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Meningoencephalitis due to Acanthamoeba SP. Pathogenesis and clinico-pathological study
Abstract:
Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are infectious diseases essentially confined to the Central Nervous System (CNS) and caused by free-living amebas of the genus Acanthamoeba (A.) and Naegleria (N.) respectively. AM due to A. sp. (Acanthamoeba castellanii and Acanthamoeba culbertsoni) have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, or in immunologically impaired patients without a history of recent swimming in contrast to cases due to N. sp. which usually occurs in healthy, young individuals with a recent history of swimming in man-made lakes or heated swimming pools. AM due to A.sp. is characterized by a subacute or chronic granulomatous meningoencephalitis involving mainly the midbrain, basal areas of the temporal and occipital lobes and posterior fossa structures. CNS lesions in AM are perhaps secondary and the portal of entry in humans is probably from the lower respiratory tract, genitourinary system or skin reaching the CNS by hematogenous spread. The predominant host reaction is usually composed of lymphocytes, plasma cells, monocytes and multinucleated foreign body giant cells. Necrosis is moderate and hemorrhage scant or absent. Cysts as well as trophozoites may be seen within the CNS lesions. PAM is due to Naegleria fowleri and is characterized by an hemorrhagic necrotizing meningoencephalities with an acute inflammatory response. Only trophozoites are found in lesions. The portal of entry is through the olfactory neuroepithelium. CNS tissues fixed in formalin may be used for further identification and taxonomical classification of the causative protoza using immunofluorescent antibody techniques (IFAT) and electron microscopic methods.
Insights
Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are distinct CNS infections caused by Acanthamoeba and Naegleria, respectively. PAM typically affects healthy individuals after swimming, while AM occurs in immunocompromised patients.
Area of Science:
- Neurology
- Infectious Diseases
- Parasitology
Background:
- Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are severe central nervous system infections.
- AM is caused by Acanthamoeba (A. sp.), often in immunocompromised individuals.
- PAM is caused by Naegleria fowleri, typically affecting healthy individuals after swimming.
Purpose of the Study:
- To differentiate the clinical presentations and pathological characteristics of AM and PAM.
- To elucidate the distinct host-pathogen interactions and routes of infection for each disease.
Main Methods:
- Comparative analysis of clinical case reports and neuropathological findings.
- Histopathological examination of central nervous system tissues.
- Discussion of diagnostic techniques including immunofluorescent antibody techniques (IFAT) and electron microscopy.
Main Results:
- AM presents as subacute/chronic granulomatous meningoencephalitis with cysts and trophozoites, often with hematogenous spread.
- PAM is an acute hemorrhagic necrotizing meningoencephalitis with only trophozoites, entering via the olfactory epithelium.
- Host response in AM involves lymphocytes, plasma cells, and giant cells; PAM shows acute inflammation.
Conclusions:
- AM and PAM exhibit distinct epidemiological, clinical, and pathological features.
- Understanding these differences is crucial for accurate diagnosis and management of amebic CNS infections.
- Advanced techniques like IFAT and electron microscopy aid in identifying causative agents.