[Early endoscopic diagnosis can save lives and reduce the extent of colon resection for acute fulminant amebic colitis: a case report with review].

A man in his 50s was referred to the hospital with fever, right lower abdominal pain, and bloody diarrhea. Based on computed tomography images and characteristic varioliform erosions observed during the colonoscopic examination, the patient was diagnosed with fulminant amebic colitis. Intravenous metronidazole was administered immediately. After symptom improvement, a second colonoscopic examination revealed inflammation localized to the right hemicolon. A right colectomy was performed on the 75th hospital day, and the patient was discharged without further problems. Prompt antiamebic therapy based on early endoscopic diagnosis was effective in quelling colonic inflammation in a life-threatening case of acute fulminant amebic colitis. Moreover, colonoscopic reexamination was useful in determining the extent of inflammation and minimizing colon resection.

Twenty years of acanthamoeba diagnostics in Austria.

Acanthamoebae are the causative agents of an often seriously progressing keratitis (AK) occurring predominantly in contact lens wearers and can cause several disseminating infections potentially resulting in granulomatous amoebic encephalitis (GAE) in the immunocompromised host. Our institution is the Austrian reference laboratory for Acanthamoeba diagnostics and the aim of this study was to give an overview of proven cases of Acanthamoeba infections in Austria during the past 20 yr. All samples of patients with suspected AK or GAE were screened for Acanthamoeba spp. by culture and/or PCR and the detected amoebae were genotyped. Altogether, 154 cases of AK and three cases of GAE were diagnosed. Age of the AK patients ranged from 8 to 82 yr (mean 37.8) and 58% of the patients were female. Approximately 89% of the AK patients were contact lens wearers, almost all cases were unilateral and 19% of the patients required a keratoplasty. Age of the GAE patients ranged from 2 to 25 yr (mean 14.7), all were HIV-negative, but two were severely immunosuppressed at the time of diagnosis. The predominant genotype in the AK cases was T4, other genotypes found were T3, T5, T6, T10 and T11. The three GAE cases involved genotypes T2, T4 and T5.

Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.

BACKGROUND: Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years. METHODS: A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved. RESULTS: Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15). CONCLUSION: Amoebic colonic perforation is associated with unusually high mortality.

[Ileocecal ameboma: a case diagnosed by pathology and molecular biology]. / Amoebome iléocaecal: un cas diagnostique par l'anatomie pathologique et la biologie moléculaire.

Colonic ameboma is a rare benign inflammatory tumor due to the infection by Entamoeba histolytica and poses frequently the problem of colon cancer. We report a case of a 52 year-old patient who presented a cecal amoeboma revealed by a painful mass in the right iliac fossa. Radiologic and endoscopic examinations depicted a parietal thickening of the right colon and the cecum. A presumptive diagnosis of colon cancer was firstly discussed. Confirmation of ameboma was made on pathological examination, PCR and serology.

Successful Treatment of a Balamuthia mandrillaris Cerebral Abscess in a Pediatric Patient With Complete Surgical Resection and Antimicrobial Therapy.

Cerebral amebic encephalitis due to Balamuthia mandrillaris is a rare yet typically fatal disease. As such, identification of the clinical characteristics, appropriate diagnostic workup and commencement of treatment is frequently delayed. Here, we present a case of a 4-year-old male with a B. mandrillaris cerebral abscess successfully treated with expedited neurosurgical resection and broad-spectrum antimicrobial therapy.

Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea.

