Could giant viruses be considered as a biotechnological tool for preventing and controlling Acanthamoeba infections?

AIM: The aim of the study was to evaluate the efficiency of mimivirus as a potential therapeutic and prophylactic tool against Acanthamoeba castellanii, the etiological agent of Acanthamoeba keratitis, a progressive corneal infection, that is commonly associated with the use of contact lenses and can lead to blindness if not properly treated. METHODS AND RESULTS: Mimivirus particles were tested in different multiplicity of infection, along with commercial multipurpose contact lenses' solutions, aiming to assess their ability to prevent encystment and excystment of A. castellanii. Solutions were evaluated for their amoebicidal potential and cytotoxicity in MDCK cells, as well as their effectiveness in preventing A. castellanii damage in Madin-Darby canine kidney (MDCK) cells. Results indicated that mimivirus was able to inhibit the formation of A. castellanii cysts, even in the presence of Neff encystment solution. Mimivirus also showed greater effectiveness in controlling A. castellanii excystment compared to commercial solutions. Additionally, mimivirus solution was more effective in preventing damage caused by A. castellanii, presented greater amoebicidal activity, and were less cytotoxic to MDCK cells than commercial MPS. CONCLUSIONS: Mimivirus demonstrates a greater ability to inhibit A. castellanii encystment and excystment compared to commercial multipurpose contact lens solutions. Additionally, mimivirus is less toxic to MDCK cells than those commercial solutions. New studies utilizing in vivo models will be crucial for confirming safety and efficacy parameters.

Genome-Wide Classification of Myb Domain-Containing Protein Families in Entamoeba invadens.

Entamoeba histolytica, the causative agent of amebiasis, is the third leading cause of death among parasitic diseases globally. Its life cycle includes encystation, which has been mostly studied in Entamoeba invadens, responsible for reptilian amebiasis. However, the molecular mechanisms underlying this process are not fully understood. Therefore, we focused on the identification and characterization of Myb proteins, which regulate the expression of encystation-related genes in various protozoan parasites. Through bioinformatic analysis, we identified 48 genes in E. invadens encoding MYB-domain-containing proteins. These were classified into single-repeat 1R (20), 2R-MYB proteins (27), and one 4R-MYB protein. The in-silico analysis suggests that these proteins are multifunctional, participating in transcriptional regulation, chromatin remodeling, telomere maintenance, and splicing. Transcriptomic data analysis revealed expression signatures of eimyb genes, suggesting a potential orchestration in the regulation of early and late encystation-excystation genes. Furthermore, we identified probable target genes associated with reproduction, the meiotic cell cycle, ubiquitin-dependent protein catabolism, and endosomal transport. In conclusion, our findings suggest that E. invadens Myb proteins regulate stage-specific proteins and a wide array of cellular processes. This study provides a foundation for further exploration of the molecular mechanisms governing encystation and unveils potential targets for therapeutic intervention in amebiasis.

Encefalitis amebiana granulomatosa por Balamuthia mandrillaris en Chile confirmada con secuenciación de ADN / Granulomatous amoebic encephalitis due to Balamuthia mandrillaris in Chile confirmed with DNA sequencing

Las enfermedades causadas por amebas de vida libre son infecciones oportunistas que pueden tener un curso fatal. Pueden producir afecciones diseminadas graves con compromiso del sistema nervioso central, como la encefalitis amebiana granulomatosa. Esta infección es cada vez más frecuente en América Latina, aunque se reconocen tardíamente debido a la similitud con otras patologías o porque es inusual incluirla en el diagnóstico diferencial. Comunicamos un caso fatal de una encefalitis amebiana granulomatosa por Balamuthia mandrillaris en una niña de 10 años. Destacamos la gravedad de la afectación cerebral y la falta de esquemas antimicrobianos validados para su tratamiento. Hoy en el mundo esta infección es considerada una enfermedad emergente, influenciada por el cambio climático, lo que llama a estar atentos a su presencia.

