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Spontaneous granulomatous amebic encephalitis: report of four cases from Thailand
T Sangruchi1, A J Martinez, G S Visvesvara
1Department of Pathology, Siriraj Hospital Mahidol University, Bangkok, Thailand.
Abstract:
Granulomatous amebic encephalitis (GAE), or meningoencephalitis caused by Acanthamoeba sp and leptomyxid amebae are uncommon CNS infections that usually occur in an immunocompromised host. From 1990 to 1992, 4 patients with GAE were treated at Siriraj Hospital, Bangkok. One case was diagnosed antemortem, from a brain biopsy. The other three cases were diagnosed as GAE postmortem. Pathological findings included acute and subacute granulomatous inflammation with extensive cerebral necrosis, angiitis, fibrinoid necrosis and fibrin thrombi. One patient had a chronic skin ulcer in which free-living amebic trophozoites were found. No visceral involvement was observed. All patients developed "spontaneous" GAE, but we suspect an undiagnosed abnormality in cell mediated immunity or a deficient humoral immune response.
Insights
Granulomatous amebic encephalitis (GAE) is a rare CNS infection. This study details four cases, highlighting pathological findings and suggesting immune deficiencies may predispose individuals to GAE.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Granulomatous amebic encephalitis (GAE) is an uncommon central nervous system infection.
- It is typically observed in immunocompromised individuals.
- Caused by Acanthamoeba and leptomyxid amebae, GAE affects the brain and meninges.
Observation:
- Four cases of GAE were treated at Siriraj Hospital between 1990 and 1992.
- One case was diagnosed antemortem via brain biopsy; three were diagnosed postmortem.
- A skin ulcer with amebic trophozoites was noted in one patient, with no visceral involvement.
Findings:
- Pathological findings included acute and subacute granulomatous inflammation.
- Extensive cerebral necrosis, angiitis, fibrinoid necrosis, and fibrin thrombi were observed.
- All patients presented with "spontaneous" GAE, suggesting an underlying immune issue.
Implications:
- The study suggests potential undiagnosed cell-mediated immunity abnormalities or humoral immune deficiencies.
- Understanding these immune factors is crucial for GAE pathogenesis.
- Further research into immune responses in GAE is warranted.