Here we present the neuropathological, ultrastructural, and radiological features of Sappinia diploidea, a newly recognized human pathogen. The patient was a 38-year-old man with visual disturbances, headache, and a seizure. Brain images showed a solitary mass in the posterior left temporal lobe. The mass was composed of necrotizing hemorrhagic inflammation that contained free-living amebae. Immunofluorescence microscopy showed that the organism was not a species of ameba previously known to cause encephalitis. Trophozoites had a highly distinctive double nucleus, and transmission electron microscopy confirmed that they contained 2 nuclei closely apposed along a flattened surface. The 2 nuclei were attached to each other by distinctive connecting perpendicular filaments. This and several other unique structural features led to the diagnosis of S. diploidea encephalitis. The patient was treated postoperatively with a sequential regimen of anti-amebic drugs (azithromycin, pentamidine, itraconazole, and flucytosine) and is alive after 5 years. Guidelines to recognize future cases of S. diploidea encephalitis are as follows. 1) It presented as a tumor-like cerebral mass without an abscess wall. 2) It had central necrotic and hemorrhagic inflammation that contained acute and chronic inflammatory cells without granulomas or eosinophils. 3) It contained trophozoites (40-70 microm diameter) that contained a distinctive double nucleus. 4) Cyst forms in the host were not excluded or definitely evident. 5) Trophozoites engulfed host blood cells and were stained brightly with Giemsa and periodic acid-Schiff. 6) Trophozoites often were present in viable brain parenchyma on the periphery of the mass without inflammatory response. 7) The prognosis after surgical excision and medical treatment was favorable in this instance.

The treatment of pleuropulmonary amebiasis with metronidazole.

One hundred forty patients with pleuropulmonary amebiasis were classified radiographically in order to rationalize therapy based on the use of metronidazole. Amebic testing with gel diffusion, serial chest x-ray films, and observation of the patient's response to treatment have dominated management of the patients, 135 of whom made a successful recovery. Five patients died. Sixty percent of the surviving patients have been reviewed at a follow-up clinic, and there has been no instance of recurrence of amebiasis.

Management of thoracic amebiasis.

The thoracic complications of amebiasis frequently necessitate surgical intervention. Experience with 28 patients is presented. Involvement included the pleura in 19 patients, the lungs in 10, and the pericardium in five. In 25%, more than one site was involved. Treatment consisted of measures designed to obliterate the pleural space or widely drain the pericardial sac, as indicated. Concurrent drainage of the associated amebic liver abscess was done in half the cases. The mortality rate was 36%, generally related to the poor general condition of the patients and their delay in seeking hospitalization.

Acanthamoeba keratitis possibly acquired from a hot tub.

An irritated left eye followed by a geographic epithelial corneal defect developed in a 42-year-old man. Disciform edema developed in the cornea, and the lesion progressed to a ring-shaped abscess. The lesion failed to respond to medical therapy. After two penetrating keratoplasties, histopathologic examination and electron microscopic studies established the diagnosis of Acanthamoeba keratitis. Subsequent cultures and immunofluorescent studies identified the organism as Acanthamoeba castellani. Following treatment with antibiotics and corneal cryotherapy, there has been no evidence of recurrence. Morphologically and immunologically identical amebae were also cultured from the patient's hot tub and surrounding garden.

Cutaneous amebiasis of the face: a case report.

This paper describes a case of cutaneous amebiasis of the face in a 17-month-old girl. About four weeks prior to admission she had diarrhea with high suspicion of intestinal amebiasis. Fifteen days later she presented with edema of the right lower eyelid and epiphora. There was a vesicle in the inner angle of the eye which spontaneously drained, causing loss of the underlying tissue. The ulcer developed rapidly, destroying periorbital tissue. Both cytology and biopsy of the ulceration border showed abundant trophozoites of Entamoeba histolytica. Treatment was specific therapy and surgery.

Granulomatous brain tumor caused by Acanthamoeba. Case report.

A case of a previously healthy 7-year-old girl with a left frontoparietal tumor identified as an Acanthamoeba-induced granuloma is reported, and the literature on Acanthamoeba meningoencephalitis is reviewed. Unlike most reported cases, the Acanthamoeba central nervous system infection presented in this girl as a discrete tumor without meningeal involvement or diffuse encephalitis. A favorable outcome was obtained following total excision of the mass and treatment with ketoconazole.

Cerebrospinal acanthamebic granulomas. Case report.

