Skip to main content
SpringerLink
Log in

Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela

  • Case Report
  • Published:
Acta Neuropathologica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Anzil AP, Rao C, Wrzolek MA, Visvesvara GS, Sher JH, Kozlowski PB (1991) Amebic meningoencephalitis in a patient with AIDS caused by a newly recognized opportunistic pathogen. Arch Pathol Lab Med 115: 21–25

    Google Scholar 

  2. Carter RF, Cullity GJ, Ojeda VJ, Silberstein P, Willaert E (1981) A fatal case of meningoencephalitis due to a free-living amoeba of uncertain indentity probably Acanthamoeba sp. Pathology 13: 51–68

    Google Scholar 

  3. Chimelli L, Hahn MD, Scaravilli F, Wallace S, Visvesvara GS (1992) Granulomatous amoebic encephalitis due to leptomyxid amoebae: report of the first Brazilian case. Trans R Soc Trop Med Hyg 86: 635

    Google Scholar 

  4. DiGregorio C, Rivasi F, Monigardo M, DeRienzo B, Wallace S, Visvesvara GS (1992) Acanthamoeba meningoencephalitis in a patient with acquired immunodeficiency syndrome: first report from Europe. Arch Pathol Lab Med 116: 1363–1365

    Google Scholar 

  5. Ferrante A (1991) Free-living amoeba: pathogenicity and immunity. Parasite Immunol 13: 31–47

    Google Scholar 

  6. Friedland LR, Raphael SA, Deutsch ES, Johal J, Martyn LJ, Visvesvara GS, Lischner HW (1992) Disseminated Acanthamoeba infection in a child with symptomatic human immunodeficiency virus infection. Pediatr Infect Dis J 11: 404–407

    Google Scholar 

  7. Gardner HAR, Martínez AJ, Visvesvara GS, Sotrel A (1991) Granulomatous amebic encephalitis in an AIDS patient. Neurology 41: 1993–1995

    Google Scholar 

  8. González MM, Gould E, Dickinson G, Martínez AJ, Visvesvara GS, Cleary TJ, Hensley GT (1986) Acquired immunodeficiency syndrome associated with Acanthamoeba infection and other opportunistic organisms. Arch Pathol Lab Med 110: 749–751

    Google Scholar 

  9. González-Alfonzo JE, Martínez AJ, García V, García-Tamayo J, Céspedes G (1991) Granulomatous encephalitis due to a Leptomyxid amoeba. Trans R Soc Trop Med Hyg 85: 480

    Google Scholar 

  10. Gordon SM, Steinberg JP, DuPuis M, Kozarsky PE, Nickerson JF, Visvesvara GS (1992) Culture isolation of Acanthamoeba spp. and leptomyxid amebas from patients with amebic meningoencephalitis including two patients with AIDS. Clin Infect Dis 15: 1024–1030

    Google Scholar 

  11. Jaramillo-Rodríguez Y, Chavez-Macías LG, Olvera-Rabiela JE, Martínez AJ (1989) Encefalitis por una nueva Amiba de Vida Libre, probablemente Leptomyxid. Patología (Mexico) 27: 137–141

    Google Scholar 

  12. John DT (1986) Primary amebic meningoencephalitis and the biology of Naegleria fowleri. Annu Rev Microbiol 36: 101–123

    Google Scholar 

  13. Jones DB (1986) Acanthamoeba the ultimate opportunist? Am J Ophthalmol 102: 527–530

    Google Scholar 

  14. Lares-Villa F, DeJonckheere JF, DeMoura H, Rechi-Iruretagoyena A, Ferreira-Guerrero E, Fernández-Quintanilla G, Ruiz-Mateo C, Visvesvara GS (1993) Five case of primary amebic meningoencephalitis in Mexicali, Mexico: study of isolates. J Clin Microbiol 31: 685–688

    Google Scholar 

  15. Lombardo L, Alonso P, Sáenz Arroyo L, Brandt H, Mateos JH (1964) Cerebral Amebiasis: report of 17 cases. J Neurosurg 21: 704–709

    Google Scholar 

  16. Ma P, Visvesvara GS, Martínez AJ, Theodore F, Daggett PM, Sawyer TK (1990) Naegleria and Acanthamoeba infections: review. Rev Infect Dis 12: 490–513