Diseases caused by free-living amoebae are opportunistic infections that can have a fatal course. They can cause very serious disseminated conditions with involvement of the central nervous system such as granulomatous amoebic encephalitis. This infection has become more common in Latin America, although its recognition is late due to the similarity with other pathological conditions or because it is unusual to include it in the differential diagnosis. We report a fatal case of granulomatous amoebic encephalitis due to Balamuthia mandrillaris in a 10-year-old girl. We highlight the severity of the brain involvement and the lack of validated schemes for its treatment. Today in the world this infection is considered an emerging disease, influenced by climate change, which calls for being attentive to its presence.

Oxidase enzyme genes are differentially expressed during Acanthamoeba castellanii encystment.

Acanthamoeba castellanii, a ubiquitous protozoan, is responsible for significant diseases such as Acanthamoeba keratitis and granulomatous amoebic encephalitis. A crucial survival strategy of A. castellanii involves the formation of highly resistant cysts during adverse conditions. This study delves into the cellular processes underpinning encystment, focusing on gene expression changes related to reactive oxygen species (ROS) balance, with a particular emphasis on mitochondrial processes. Our findings reveal a dynamic response within the mitochondria during encystment, with the downregulation of key enzymes involved in oxidative phosphorylation (COX, AOX, and NADHalt) during the initial 48 h, followed by their overexpression at 72 h. This orchestrated response likely creates a pro-oxidative environment, facilitating encystment. Analysis of other ROS processing enzymes across the cell reveals differential expression patterns. Notably, antioxidant enzymes, such as catalases, glutaredoxins, glutathione S-transferases, peroxiredoxins, and thioredoxins, mirror the mitochondrial trend of downregulation followed by upregulation. Additionally, glycolysis and gluconeogenesis are downregulated during the early stages in order to potentially balance the metabolic requirement of the cyst. Our study underscores the importance of ROS regulation in Acanthamoeba encystment. Understanding these mechanisms offers insights into infection control and identifies potential therapeutic targets. This work contributes to unraveling the complex biology of A. castellanii and may aid in combatting Acanthamoeba-related infections. Further research into ROS and oxidase enzymes is warranted, given the organism's remarkable respiratory versatility.

Amoebiasis: Advances in Diagnosis, Treatment, Immunology Features and the Interaction with the Intestinal Ecosystem.

This review of human amoebiasis is based on the most current knowledge of pathogenesis, diagnosis, treatment, and Entamoeba/microbiota interactions. The most relevant findings during this last decade about the Entamoeba parasite and the disease are related to the possibility of culturing trophozoites of different isolates from infected individuals that allowed the characterization of the multiple pathogenic mechanisms of the parasite and the understanding of the host-parasite relationship in the human. Second, the considerable advances in molecular biology and genetics help us to analyze the genome of Entamoeba, their genetic diversity, and the association of specific genotypes with the different amoebic forms of human amoebiasis. Based on this knowledge, culture and/or molecular diagnostic strategies are now available to determine the Entamoeba species and genotype responsible for invasive intestinal or extraintestinal amoebiasis cases. Likewise, the extensive knowledge of the immune response in amoebiasis with the appearance of new technologies made it possible to design diagnostic tools now available worldwide. Finally, the understanding of the interaction between the Entamoeba species and the intestinal microbiota aids the understanding of the ecology of this parasite in the human environment. These relevant findings will be discussed in this review.

The Gal/GalNac lectin as a possible acetylcholine receptor in Entamoeba histolytica.

