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Acanthamoeba meningoencephalitis after bone marrow transplantation
P Anderlini1, D Przepiorka, M Luna
1Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston.
Bone Marrow Transplantation
|September 1, 1994
Summary
Disseminated Acanthamoeba infection caused fatal necrotizing meningoencephalitis in two leukemia patients post-marrow transplant. This opportunistic infection highlights a potential new threat in immunocompromised individuals.
Area of Science:
- Immunology
- Infectious Diseases
- Neurology
Background:
- Hematopoietic stem cell transplantation (HSCT) recipients are susceptible to opportunistic infections due to profound immunosuppression.
- Prior sinusitis and corticosteroid use may predispose patients to specific infections post-HSCT.
Observation:
- Two leukemia patients developed fever, pulmonary infiltrates, and neurological decline months after HSCT.
- Clinical presentation included rapid mental deterioration, seizures, and coma, with characteristic cerebrospinal fluid abnormalities.
- CT scans revealed hydrocephalus with cerebral and cerebellar lesions.
Findings:
- Autopsy confirmed disseminated Acanthamoeba infection, causing necrotizing meningoencephalitis, pneumonitis, and dermatitis.
- Acanthamoeba species were identified as the causative agent in these fatal cases.
- Despite broad-spectrum antimicrobial and antifungal therapy, outcomes were uniformly poor.
Implications:
- Disseminated Acanthamoeba infection represents a novel and severe opportunistic infection in HSCT recipients.
- Early recognition and diagnosis are critical, though treatment challenges remain.
- This organism should be considered in the differential diagnosis of opportunistic infections in immunocompromised patients.