Amebic abscess of the brain

Area of Science:

• Neurology
• Infectious Diseases
• Parasitology

Background:

• Entamoeba histolytica is a protozoan parasite that can cause invasive disease, including amebic liver abscess and, rarely, brain abscess.
• While amebiasis is typically associated with travel to endemic areas, autochthonous cases can occur, highlighting the importance of considering this diagnosis in non-travelers.

Observation:

• Two residents of New Jersey, with no recent travel history outside the eastern United States, presented with brain abscesses.
• Diagnostic methods included direct identification of amebas in abscesses and serological testing (indirect hemagglutination titer).
• Computerized tomography revealed rapidly progressive lesions without adjacent brain reaction.

Findings:

• Case 1 diagnosis was confirmed by identifying amebas in brain and pituitary abscesses.
• Case 2 diagnosis was based on an elevated indirect hemagglutination titer (1:4096) and positive response to metronidazole and chloroquine.
• All seven reported cures for amebic brain abscess involved appropriate chemotherapy, with five also undergoing surgery.

Implications:

• These cases underscore the possibility of amebic brain abscesses in non-travelers within the United States.
• Early diagnosis and effective chemotherapy, such as metronidazole and chloroquine, are vital for patient outcomes.
• The distinct radiological appearance on CT scans aids in differentiating amebic abscesses from other brain lesions.