Entamoeba histolytica (E. histolytica) is a protozoan responsible for intestinal amebiasis in at least 500 million people per year, although only 10% of those infected show severe symptoms. It is known that E. histolytica captures molecules released during the host immune response through membrane receptors that favor its pathogenetic mechanisms for the establishment of amebic invasion. It has been suggested that E. histolytica interacts with acetylcholine (ACh) through its membrane. This promotes the increase of virulence factors and diverse mechanisms carried out by the amoeba to produce damage. The aim of this study is to identify a membrane receptor in E. histolytica trophozoites for ACh. Methods included identification by colocalization for the ACh and Gal/GalNAc lectin binding site by immunofluorescence, western blot, bioinformatic analysis, and quantification of the relative expression of Ras 5 and Rab 7 GTPases by RT-qPCR. Results show that the Gal/GalNAc lectin acts as a possible binding site for ACh and this binding may occur through the 150 kDa intermediate subunit. At the same time, this interaction activates the GTPases, Ras, and Rab, which are involved in the proliferation, and reorganization of the amoebic cytoskeleton and vesicular trafficking. In conclusion, ACh is captured by the parasite, and the interaction promotes the activation of signaling pathways involved in pathogenicity mechanisms, contributing to disease and the establishment of invasive amebiasis.

Change in the incidence of intestinal diseases caused by parasitic protozoa in the Mexican population during the period (2015-2019) and its association with environmental and socioeconomic risk factors.

Diarrheal diseases are one of the main health problems worldwide, especially in developing countries with poor health systems, high rates of poverty, and poor nutrition. The main causative agents of diarrheal disease are bacteria, viruses, and parasites; among the latter, the intestinal protozoa Giardia and Entamoeba stand out. In the present work, a observational analysis of the national surveillance data of amebiasis, giardiasis, and other protozoan intestinal infections was carried out. The data issued by the Directorate General of Epidemiology was analyzed to establish its relationship with geography, socioeconomic, and environmental conditions in Mexico during the 2015-2019 period. New cases of amebiasis decreased by 25.03% between 2015 and 2019, while giardiasis and other protozoan intestinal infections remained constant; in all cases, incidence was higher in females than in males, and children under 5 years of age were the most affected. The contribution of environmental conditions (seasonality, temperature, and humidity) and socioeconomic factors in the number of protozoan intestinal infection cases was assessed by a multivariable regression model using a backward selection procedure. Peaks in cases were observed in spring and summer, which are characterized by warm and humid climates. Additionally, states with high humidity and annual average temperature contribute to a notably higher incidence of these parasites, especially annual average temperature, as demonstrated through multivariable linear regression models. Moreover, the majority of these states have the largest population living in poverty with inadequate measures for the distribution, dispensing, and sanitation of water. These data are essential to incidence rate monitoring and focus efforts on eliminating risk factors and improving health programs in Mexico.

Aislamiento de Acanthamoeba spp. en salas cerradas de un hospital de la provincia de Buenos Aires, Argentina / Isolation of Acanthamoeba spp. in closed rooms of a hospital in Buenos Aires province, Argentina

Resumen Las amebas de vida libre (AVL) son protozoos ubicuos con cuatro géneros patógenos para el ser humano: Acanthamoeba, Naegleria, Balamuthia, y Sappinia. Acanthamoeba puede actuar como reservorio de microorganismos (endosimbiontes), por lo cual, en medio hospitalario, implicaría un riesgo para la transmisión de bacterias, virus y hongos intranosocomiales. Se investigó la presencia de AVL, con énfasis en Acanthamoeba spp., en un hospital pediátrico de la provincia de Buenos Aires, Argentina. Se colectaron 22 muestras de lavamanos e incubadoras en salas de Neonatología y Terapia Intensiva, las que fueron cultivadas a 37 y 42 °C. Los aislados fueron identificados molecularmente. El 63,64% de las muestras presentaron Acanthamoeba spp. Esta investigación representa el primer estudio realizado en la Argentina sobre la detección de Acanthamoeba spp. en salas cerradas de un hospital. Su presencia es una señal de alarma y resulta un blanco útil para investigar posibles reservorios de microorganismos patógenos en ambientes hospitalarios.

