Advertisement

Free-Living Amoebae in Southeast Asia

  • Init IthoiEmail author
  • Arine F. Ahmad
Chapter

Abstract

In Southeast Asia (SEA), human infections caused by free-living amoebae (FLA) such as species of Acanthamoeba, Naegleria, Balamuthia, Vahlkampfia and Hartmannella were occasionally reported. To date, human cases or research work on these FLA have only been detected or performed in five countries which were Thailand, Malaysia, Singapore, Vietnam and the Philippines. Acanthamoeba keratitis (AK) has been increasingly recognised and diagnosed, along with the spread of contact lens use, and most cases were reported from Thailand, Malaysia and Singapore. As for granulomatous amoebic encephalitis (GAE) and Balamuthia amoebic encephalitis (BAE) cases, the only available reports were from Thailand. At least 11 GAE cases (8 were fatal and 3 were cured) have been reported sporadically since the first highlighted case in 1992. While for BAE, only a single fatal case was reported in a 23-year-old healthy male after falling into a swamp during a motorbike accident in 2004. For primary amoebic meningoencephalitis (PAM), an acute fulminant necrotising meningoencephalitis caused by Naegleria fowleri has only been reported in two countries; 12 (10 were fatal and 2 were cured) and 2 fatal cases were from Thailand and Vietnam, respectively. Almost all of the individuals with PAM cases had a history of water-related activities including swimming in canals, rivers, community pools and exposure to contaminated water during a traditional Thailand festival called ‘Songkran’, where people splash water at each other. All of the lethal PAM cases reported in SEA were misdiagnosed as microbial meningitis due to the inability to detect the amoebic trophozoite in the CSF. In cases where amoebae were detected early, a good treatment outcome was achieved and three GAE and two PAM cases in Thailand were cured. The delay in the diagnosis of AK cases may result in severe visual outcomes and require surgical treatment. Finally, the absence of reports or cases from other countries in SEA region does not imply that there were absolutely no human infections. In fact, there might be cases which were undiagnosed, misdiagnosed or overlooked. As most of the FLA diseases have a rapid progression and may also cause death, awareness of the diseases by clinician and laboratory personnel together with the availability of suitable diagnostic tools are crucial in successful treatments of infected individuals. In addition, FLA ecological studies should be regularly performed in order to understand their geographical distribution, environment niche and risk to humans.

