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Meningoencephalitis Due to Free-Living Amoebas in the Tropics

  • CNS Infections in Tropical Settings (C Franco-Paredes, Section Editor)
  • Published:
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Abstract

Purpose of Review

To asses recent advances in our understanding of the epidemiology, clinical presentation, diagnosis, and treatment of infections caused by free-living amoebas

Recent Findings

The burden of disease by free-living amoebas is underestimated; global warming could increase incidence in future years. Early recognition of clinical syndromes may allow for prompt initiation of therapy and better disease outcome. Molecular tests allow for rapid identification of the amoeba. Treatment is based on successful clinical outcomes reported using repurposed drugs. The optimal regimen for each of the clinical syndromes is unknown.

Summary

As global warming increases, clinicians will be challenged to diagnose and treat infections by free-living amoebas. Therefore, awareness of clinical syndromes, diagnostic tools, and therapeutic interventions is crucial.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Zhang H, Cheng X. Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease. Front Med. 2021;15(6):842–66. https://doi.org/10.1007/s11684-021-0865-2. Excellent review of the topic.

    Article  PubMed  Google Scholar 

  2. Angelici MC, Walochnik J, Calderaro A, Saxinger L, Dacks JB. Free-living amoebae and other neglected protistan pathogens: health emergency signals? Eur J Protistol. 2021;77:125760. https://doi.org/10.1016/j.ejop.2020.125760.

    Article  PubMed  Google Scholar 

  3. Maciver SK, Piñero JE, Lorenzo-Morales J. Is Naegleria fowleri an emerging parasite? Trends Parasitol. 2020;36(1):19–28. https://doi.org/10.1016/j.pt.2019.10.00. Comparison of the epidemiological pattern of PAM between the USA and the Indian sub-continent.

    Article  PubMed  Google Scholar 

  4. Ong TYY, Khan NA, Siddiqui R. Brain-eating amoebae: predilection sites in the brain and disease outcome. J Clin Microbiol. 2017 Jul;55(7):1989–97. https://doi.org/10.1128/JCM.02300-16.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gharpure R, Gleason M, Salah Z, Blackstock AJ, Hess-Homeier D, Yoder JS, et al. Geographic range of recreational water–associated primary amebic meningoencephalitis, United States, 1978–2018. Emerg Infect Dis. 2021;27(1):271–4. https://doi.org/10.3201/eid2701.202119. Excellent review of the epidemiological pattern of PAM in the USA.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010 Jul;138(7):968–75. https://doi.org/10.1017/S0950268809991014.

    Article  CAS  PubMed  Google Scholar 

  7. Panda A, Mirdha BR, Rastogi N, Kasuhik S. Understanding the true burden of “Naegleria fowleri” (Vahlkampfiidae) in patients from Northern states of India: Source tracking and significance. Eur J Protistol. 2020 Oct;76:125726. https://doi.org/10.1016/j.ejop.2020.125726.

    Article  PubMed  Google Scholar 

  8. Cooper AM, Aouthmany S, Shah K, Rega PP. Killer amoebas: primary amoebic meningoencephalitis in a changing climate. JAAPA. 2019;32(6):30–5. https://doi.org/10.1097/01.JAA.0000558238.99250.4a.

    Article  PubMed  Google Scholar 

  9. Sazzad HMS, Luby SP, Sejvar J, Rahman M, Gurley ES, Hill V, et al. A case of primary amebic meningoencephalitis caused by Naegleria fowleri in Bangladesh. Parasitol Res. 2020;119(1):339–44. https://doi.org/10.1007/s00436-019-06463-y.

