety of habitats including fresh water, thermal discharges of power plants, soil, sewage and also from the nose and throats of patients with respiratory illness as well as healthy persons. Although the true incidence of human infections with these amebas is not known, it is believed that as many as 200 cases of central nervous system infections due to these amebas have occurred worldwide. A majority (144) of these cases have been due to Naegleria fowleri which causes an acute, fulminating disease, primary amebic meningoencephalitis. The remaining 56 cases have been reported as due either to Acanthamoeba or some other free-living ameba which causes a subacute and/or chronic infection called granulomatous amebic encephalitis (GAE). Acanthamoeba, in addition to causing GAE, also causes nonfatal, but nevertheless painful, vision-threatening infections of the human cornea, Acanthamoeba keratitis. Infections due to Acanthamoeba have also been reported in a variety of animals. These observations, together with the fact that Acanthamoeba spp., Naegleria fowleri, and Hartmannella sp. can harbor pathogenic microorganisms such as Legionella and or mycobacteria indicate the public health importance of these amebas.
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Affiliation(s)
- G S Visvesvara
- Division of Parasitic Diseases, Centers for Disease Control, U.S. Department of Health and Human Services, Atlanta, Georgia 30333
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 17-1988. A 40-year-old man with a cerebral mass one month after severe pain in the region of an upper tooth. N Engl J Med 1988; 318:1116-22. [PMID: 3352711 DOI: 10.1056/nejm198804283181707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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30
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Abstract
A 55-year-old diabetic aboriginal woman presented with a two-week history of fever, altered mental state and convulsions. On the basis of computed tomographic scanning a diagnosis of cerebral abscess was made. The pus that was drained produced no bacterial growth but, on microscopy, amoebic cysts were observed. Special cultures produced a growth of Acanthamoeba. The patient appeared to respond to drainage of the abscess and antiprotozoal therapy. Unfortunately, she developed necrotizing enteritis which led ultimately to her death. Antibiotic sensitivity and pathogenicity testing suggest that the Acanthamoeba were unusually virulent. The problems of diagnosis and management are discussed.
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Affiliation(s)
- C R Harwood
- State Health Laboratory Services, Queen Elizabeth II Medical Centre, Nedlands, WA
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