Abstract Free-living amoebae (FLA) are ubiquitous protozoa with four pathogenic genera for humans: Acanthamoeba, Naegleria, Balamuthia, and Sappinia. Acanthamoeba can act as a reservoir of microorganisms (endosymbionts), for which reason, in a hospital environment, it would imply a risk for transmission of nosocomial bacteria, viruses and fungi. The presence of AVL, with emphasis on Acanthamoeba spp., was investigated in a pediatric hospital. Twenty-two samples were collected from sinks and incubators in Neonatology and Intensive Care rooms, which were cultured at 37 and 42 °C. The isolates found were molecularly identified. A total of 63.64% of the samples presented Acanthamoeba spp. This research represents the first study in Argentina on the detection of Acanthamoeba spp. in closed rooms of a hospital. Its presence is an alarm signal, and it is a useful target to investigate possible reservoirs of pathogenic microorganisms in hospital environments.

Resumo As amebas de vida livre (AVL) são protozoários ubíquos com quatro gêneros patogênicos para o ser humano: Acanthamoeba, Naegleria, Balamuthia, e Sappinia. Acanthamoeba pode atuar como um reservatório de microrganismos (endossimbiontes), e portanto, em um ambiente hospitalar, representaria um risco de transmissão de bactérias, vírus e fungos intra-nosocomiais. A presença de AVL, com em Acanthamoeba spp. em um hospital pediátrico da província de Buenos Aires, Argentina, foi investigada. Vinte e duas amostras foram coletadas em lavatórios e incubadoras em Salas de Neonatologia e Cuidados Intensivos, cultivadas a 37 e 42 °C. Os isolados foram identificadas molecularmente. Foram encontradas Acanthamoeba spp. em 63,64% das amostras. Esta investigação representa o primeiro estudo realizado na Argentina sobre a detecção de Acanthamoeba spp. em salas fechadas de um hospital. A sua presença é um sinal de alarme e um alvo para investigar possíveis reservatórios de microrganismos patogênicos em ambientes hospitalares.

Occurrence of Naegleria fowleri and their implication for health - a look under the One Health approaches.

One Health approaches are becoming increasingly necessary in the world we live in. Human beings, animals, plants and the environment are intrinsically interconnected and when some intervention occurs, mainly through the action of man himself, everyone suffers the consequences. The objective of this review was to collect data about the occurrence and dispersion of Naegleria fowleri, an amphizoic free-living amoeba, and its implications for health approaches through the One Health concept. N. fowleri is an opportunistic amoeba, better known as brain-eating amoeba, which causes Primary Amoebic Meningoencephalitis. This amoeba is widely distributed around the world, being isolated from different matrices of natural or anthropogenic environments with temperatures above 30 °C with an upper limit of 45-46 °C. Highly lethal, it has claimed numerous humans patients and only five people have survived the disease so far. Our results indicate that climate change plays a major role in the growth and dispersion of the pathogen in the environment, causing damage to humans and animals. Changes in temperature, antimicrobial resistance, possible transport of other microorganisms by the amoeba, conventional treatments with chlorination, among others, were addressed in our study and should be considered in order to raise questions and possible solutions to this problem that involves health as a whole. The diagnostic methods, prospection of new anti-Naegleria drugs and the control of this parasite in the environment are specific and urgent issues. We know that the human-animal-plants-environment spheres are inseparable, so it is necessary to turn a directed look at the One Health approaches related to N. fowleri.

From Argentine Abyssal Plain to farmed turbot in Spain: A ubiquitous amoeba species Vannella robusta sp. nov. (Amoebozoa, Vannellida).

A strain with the characters of the genus Vannella was isolated from the water layer immediately above the deep-sea sediment collected in the south-western Atlantic Ocean, ca. 4.6 km deep. Small-subunit ribosomal RNA (SSU rRNA) and cytochrome c oxidase (Cox1) gene phylogenetic analyses showed that the new strain branches within the clade of previously isolated unnamed Vannella strains from different marine fish and invertebrate hosts. Although the SSU rRNA gene sequences of these strains show variability within 2% of all nucleotide positions without any regular pattern, the available Cox1 gene sequences from within this clade are identical. Given the morphological homogeneity of the revealed clade, all of its strains can be assigned under the same species name, and the variation of their SSU rRNA is comparable to its intragenomic variation, as shown by molecular cloning of the PCR amplicons. High variability of the SSU rRNA gene sequences within and between independently isolated morphologically identical strains in combination with highly conserved Cox1 gene sequences may be a feature in some clades of Vannella, but is not a general rule for this genus, as SSU rRNA genes conserved between different morphospecies occur in several other clades within Vannella.

