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CNS infections with free-living amebas: neuroimaging findings
1Department of Radiological Sciences, UCIMC, Orange, CA 92868-3298, USA.
Objective:
The purpose of this report is to describe the clinical history, treatment, pathology, and imaging in two cases of rare CNS infection caused by free-living amebas. The Naegleria fowleri and Acanthamoeba species cause primary amebic meningoencephalitis and granulomatous amebic encephalitis, respectively. We describe the neuroimaging findings of a case involving a nonspecific cerebral edema pattern in primary amebic meningoencephalitis and a case involving focal enhancing lesions in granulomatous amebic encephalitis.
Conclusion:
Primary amebic meningoencephalitis and granulomatous amebic encephalitis have a grave prognosis and, although rare, should be considered in the differential diagnosis for patients who present with appropriate histories and imaging findings, including nonspecific brain edema on CT in primary amebic meningoencephalitis and focal punctate enhancing lesions in the posterior cranial fossa on T1-weighted MR imaging in granulomatous amebic encephalitis.
Insights
Rare CNS infections by free-living amebas, Naegleria fowleri and Acanthamoeba, present distinct neuroimaging findings. Early recognition of primary amebic meningoencephalitis and granulomatous amebic encephalitis is crucial for diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Central nervous system (CNS) infections caused by free-living amebas are rare but severe.
- Naegleria fowleri causes primary amebic meningoencephalitis (PAM), while Acanthamoeba species cause granulomatous amebic encephalitis (GAE).
Observation:
- This report details two cases of amebic CNS infections.
- One case involved PAM with nonspecific cerebral edema on CT.
- The other case involved GAE with focal enhancing lesions on MRI.
Findings:
- PAM presented with diffuse cerebral edema.
- GAE demonstrated focal, punctate enhancing lesions in the posterior cranial fossa on T1-weighted MRI.
- Both conditions have a grave prognosis.
Implications:
- Awareness of these rare amebic infections is vital for clinicians.
- Distinct neuroimaging patterns aid in differentiating PAM and GAE.
- Timely diagnosis based on clinical history and imaging is critical for patient management.