trimethoprim--sulfamethoxazole-drug-combination and Amebiasis

Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.

Topics: Acanthamoeba; Adult; Amebiasis; Animals; Antimalarials; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Frontal Lobe; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Male; Opportunistic Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Acanthamoeba spp. is a free-living amoeba, frequently involved in keratitis by contact lens in immunocompetent hosts. Anecdotal reports associate Acanthamoeba spp. as a cause of severe granulomatous encephalitis in immunocompromised and, less frequently, in immunocompetent subjects. Data regarding clinical and therapeutic management are scanty and no defined therapeutic guidelines are available. We describe an unusual case of non-granulomatous Acanthamoeba cerebellitis in an immunocompetent adult male, with abrupt onset of neurological impairment, subtle hemorrhagic infarction at magnetic resonance imaging, and initial suspicion of cerebellar neoplasm. Histopathological findings of excised cerebellar mass revealed the presence of necrosis and inflammation with structure resembling amoebic trophozoites, but without granulomas. Polymerase chain reaction from cerebellar tissue was positive for Acanthamoeba T4 genotype. Due to gastrointestinal intolerance to miltefosine, the patient was treated with long-term course of fluconazole and trimethoprim/sulphamethoxazole, obtaining complete clinical and neuroradiological resolution.

Topics: Acanthamoeba; Adult; Amebiasis; Antiprotozoal Agents; Cerebellum; Dominican Republic; Encephalitis; Fluconazole; Humans; Italy; Male; Polymerase Chain Reaction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

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.

Topics: Acanthamoeba; Administration, Oral; Amebiasis; Animals; Anti-Infective Agents; Antifungal Agents; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Ketoconazole; Magnetic Resonance Imaging; Male; Meningitis; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

A patient with AIDS, treated with highly active antiretroviral therapy and trimethoprim-sulfamethoxazole, presented with confusion, a hemifield defect, and a mass lesion in the right occipital lobe. A brain biopsy confirmed granulomatous amebic encephalitis (GAE) due to Acanthamoeba castellanii. The patient was treated with fluconazole and sulfadiazine, and the lesion was surgically excised. This is the first case of AIDS-associated GAE responding favorably to therapy. The existence of a solitary brain lesion, absence of other sites of infection, and intense cellular response in spite of a very low CD4 count conditioned the favorable outcome. We review and discuss the diagnostic microbiologic options for the laboratory diagnosis of infections due to free-living amebae.

Topics: Acanthamoeba; Acquired Immunodeficiency Syndrome; Adult; Amebiasis; Animals; Antibiotic Prophylaxis; Antiretroviral Therapy, Highly Active; Biopsy; Brain; Brain Abscess; Didanosine; Fluconazole; Humans; Male; Saquinavir; Sulfadiazine; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amebiasis; Aminoquinolines; Antiprotozoal Agents; Humans; Malaria; Metronidazole; Pneumonia, Pneumocystis; Pyrimethamine; Quinine; Suramin; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Trypanosomiasis