    Google Scholar 

  17. Martínez AJ (1980) Is Acanthamoeba encephalitis an opportunistic infection? Neurology 30: 567–574

    Google Scholar 

  18. Martínez AJ (1982) Acanthamoebiasis and immunosuppression. Case report. J Neuropathol Exp Neurol 41: 548–557

    Google Scholar 

  19. Martínez AJ (1985) Free-living amebas: natural history, prevention, diagnosis, pathology and treatment of disease. CRC Press, Boca Raton, pp 1–156

    Google Scholar 

  20. Martínez AJ, Janitschke K (1985) Acanthamoeba, an opportunistic microorganism. A review. Infection 13: 251–256

    Google Scholar 

  21. Martínez AJ, García CA, Halks-Miller M, Arce-Vela R (1980) Granulomatous amebic encephalitis presenting as a cerebral mass lesion. Acta Neuropathol (Berl) 55: 85–91

    Google Scholar 

  22. Matson DO, Rovah E, Rita TL, Armstrong D, Park L, Bakes CJ (1988) Acanthamoeba meningoencephalitis masquerading as neurocysticercosis. Pediatr Infect Dis 7: 121–124

    Google Scholar 

  23. Ofori-Kwakye SK, Sidebottom DG, Herbert J, Fisher EG, Visvesvara GS (1986) Granulomatous brain tumor caused by Acanthamoeba. Case Report. J Neurosurg 64: 505–509

    Google Scholar 

  24. Seidel JS, Harmatz P, Visvesvara GS, Cohen A, Edwards J, Turner J (1982) Successful treatment of primary amebic meningoencephalitis. N Engl J Med 306: 346–348

    Google Scholar 

  25. Taratuto AL, Monges J, Acefe JC, Meli F, Paredes A, Martínez AJ (1991) Leptomyxid amoeba encephalitis: report of the first case in Argentina. Trans R Soc Trop Med Hyg 85: 77

    Google Scholar 

  26. Valenzuela G, López-Corella E, DeJonckheere JF (1984) Primary amoebic meningoencephalitis in a young male from Northwestern Mexico. Trans R Soc Trop Med Hyg 78: 558–559

    Google Scholar 

  27. Visvesvara GS, Stehr-Green JK (1990) Epidemiology of free-living ameba infections. J Protozool 37: 255–335

    Google Scholar 

  28. Visvesvara GS, Martínez AJ, Schuster FL, Leitch GJ, Wallace SV, Sawyer TK, Anderson M (1990) Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol 28: 2750–2756

    Google Scholar 

  29. Visvesvara GS, Schuster FL, Martínez AJ (1993) Balamuthia mandrillaris, N.G., N.Sp, agent of amebic meningoencephalitis in humans and other animals. J Eukaryotic Microbiol 40: 504–514

    Google Scholar 

  30. Wiley CA, Safrin RE, Davis CE, Lampert PW, Braude AI, Martínez AJ, Visvesvara GS (1987) Acanthamoeba meningoencephalitis in a patient with AIDS. J Infect Dis 155: 130–133

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Division of Neuropathology, University of Pittsburgh School of Medicine, Presbyterian University Hospital, Pittsburgh, PA, USA

    Augusto Julio Martínez

  2. Institute für Neuropathologie, Freie Universität Berlin, Hindenburgdamm 30, D-12200, Berlin, Germany

    Augusto Julio Martínez

  3. Instituto Anatomopatologico, Universidad Central de Venezuela, Caracas, Venezuela

    Ana Elia Guerra, Jorge García-Tamayo, Ghislaíne Céspedes & Jusús E. González-Alfonzo

  4. Division of Parasitic Diseases, Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, GA, USA

    Govinda S. Visvesvara

Authors
  1. Augusto Julio Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Elia Guerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jorge García-Tamayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ghislaíne Céspedes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jusús E. González-Alfonzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Govinda S. Visvesvara
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by the Pathology Education and Research Foundation (PERF) of the Department of Pathology, University of Pittsburgh

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martínez, A.J., Guerra, A.E., García-Tamayo, J. et al. Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela. Acta Neuropathol 87, 430–434 (1994). https://doi.org/10.1007/BF00313614

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00313614

Key words

Search

Navigation