    Article  PubMed  Google Scholar 

  10. Herman EK, Greninger A, van der Giezen M, Ginger ML, Ramirez-Macias I, Miller HC, et al. Genomics and transcriptomics yields a system-level view of the biology of the pathogen Naegleria fowleri. BMC Biol. 2021;19(1):142. https://doi.org/10.1186/s12915-021-01078-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Tillery L, Barrett K, Goldstein J, Lassner JW, Osterhout B, Tran NL, et al. Naegleria fowleri: protein structures to facilitate drug discovery for the deadly, pathogenic free-living amoeba. PLoS One. 2021;16(3):e0241738. https://doi.org/10.1371/journal.pone.0241738.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Moseman EA. Battling brain-eating amoeba: enigmas surrounding immunity to Naegleria fowleri. PLoS Pathog. 2020;16(4):e1008406. https://doi.org/10.1371/journal.ppat.1008406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Matanock A, Mehal JM, Liu L, Blau DM, Cope JR. Estimation of undiagnosed Naegleria fowleri primary amebic meningoencephalitis, United States1. Emerg Infect Dis. 2018 Jan;24(1):162–4. https://doi.org/10.3201/eid2401.170545.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dunn AL, Reed T, Stewart C, Levy RA. Naegleria fowleri that induces primary amoebic meningoencephalitis: rapid diagnosis and rare case of survival in a 12-year-old Caucasian girl. Lab Med. 2016 May;47(2):149–54. https://doi.org/10.1093/labmed/lmw008.

    Article  PubMed  Google Scholar 

  15. Escrig JI, Hahn HJ, Debnath A. Activity of auranofin against multiple genotypes of Naegleria fowleri and its synergistic effect with amphotericin B in vitro. ACS Chem Neurosci. 2020;11(16):2464–71. https://doi.org/10.1021/acschemneuro.0c00165.

    Article  CAS  PubMed  Google Scholar 

  16. Güémez A, García E. Primary amoebic meningoencephalitis by Naegleria fowleri: pathogenesis and treatments. Biomolecules. 2021;11(9):1320. https://doi.org/10.3390/biom11091320.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Rajendran K, Anwar A, Khan NA, Siddiqui R. Brain-eating amoebae: silver nanoparticle conjugation enhanced efficacy of anti-amoebic drugs against Naegleria fowleri. ACS Chem Neurosci 2017 8(12):2626-2630. doi: https://doi.org/10.1021/acschemneuro.7b00430.

  18. Bellini NK, Santos TM, da Silva MTA, Thiemann OH. The therapeutic strategies against Naegleria fowleri. Exp Parasitol. 2018;187:1–11. https://doi.org/10.1016/j.exppara.2018.02.010.

    Article  PubMed  Google Scholar 

  19. Bhosale NK, Parija SC. Balamuthia mandrillaris: an opportunistic, free-living ameba - an updated review. Trop Parasitol. 2021;11(2):78–88. https://doi.org/10.4103/tp.tp_36_21. An excellent review of the topic.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bravo FG. Emerging infections: mimickers of common patterns seen in dermatopathology. Mod Pathol. 2020;33(Suppl 1):118–27. https://doi.org/10.1038/s41379-019-0399-1. Excellent review of clinical and pathological findings of cutaneous balamuthiasis.

    Article  PubMed  Google Scholar 

  21. Alvarez P, Torres-Cabala C, Gotuzzo E, Bravo F. Cutaneous balamuthiasis: a clinicopathological study. JAAD Int. 2022;6:51–8. https://doi.org/10.1016/j.jdin.2021.11.005. Another updated review of clinical and pathological findings of cutaneous balamuthiasis.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wang L, Cheng W, Li B, Jian Z, Qi X, Sun D, Gao J, Lu X, Yang Y, Lin K, Lu C, Chen J, Li C, Wang G, Gao T. Balamuthia mandrillaris infection in China: a retrospective report of 28 cases. Emerg Microbes Infect. 2020;9(1):2348–57. https://doi.org/10.1080/22221751.2020.1835447. Excellent review of epidemiological and clinical findings in China.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Cope JR, Landa J, Nethercut H, Collier SA, Glaser C, Moser M, et al. The epidemiology and clinical features of Balamuthia mandrillaris disease in the United States, 1974-2016. Clin Infect Dis. 2019;68(11):1815–22. https://doi.org/10.1093/cid/ciy813. Excellent review of epidemiological and clinical findings in the USA.