The authors present the case of a previously healthy 26-year-old man who presented with cerebrospinal acanthamebic granulomas, and they review the literature on acanthamebic granulomas of the central nervous system (CNS). The appearance of the lesion on imaging studies suggested the presence of tuberculous granulomas, which are common in India, and antituberculosis treatment was started. Despite surgical excision of a granuloma located in the right temporoparietal region and an intramedullary granuloma at T7-8, the disease progressed and resulted in death. Unlike other cases, this patient was not immunocompromised, had no history of engaging in water activities, and had no ulcers on his body, leaving in question the mode of entry used by the ameba. Acanthamebic granulomas can cause severe infections in healthy patients as well as in sick ones. This disease should be considered in the differential diagnosis when treating infective granulomas of the CNS.

Cryotherapy for medically unresponsive acanthamoeba keratitis.

Five cases of culture-proven Acanthamoeba keratitis underwent cryotherapy to the host cornea as an adjunctive treatment to medical and surgical therapy. Four of the 5 cases had progression of disease while receiving medical therapy considered to be appropriate for Acanthamoeba keratitis. One case underwent cryotherapy to the entire cornea after the disease had recurred in two penetrating keratoplasties; the organisms were eliminated but the patient never recovered useful vision. Two cases underwent cryotherapy to the host cornea at the time of a second penetrating keratoplasty. The organism was eliminated in both cases. Two cases underwent cryotherapy to the host cornea at the time of primary corneal transplantation with elimination of the organism and recovery of excellent acuity. This study does not provide conclusive evidence that cryotherapy eliminated the organism, but suggests that it can be an adjunctive measure to medical and surgical therapy. The risks of the adverse effects of freezing of the cornea must be weighted against the possibility of recurrence after keratoplasty with spread of disease to the sclera or to the development of corneal melting and perforation. Prevention of Acanthamoeba keratitis is by far the best approach to this disease entity.

Corneal allograft rejection in a pregnant woman.

We report a case of corneal allograft rejection that occurred in a gravid woman 1 year following transplantation. This is the first report, to our knowledge, of corneal allograft rejection occurring in a pregnant woman.

Acanthamoeba keratitis successfully treated with penetrating keratoplasty: suggested immunogenic mechanisms of action.

A patient with a corneal ulcer caused by Acanthamoeba polyphaga has been successfully treated with a penetrating keratoplasty. The pathologic specimen showed no inflammatory infiltrate surrounding the intact amoeba, whereas necrotic organisms were surrounded by an intense cellular reaction. Indirect immunochemical studies showed that the trophozoite stained profusely, but the cyst form exhibited the antigenic site on the cyst wall.

Successful treatment of amoebic meningoencephalitis in a Chinese living in Hong Kong.

Primary amoebic meningoencephalitis due to Naegleria fowleri was found in a 38-year-old Chinese man living in Hong Kong who presumably acquired the infection from swimming in a hot spring in neighbouring China. Amoebic cysts were identified in tissue taken from a brain abscess. The patient responded to surgical drainage and a 6-week course of amphotericin B, rifampicin and chloramphenicol. This is one of 6 cases of successful treatment of primary amoebic meningoencephalitis documented in the medical literature.

Amebiasis in Japanese homosexual men with human immunodeficiency virus infection.

We report cases of amebiasis in 6 human immunodeficiency virus (HIV)-positive male patients. Five were confirmed homosexuals while one was suspected. Three patients had liver abscess and 5 had colitis with duration of 10 days to months. The patients with liver abscess showed a lower incidence of abdominal pain but a higher incidence of concomitant diarrhea. Drainage therapy was effective for rapid afebrile results. Two invasive colitis cases died from perforation. This may have been due to delayed diagnosis. Invasive amebiasis is not common even in HIV-infected individuals. Among Japanese homosexual men, however, it may cause symptomatic diseases.

Amoebic cervicitis mimicking posterior wall fibroid: a rare presentation.

Amoebiasis of the uterine cervix is an extremely rare entity, and presentation as fibroid uterus has not been reported, to the best of our knowledge in our extensive search of the English literature. It can clinically simulate cervical malignancy by virtue of surface papillomatous and overall ulcerated and necrotic appearance. We present a case of amoebic infection of the cervix in a 45-year-old female which was suspected to be a posterior wall fibroid with degeneration until a histopathological examination of the surgical specimen revealed the presence of Entamoeba histolytica trophozoites. The patient recovered after surgery and antiamoebic therapy.