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

Anson Chan Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia;

Search for other papers by Anson Chan in
Current site
Google Scholar
PubMed
Close
,
Simon Smith Department of Infectious Diseases, Cairns Base Hospital, Cairns, Queensland, Australia;

Search for other papers by Simon Smith in
Current site
Google Scholar
PubMed
Close
,
Edwin Tan Department of Anatomical Pathology, Townsville University Hospital, Douglas, Townsville, Queensland, Australia

Search for other papers by Edwin Tan in
Current site
Google Scholar
PubMed
Close
, and
Sarin Kuruvath Department of Neurosurgery, Townsville University Hospital, Douglas, Townsville, Queensland, Australia;

Search for other papers by Sarin Kuruvath in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

  • 1.

    Fowler M, Carter RF , 1965. Acute pyogenic meningitis probably due to Acanthamoeba sp.: a preliminary report. BMJ 2: 740–742.

  • 2.

    Reddy R, Vijayasaradhi M, Uppin MS, Challa S, Jabeen A, Borghain R , 2011. Acanthamoeba meningoencephalitis in an immunocompetent patient: an autopsy case report. Neuropathology 31: 183–187.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ofori-Kwakye SK, Sidebottom D, Herbert J, Fischer EG, Visvesvara GS , 1986. Granulomatous brain tumor caused by Acanthamoeba. J Neurosurg 64: 505–509.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Harwood CR, Rich GE, McAleer R, Cherian G , 1988. Isolation of Acanthamoeba from a cerebral abscess. Med J Aust 148: 47–49.

  • 5.

    Seijo Martinez M, Gonzalez-Mediero G, Santiago P, Rodriguez De Lope A, Diz J, Conde C, Visvesvara GS , 2000. Granulomatous amebic encephalitis in a patient with AIDS: isolation of Acanthamoeba sp. group II from brain tissue and successful treatment with sulfadiazine and fluconazole. J Clin Microbiol 38: 3892–3895.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Velho V, Sharma G, Palande D , 2003. Cerebrospinal acanthamebic granulomas. J Neurosurg 99: 572–574.

  • 7.

    Castellano-Sanchez A, Popp AC, Nolte FS, Visvesvara GS, Thigpen M, Redei I, Somani J , 2003. Acanthamoeba castellani encephalitis following partially mismatched related donor peripheral stem cell transplantation. Transpl Infect Dis 5: 191–194.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    McKellar MS, Mehta LR, Greenlee JE, Hale DC, Booton GC, Kelly DJ, Fuerst PA, Sriram R, Visvesvara GS , 2006. Fatal granulomatous Acanthamoeba encephalitis mimicking a stroke, diagnosed by correlation of results of sequential magnetic resonance imaging, biopsy, in vitro culture, immunofluorescence analysis, and molecular analysis. J Clin Microbiol 44: 4265–4269.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Fung KT, Dhillon AP, McLaughlin JE, Lucas SB, Davidson B, Rolles K, Patch D, Burroughs AK , 2008. Cure of Acanthamoeba cerebral abscess in a liver transplant patient. Liver Transpl 14: 308–312.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Maritschnegg P, Sovinz P, Lackner H, Benesch M, Nebl A, Schwinger W, Walochnik J, Urban C , 2011. Granulomatous amebic encephalitis in a child with acute lymphoblastic leukemia successfully treated with multimodal antimicrobial therapy and hyperbaric oxygen. J Clin Microbiol 49: 446–448.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Pietrucha-Dilanchian P, Chan JC, Castellano-Sanchez A, Hirzel A, Laowansiri P, Tuda C, Visvesvara GS, Qvarnstrom Y, Ratzan KR , 2012. Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection. J Clin Microbiol 50: 1128–1131.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Zamora A, Henderson H, Swiatlo E , 2014. Acanthamoeba encephalitis: a case report and review of therapy. Surg Neurol Int 5: 68.

  • 13.

    Thamtam VK, Uppin MS, Pyal A, Kaul S, Rani JY, Sundaram C , 2016. Fatal granulomatous amoebic encephalitis caused by Acanthamoeba in a newly diagnosed patient with systemic lupus erythematosus. Neurol India 64: 101–104.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wara-Asawapati S, Intapan PM, Chotmongkol V , 2017. Acanthamoeba brain abscess confirmed by molecular identification. Am J Trop Med Hyg 97: 307–308.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Nampoothiri RV et al.2018. An unusual cause of central nervous system infection during acute myeloid leukemia induction chemotherapy: Acanthamoeba brain abscess. Indian J Hematol Blood Transfus 34: 153–155.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Yang S, 1981. Brain abscess: a review of 400 cases. J Neurosurg 55: 794–799.

  • 17.

    Cope JR, 2013. Investigational Drug Available Directly from CDC for the Treatment of Infections with Free-Living Amebae. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6233a4.htm. Accessed October 19, 2020.

    • PubMed
    • Export Citation
  • 18.

    D’Auria A et al., 2012. Cutaneous acanthamoebiasis with CNS involvement post-transplantation: implication for differential diagnosis of skin lesions in immunocompromised patients. J Parasitol 3: 1–7.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Zhang Z et al.2016. Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period. Acta Neurochir (Wien) 158: 733–739.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Carpenter J, Stapleton S, Holliman R, 2007. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis 26: 1–11.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Manzar N, Manzar B, Kumar R, Bari ME , 2011. The study of etiologic and demographic characteristics of intracranial brain abscess: a consecutive case series study from Pakistan. World Neurosurg 76: 195–200.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 15640 452 44
Full Text Views 290 142 0
PDF Downloads 159 15 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save