    Article  Google Scholar 

  24. Yang Y, Hu X, Min L, Dong X, Guan Y. Balamuthia mandrillaris-related primary amoebic encephalitis in China diagnosed by next generation sequencing and a review of the literature. Lab Med. 2020;51(2):e20–6. https://doi.org/10.1093/labmed/lmz079.

    Article  PubMed  Google Scholar 

  25. Wu X, Yan G, Han S, Ye Y, Cheng X, Gong H, Yu H. Diagnosing Balamuthia mandrillaris encephalitis via next-generation sequencing in a 13-year-old girl. Emerg Microbes Infect. 2020 Dec;9(1):1379–87. https://doi.org/10.1080/22221751.2020.1775130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kalyatanda G, Rand K, Lindner MS, Hong DK, Sait Albayram M, Gregory J, Kresak J, Ibne KMA, Cope JR, Roy S, Gary JM, Reddy V, Ahmed AA. Rapid, noninvasive diagnosis of Balamuthia mandrillaris encephalitis by a plasma-based next-generation sequencing test. Open Forum Infect Dis Ther. 2020;7(7):ofaa189. https://doi.org/10.1093/ofid/ofaa189. A novel and rapid method to diagnose balamuthiasis.

    Article  CAS  Google Scholar 

  27. Martínez DY, Seas C, Bravo F, Legua P, Ramos C, Cabello AM, Gotuzzo E. Successful treatment of Balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement. Clin Infect Dis. 2010;51(2):e7–11. https://doi.org/10.1086/653609. First report of successful treatment using miltefosine.

    Article  CAS  PubMed  Google Scholar 

  28. Bravo FG, Seas C. Balamuthia mandrillaris amoebic encephalitis: an emerging parasitic infection. Curr Infect Dis Rep. 2012;14(4):391–6. https://doi.org/10.1007/s11908-012-0266-4.

    Article  PubMed  Google Scholar 

  29. Fuerst PA, Booton GC, Crary M. Phylogenetic analysis and the evolution of the 18S rRNA gene typing system of Acanthamoeba. J Eukaryot Microbiol. 2015;62(1):69–84. https://doi.org/10.1111/jeu.12186.

    Article  CAS  PubMed  Google Scholar 

  30. Cirelli C, Mesquita EIS, Chagas IAR, Furst C, Possamai CO, Abrahão JS, Dos Santos Silva LK, Grossi MF, Tagliati CA, Costa AO. Extracellular protease profile of Acanthamoeba after prolonged axenic culture and after interaction with MDCK cells. Parasitol Res. 2020;119(2):659–66. https://doi.org/10.1007/s00436-019-06562-w.

    Article  PubMed  Google Scholar 

  31. Gabriel S, Rasheed AK, Siddiqui R, Appaturi JN, Fen LB, Khan NA. Development of nanoparticle-assisted PCR assay in the rapid detection of brain-eating amoebae. Parasitol Res. 2018;117(6):1801–11. https://doi.org/10.1007/s00436-018-5864-0.

    Article  PubMed  Google Scholar 

  32. Damhorst G, Watts A, Hernandez-Romieu A, Mel N, Palmore M, Ali IKM, et al. Acanthamoeba castellanii encephalitis in a patient with AIDS; a case report and literature review. Lancet Infect Dis. 2002. https://doi.org/10.1016/S1473-3099(20)30933-6.

  33. Alli A, Ortiz JF, Morillo Cox Á, Armas M, Orellana VA. Miltefosine: a miracle drug for meningoencephalitis caused by free-living amoebas. Cureus. 2021;13(3):e13698. https://doi.org/10.7759/cureus.13698.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Taravaud A, Fechtali-Moute Z, Loiseau PM, Pomel S. Drugs used for the treatment of cerebral and disseminated infections caused by free-living amoebae. Clin Transl Sci. 2021;14(3):791–805. https://doi.org/10.1111/cts.12955.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Diehl MLN, Paes J, Rott MB. Genotype distribution of Acanthamoeba in keratitis: a systematic review. Parasitol Res. 2021 Sep;120(9):3051–63. https://doi.org/10.1007/s00436-021-07261-1.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pinna A, Porcu T, Boscia F, Cano A, Erre G, Mattana A. Free-living amoebae keratitis. Cornea. 2017;36(7):785–90. https://doi.org/10.1097/ICO.0000000000001226.