Keywords

Southeast Asian Country Contact Lens Wearer Human Brain Microvascular Endothelial Cell Acanthamoeba Keratitis Bullous Keratopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    F.L. Schuster, G.S. Visvesvara, Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals. Int. J. Parasitol. 34, 1001–1027 (2004)PubMedCrossRefGoogle Scholar
  2. 2.
    D. Aitken et al., Amebic keratitis in a wearer of disposable contact lenses due to a mixed Vahlkampfia and Hartmannella infection. Ophthalmology 103, 485–494 (1996)PubMedCrossRefGoogle Scholar
  3. 3.
    G.S. Visvesvara et al., Balamuthia mandrillaris, N. G., N. Sp., agent of amebic meningoencephalitis in humans and other animals. J. Eukaryot. Microbiol. 40, 504–514 (1993)PubMedCrossRefGoogle Scholar
  4. 4.
    J.F. De Jonckheere et al., The amoeba-to-flagellate transformation test is not reliable for the diagnosis of the genus Naegleria. Description of three new Naegleria spp. Protist 152, 115–121 (2001)PubMedCrossRefGoogle Scholar
  5. 5.
    I. Ithoi et al., Morphological characteristics of developmental stages of Acanthamoeba and Naegleria species before and after staining by various techniques. Southeast Asian J. Trop. Med. Public Health 42, 1327–1338 (2011)PubMedGoogle Scholar
  6. 6.
    A.F. Kiderlen, U. Laube, Balamuthia mandrillaris, an opportunistic agent of granulomatous amebic encephalitis, infects the brain via the olfactory nerve pathway. Parasitol. Res. 94, 49–52 (2004)PubMedCrossRefGoogle Scholar
  7. 7.
    F.L. Schuster, G.S. Visvesvara, Opportunistic amoebae: challenges in prophylaxis and treatment. Drug Resist. Updat. 7, 41–51 (2004)PubMedCrossRefGoogle Scholar
  8. 8.
    X. Sun et al., Acanthamoeba keratitis: clinical characteristics and management. Ophthalmology 113, 412–416 (2006)PubMedCrossRefGoogle Scholar
  9. 9.
    J.D. Auran et al., Acanthamoeba keratitis. A review of the literature. Cornea 6, 2–26 (1987)PubMedCrossRefGoogle Scholar
  10. 10.
    E.W. Chynn et al., Acanthamoeba keratitis. Contact lens and noncontact lens characteristics. Ophthalmology 102, 1369–1373 (1995)PubMedCrossRefGoogle Scholar
  11. 11.
    S.C. Parija et al., Acanthamoeba keratitis in Pondicherry. J. Commun. Dis. 33, 126–129 (2001)PubMedGoogle Scholar
  12. 12.
    S. Sharma et al., Patient characteristics, diagnosis, and treatment of non-contact lens related Acanthamoeba keratitis. Br. J. Ophthalmol. 84, 1103–1108 (2000)PubMedCrossRefGoogle Scholar
  13. 13.
    A.G. Kamel, A. Norazah, First case of Acanthamoeba keratitis in Malaysia. Trans. R. Soc. Trop. Med. Hyg. 89, 652 (1995)PubMedCrossRefGoogle Scholar
  14. 14.
    Y.M. Por et al., Acanthamoeba keratitis associated with contact lens wear in Singapore. Am. J. Ophthalmol. 148(7–12), e2 (2009)PubMedGoogle Scholar
  15. 15.
    M. Mowrey-Mckee, M. George, Contact lens solution efficacy against Acanthamoeba castellanii. Eye Contact Lens 33, 211–215 (2007)PubMedCrossRefGoogle Scholar
  16. 16.
    D. Wanachiwanawin et al., Clinical features of Acanthamoeba keratitis in contact lens wearers and non-wearers. Southeast Asian J. Trop. Med. Public Health 43, 549–556 (2012)PubMedGoogle Scholar
  17. 17.
    P. Jariya et al., Acanthamoeba spp: a cause of chronic granulomatous amoebic encephalitis. Siriraj Hosp. Gaz. 44, 148–153 (1992)Google Scholar
  18. 18.
    A. Arayawichainon et al., Granulomatous amebic encephalitis: report of two patients with neuroimaging finding. Asian J. Radiol. 5, 83–89 (2000)Google Scholar
  19. 19.
    S. Nidanandana, S. Leelayoova, Report of three patients of Acanthamoeba meningoencephalitis and literature review. R. Thai. Army Med. J. 51, 235–239 (1998)Google Scholar
  20. 20.
    T. Sangruchi et al., Spontaneous granulomatous amebic encephalitis: report of four cases from Thailand. Southeast Asian J. Trop. Med. Public Health 25, 309–313 (1994)PubMedGoogle Scholar
  21. 21.
    M. Scaglia, [Human pathology caused by free-living amoebae]. Ann. Ist. Super. Sanita 33, 551–566 (1997)PubMedGoogle Scholar
  22. 22.
    V. Wiwanitkit, A story on emerging and endemic neurological infection in Thailand, In: V. Wiwanitkit (ed) Update in Infection Diseases. Bentham, Bentham Science Publishers Ltd. [Online] (2009), http://www.benthamscience.com/ebooks/Sample/9781608050055-Sample.pdf
  23. 23.
    N. Anisah et al., Isolation of Acanthamoeba sp. from conjunctival sac of healthy individuals using swab. Trop. Biomed. 22, 11–14 (2005)PubMedGoogle Scholar
  24. 24.
    L.L. Chan et al., Isolation and characterization of Acanthamoeba spp. from air-conditioners in Kuala Lumpur, Malaysia. Acta Trop. 117, 23–30 (2011)PubMedCrossRefGoogle Scholar