Fatal Balamuthia mandrillaris infection with red plaques on the nasal dorsum as the first presentation.

Balamuthia mandrillaris infection is a rare infectious disease around the world, with high rates of morbidity and mortality. Its early and correct diagnosis is a big challenge for us, and without it the delay in starting effective treatment can lead to the development of encephalitis. This is a report of a case of Balamuthia mandrillaris infection in a Chinese boy, with red plaques on the nasal dorsum as the first presentation, who finally developed into fatal encephalitis. The authors have reviewed the related literature and share the special skin features in order to favor the early diagnosis of the disease and increase the chances of survival.

Ubiquitin of Entamoeba histolytica induces antibody response in patients with invasive amoebiasis.

Entamoeba histolytica causes amoebic liver abscess (ALA) in humans. The injury of target cells by E. histolytica includes processes controlled by the ubiquitin Ehub. Previously, we found immunodominance of Ehub glycan moieties using immunized rabbits. In this work, we analysed dominance of antibodies to the glycoprotein Ehub in the sera from 52 patients with ALA. Controls were sera from 20 healthy people living in endemic areas with a high seroprevalence of antibodies to amoebas, and 20 patients with alcoholic hepatitis (AH) to rule out the cross-reaction of Ehub with autoantibodies induced by liver damage. Antigens were trophozoite extract, glycoprotein Ehub and the recombinant protein E. histolytica recombinant ubiquitin (rEhub). The sera from healthy volunteers and patients with AH do not have antibodies to glycoprotein Ehub. Surprisingly, only the antibodies from patients with ALA recognized the glycoprotein Ehub, and some sera gave a faint reaction with the recombinant protein, especially because evolutionarily, the ubiquitin is conserved between species. This is the first report demonstrating that antibodies to ubiquitin Ehub are induced exclusively in patients with invasive amoebiasis, and the antibody response is mainly to the glycoprotein, indicating glycans are immunodominant. Inhibitors of the Ehub glycans could be potential treatment for amoebiasis by selectively damaging trophozoites.

Clinical and molecular diagnosis of Acanthamoeba keratitis in contact lens wearers in southern Brazil reveals the presence of an endosymbiont.

Acanthamoeba keratitis (AK) is an infection that is mostly observed in contact lens wearers. It is often misdiagnosed causing delays in the administration of the correct treatment. The aim of this study was to report the outcome of clinical and molecular diagnosis of AK cases during the summer of 2019 in the southern region of Brazil. Three suspected cases of AK were discovered after an ophthalmic examination at a public hospital in the city of Porto Alegre. These cases were then confirmed through laboratory diagnosis (cell culture and molecular analysis by PCR and sequencing). In each of the three clinical sample cell cultures of corneal scraping and molecular analysis confirmed the presence of Acanthamoeba spp., all belonging to the morphological group II and to the genotype T4, which is the most common genotype associated with AK. In addition, Acanthamoeba spp. isolated from one of the clinical samples was found to harbor the Candidatus Paracaedibacter acanthamoeba, a bacterial endosymbiont. The presence of Ca. Paracaedibacter acanthamoeba in clinical isolates requires further research to reveal its possible role in the pathogenicity of Acanthamoeba infections.

Molecular diagnosis of amoebiasis.