    Article  PubMed  Google Scholar 

  37. Juárez MM, Tártara LI, Cid AG, Real JP, Bermúdez JM, Rajal VB, Palma SD. Acanthamoeba in the eye, can the parasite hide even more? Latest developments on the disease. Cont Lens Anterior Eye. 2018;41(3):245–51. https://doi.org/10.1016/j.clae.2017.12.017. Excellent review of Acanthamoeba keratitis.

    Article  PubMed  Google Scholar 

  38. Winchester K, Mathers WD, Sutphin JE, Daley TE. Diagnosis of Acanthamoeba keratitis in vivo with confocal microscopy. Cornea. 1995;14(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  39. Carrijo-Carvalho LC, San’tana VP, Foronda AS, de Freitas D, de Souza Carvalho FR. Therapeutic agents and biocides for ocular infections by free-living amoebae of Acanthamoeba genus. Surv Ophthalmol. 2017;62(2):203–18. https://doi.org/10.1016/j.survophthal.2016.10.009Excellent review of therapy for Acanthamoeba ocular infections.

    Article  PubMed  Google Scholar 

  40. Galarza C, Ramos W, Gutierrez EL, Ronceros G, Teran M, Uribe M, Navincopa M, Ortega-Loayza AG. Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients. Int J Dermatol. 2009;48(12):1324–9. https://doi.org/10.1111/j.1365-4632.2008.03786.x.

    Article  PubMed  Google Scholar 

  41. Marciano-Cabral F, Cabral G. Acanthamoeba spp. as agents of disease in humans. Clin Microbiol Rev. 2003 Apr;16(2):273–307. https://doi.org/10.1128/CMR.16.2.273-307.2003.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Steinberg JP, Galindo RL, Kraus ES, Ghanem KG. Disseminated acanthamebiasis in a renal transplant recipient with osteomyelitis and cutaneous lesions: case report and literature review. Clin Infect Dis. 2002;35(5):e43–9. https://doi.org/10.1086/341973.

    Article  PubMed  Google Scholar 

  43. Teh JSK, Tam PCK, Badenoch PR, Adamson PJ, Brennan C, Marshman G, Gordon DL. Successful treatment of cutaneous Acanthamoeba castellanii infection with miltefosine in a patient with chronic lymphocytic leukaemia on ibrutinib. J Antimicrob Chemother. 2021. https://doi.org/10.1093/jac/dkab397.

  44. Brondfield MN, Reid MJ, Rutishauser RL, Cope JR, Tang J, Ritter JM, et al. Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: case report and review of the literature. Transpl Infect Dis. 2017;19(2). https://doi.org/10.1111/tid.12661.

  45. Kot K, Łanocha-Arendarczyk N, Kosik-Bogacka D. Immunopathogenicity of Acanthamoeba spp. in the brain and lungs. Int J Mol Sci. 2021;22(3):1261. https://doi.org/10.3390/ijms22031261.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Kot K, Kupnicka P, Witulska O, Czepan A, Łanocha-Arendarczyk NA, Łanocha AA, Kosik-Bogacka DI. Potential biomarkers in diagnosis of renal acanthamoebiasis. Int J Mol Sci. 2021;22(12):6583. https://doi.org/10.3390/ijms22126583.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Carlos Seas.

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Seas, C., Legua, P. Meningoencephalitis Due to Free-Living Amoebas in the Tropics. Curr Trop Med Rep 9, 8–14 (2022). https://doi.org/10.1007/s40475-022-00254-9

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