  25. 25.
    I. Init et al., Detection of free living amoebae, Acanthamoeba and Naegleria, in swimming pools, Malaysia. Trop. Biomed. 27, 566–577 (2010)PubMedGoogle Scholar
  26. 26.
    I. Ithoi et al., Acanthamoeba genotype T4 detected in naturally-infected feline corneas found to be in homology with those causing human keratitis. Trop. Biomed. 30, 131–140 (2013)PubMedGoogle Scholar
  27. 27.
    A. Lekkla et al., Free-living ameba contamination in natural hot springs in Thailand. Southeast Asian J. Trop. Med. Public Health 36(Suppl 4), 5–9 (2005)PubMedGoogle Scholar
  28. 28.
    D. Nacapunchai et al., Isolation of free-living amebae from soil and water resources in Thailand. J. Trop. Med. Parasitol. 22, 22–26 (1999)Google Scholar
  29. 29.
    W.L. Rivera, D.E.V. Adao, 18S ribosomal DNA genotypes of Acanthamoeba species isolated from contact lens cases in the Philippines. Parasitol. Res. 105, 1119–1124 (2009)PubMedCrossRefGoogle Scholar
  30. 30.
    Y. Sukthana et al., Spa, springs and safety. Southeast Asian J. Trop. Med. Public Health 36(Suppl 4), 10–16 (2005)PubMedGoogle Scholar
  31. 31.
    A. Wannasan et al., Occurrence of thermotolerant Naegleria and Acanthamoeba in some natural water sources in Chiang Mai. Chiang Mai Med. J. 48, 117–124 (2009)Google Scholar
  32. 32.
    J.M. Schroeder et al., Use of subgenic 18S ribosomal DNA PCR and sequencing for genus and genotype identification of Acanthamoebae from humans with keratitis and from sewage sludge. J. Clin. Microbiol. 39, 1903–1911 (2001)PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    G.C. Booton et al., Identification and distribution of Acanthamoeba species genotypes associated with nonkeratitis infections. J. Clin. Microbiol. 43, 1689–1693 (2005)PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    W.L. Rivera, D.E.V. Adao, Identification of the 18S-ribosomal-DNA genotypes of Acanthamoeba isolates from the Philippines. Ann. Trop. Med. Parasitol. 102, 671–677 (2008)PubMedCrossRefGoogle Scholar
  35. 35.
    W. Nuprasert et al., Identification of a novel T17 genotype of Acanthamoeba from environmental isolates and T10 genotype causing keratitis in Thailand. J. Clin. Microbiol. 48, 4636–4640 (2010)PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    G. Greub et al., Amoebae-resisting bacteria isolated from human nasal swabs by amoebal coculture. Emerg. Infect. Dis. 10, 470–477 (2004)PubMedCrossRefGoogle Scholar
  37. 37.
    A.F. Ahmad, Molecular study of free-living amoebae and the detection of their extra-cellular bacteria symbionts. Master in Medical Sciences Research, University Malaya, 2007Google Scholar
  38. 38.
    K. Yagita et al., Acanthamoeba sp. from the Philippines: electron microscopy studies on naturally occurring bacterial symbionts. Parasitol. Res. 81, 98–102 (1995)PubMedCrossRefGoogle Scholar
  39. 39.
    P. Jariya et al., Primary amoebic meningoencephalitis: a first reported case in Thailand. Southeast Asian J. Trop. Med. Public Health 14, 525–527 (1983)PubMedGoogle Scholar
  40. 40.
    K. Charoenlarp et al., Primary amoebic meningoencephalitis: a second reported case in Thailand. J. Med. Assoc. Thai. 71, 581–586 (1988)PubMedGoogle Scholar
  41. 41.
    S. Sirinavin et al., Primary amoebic meningoencephalitis in Thailand: report of a case and review literatures. J. Med. Assoc. Thai. 72(Suppl 1), 174–176 (1989)PubMedGoogle Scholar
  42. 42.
    V. Wiwanitkit, Review of clinical presentations in Thai patients with primary amoebic meningoencephalitis. MedGenMed 6, 2 (2004)PubMedCentralPubMedGoogle Scholar
  43. 43.
    V. Chotmongkol et al., Eosinophilic cerebrospinal fluid pleocytosis and primary amebic meningoencephalitis. Southeast Asian J. Trop. Med. Public Health 24, 399–401 (1993)PubMedGoogle Scholar
  44. 44.
    N. Poungvarin, P. Jariya, The fifth nonlethal case of primary amoebic meningoencephalitis. J. Med. Assoc. Thai. 74, 112–115 (1991)PubMedGoogle Scholar
  45. 45.
    R. Herriman, Vietnam reports second ever ‘brain-eating amoeba’ death [Online] (2012), http://www.examiner.com/article/vietnam-reports-second-ever-brain-eating-amoeba-death. Accessed 10/11/2012
  46. 46.
    Thanh-Nien-News, Vietnam’s 2nd case of deadly brain-eating amoeba still puzzling [Online] (2012), http://www.thanhniennews.com/index/pages/20121025-vietnam-2nd-case-of-deadly-brain-eating-amoeba-still-puzzling.aspx. Accessed 10/11/2012
  47. 47.
    D. Nacapunchai et al., A brief survey of free-living amebae in Thailand and Hamamatsu District, Japan. Southeast Asian J. Trop. Med. Public Health 32(Suppl 2), 179–182 (2001)PubMedGoogle Scholar
