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Non-granulomatous cerebellar infection by Acanthamoeba spp. in an immunocompetent host

Sara Modica1,2, Clelia Miracco3, Maria Grazia Cusi4,2

  • 1Hospital Department of Specialized and Internal Medicine, Infectious Diseases Unit, University Hospital of Siena, Siena, Italy.

Infection
|October 6, 2018
PubMed

Insights

Acanthamoeba cerebellitis, a rare brain infection, occurred in an immunocompetent patient. Treatment with fluconazole and trimethoprim/sulfamethoxazole led to full recovery.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Acanthamoeba spp. commonly cause keratitis in contact lens wearers.
  • Acanthamoeba infections of the central nervous system are rare, particularly non-granulomatous forms in immunocompetent individuals.
  • Limited clinical data and treatment guidelines exist for Acanthamoeba CNS infections.

Observation:

  • An immunocompetent adult male presented with sudden neurological decline.
  • Magnetic resonance imaging revealed cerebellar infarction, initially suspected as a neoplasm.
  • Histopathology of the cerebellar mass showed necrosis and inflammation with amoebic forms but no granulomas.

Findings:

  • Polymerase chain reaction confirmed Acanthamoeba T4 genotype in cerebellar tissue.
  • The patient experienced gastrointestinal intolerance to miltefosine.
  • A combination therapy of fluconazole and trimethoprim/sulfamethoxazole was administered.

Implications:

  • This case highlights a rare presentation of Acanthamoeba cerebellitis in an immunocompetent host.
  • Successful treatment with fluconazole and trimethoprim/sulfamethoxazole offers an alternative therapeutic option.
  • Further research is needed to establish definitive treatment guidelines for CNS Acanthamoeba infections.
Keywords:
AcanthamoebaEncephalitisFree-living amoebasImmunocompetent host

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