  48. 48.
    S. Tiewcharoen, V. Junnu, Distribution of pathogenic Naegleria spp in Thailand. Southeast Asian J. Trop. Med. Public Health 32(Suppl 2), 172–178 (2001)PubMedGoogle Scholar
  49. 49.
    I. Ithoi et al., Detection of Naegleria species in environmental samples from Peninsular Malaysia. PLoS One 6, e24327 (2011)PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    J.F. De Jonckheere, A century of research on the amoeboflagellate genus Naegleria. Acta Protozool. 41, 309–342 (2002)Google Scholar
  51. 51.
    P. Intalapaporn et al., Balamuthia mandrillaris meningoencephalitis: the first case in southeast Asia. Am. J. Trop. Med. Hyg. 70, 666–669 (2004)PubMedGoogle Scholar
  52. 52.
    D.T. John, M.J. Howard, Virulence of Naegleria fowleri affected by axenic cultivation and passage in mice. Folia Parasitol. (Praha) 40, 187–191 (1993)Google Scholar
  53. 53.
    P.E. Cogo et al., Fatal Naegleria fowleri meningoencephalitis, Italy. Emerg. Infect. Dis. 10, 1835–1837 (2004)PubMedCrossRefGoogle Scholar
  54. 54.
    T. Hara, T. Fukuma, Diagnosis of the primary amoebic meningoencephalitis due to Naegleria fowleri. Parasitol. Int. 54, 219–221 (2005)PubMedCrossRefGoogle Scholar
  55. 55.
    F.L. Reveiller et al., An enzyme-linked immunosorbent assay (ELISA) for the identification of Naegleria fowleri in environmental water samples. J. Eukaryot. Microbiol. 50, 109–113 (2003)PubMedCrossRefGoogle Scholar
  56. 56.
    J.F. De Jonckheere, Sequence Variation in the Ribosomal Internal Transcribed Spacers, Including the 5.8S rDNA, of Naegleria spp. Protist 149, 221–228 (1998)PubMedCrossRefGoogle Scholar
  57. 57.
    M. Pelandakis et al., Analysis of the 5.8S rRNA gene and the internal transcribed spacers in Naegleria spp. and in N. fowleri. J. Eukaryot. Microbiol. 47, 116–121 (2000)PubMedCrossRefGoogle Scholar
  58. 58.
    Y. Qvarnstrom et al., Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. J. Clin. Microbiol. 44, 3589–3595 (2006)PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    G.S. Visvesvara et al., Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J. Clin. Microbiol. 28, 2750–2756 (1990)PubMedCentralPubMedGoogle Scholar
  60. 60.
    F.L. Schuster et al., Detection of antibodies against free-living amoebae Balamuthia mandrillaris and Acanthamoeba species in a population of patients with encephalitis. Clin. Infect. Dis. 42, 1260–1265 (2006)PubMedCrossRefGoogle Scholar
  61. 61.
    F.L. Schuster et al., Balamuthia mandrillaris, agent of amebic encephalitis: detection of serum antibodies and antigenic similarity of isolates by enzyme immunoassay. J. Eukaryot. Microbiol. 55, 313–320 (2008)PubMedCrossRefGoogle Scholar
  62. 62.
    G.C. Booton et al., Balamuthia mandrillaris: identification of clinical and environmental isolates using genus-specific PCR. J. Eukaryot. Microbiol. 50(Suppl), 508–509 (2003)PubMedCrossRefGoogle Scholar
  63. 63.
    G.C. Booton et al., Genotyping of Balamuthia mandrillaris based on nuclear 18S and mitochondrial 16S rRNA genes. Am. J. Trop. Med. Hyg. 68, 65–69 (2003)PubMedGoogle Scholar
  64. 64.
    G.C. Booton et al., Identification of Balamuthia mandrillaris by PCR assay using the mitochondrial 16S rRNA gene as a target. J. Clin. Microbiol. 41, 453–455 (2003)PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    F.L. Schuster, Cultivation of pathogenic and opportunistic free-living amebas. Clin. Microbiol. Rev. 15, 342–354 (2002)PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    A. Matin et al., Evaluation of prokaryotic and eukaryotic cells as food source for Balamuthia mandrillaris. Arch. Microbiol. 186, 261–271 (2006)PubMedCrossRefGoogle Scholar
  67. 67.
    S. Jayasekera et al., Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis, using human brain microvascular endothelial cells. J. Med. Microbiol. 53, 1007–1012 (2004)PubMedCrossRefGoogle Scholar
  68. 68.
    T.H. Dunnebacke et al., Balamuthia mandrillaris from soil samples. Microbiology 150, 2837–2842 (2004)PubMedCrossRefGoogle Scholar
  69. 69.
    F. Marciano-Cabral, G. Cabral, Acanthamoeba spp. as agents of disease in humans. Clin. Microbiol. Rev. 16, 273–307 (2003)PubMedCentralPubMedCrossRefGoogle Scholar
  70. 70.
    B. Da Rocha-Azevedo et al., Diagnosis of infections caused by pathogenic free-living amoebae. Interdiscip. Perspect. Infect. Dis. 2009, 251406 (2009)PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Department of Parasitology, Faculty of MedicineUniversity of MalayaKuala LumpurMalaysia

Personalised recommendations