Amoebiasis is an intestinal parasitosis caused by the protozoan Entamoeba histolytica that represents the third leading cause of mortality due to parasitosis. It is a prevalent disease in tropical climate regions with poor or absent sanitary services. Microscopy and antigen detection techniques are routinely used to diagnose amoebiasis because of their low cost and ease of application. However, these techniques do not differentiate E. histolytica infections and other potentially pathogenic species such as Entamoeba moshkovskii or Entamoeba bangladeshi. Therefore, in the last decades, molecular tests that allow correct identification of the causal agent of amoebiasis and the establishment of the prevalence of the infecting species have been developed. Techniques based on nucleic acids, such as conventional, multiplex, or real-time polymerase chain reaction (PCR), are being seriously considered in clinical laboratories, because they detect the etiologic agent directly from the sample without the need for previous prolonged culture, thus reducing diagnostic time. Also, the nested PCR test and the sequencing of ribosomal markers have allowed the identification of new parasitic species in humans, such as E. moshkovskii and E. bangladeshi, and an improved characterization of the known infecting species. The application of multiplex platforms allows the simultaneous identification of infecting species, increasing the sensitivity and specificity of these techniques. Therefore, the molecular diagnosis of amoebiasis is projected as an innovative tool in the fight against this parasitosis.

La amebiasis es una parasitosis intestinal causada por el protozoario Entamoeba histolytica y representa la tercera causa de mortalidad por parasitosis. Es una enfermedad prevalente en regiones de clima tropical con deficientes o nulos servicios sanitarios. Las técnicas de microscopía y detección de antígenos se emplean sistemáticamente para el diagnóstico de la amebiasis por su bajo costo y fácil aplicación. Sin embargo, no permiten diferenciar entre infecciones por E. histolytica y otras especies de potencial patogenicidad como Entamoeba moshkovskii o Entamoeba bangladeshi. Ante ello, en las últimas décadas se han desarrollado pruebas moleculares que permiten una correcta identificación del agente causal de la amebiasis y el establecimiento de la prevalencia de la especie infectante. Las técnicas basadas en ácidos nucleicos, como la reacción en cadena de la polimerasa (PCR) convencional, múltiple o en tiempo real, están siendo seriamente consideradas en los laboratorios clínicos, porque detectan al agente etiológico de manera directa en la muestra sin necesidad de cultivo prolongado previo, disminuyendo de esta forma el tiempo del diagnóstico. Asimismo, la PCR anidada sumada a la secuenciación de marcadores ribosomales ha permitido la identificación de nuevas especies parasitarias, como E. moshkovskii y E. bangladeshi en humanos, y una mejor caracterización de las especies infectantes ya conocidas. La aplicación de las plataformas multiplex permite la identificación simultánea de especies infectantes, aumentando la sensibilidad y la especificidad de estas técnicas. Por esto, el diagnóstico molecular de la amebiasis se proyecta como una verdadera herramienta innovadora en la lucha contra las parasitosis.

Occurrence of potentially highly pathogenic free-living amoebae in ready made salads from restaurants in Jatai, Goias, Brazil

Free-living amoebae (FLA) are part of a group of protozoa found worldwide and in the most diverse environments. They resist various temperatures and disinfection methods, and are a risk to human health. Pathogenic strains grow at high temperatures and under hyperosmolarity conditions. Some FLA genera are mainly related to primary amoebic meningoencephalitis (PAM), skin ulcerations, corneal lesions, kidney and lung infections and keratitis. Therefore, studies that assess the pathogenic potential of FLA are public health issues of great concern. We aimed to evaluate the pathogenic potential of FLA isolated in salads from restaurants in vitro, using osmotolerance and thermotolerance tests. Forty-five isolates were used from ready-made salads purchased in restaurants in Jatai, Goias. Twelve isolates subjected to the osmotolerance test (26.6%) showed growth in 0.5 M mannitol, 18 (40.0%) in 1.0 M mannitol and 16 (35.5%) in 1.5 M mannitol, 13 (28.8%) isolates did not show growth. Four isolates that underwent the thermotolerance test (8.9%) showed growth at 25°C, 8 (17.8%) showed growth at 30°C, 3 (6.7%) showed growth at 37°C and 30 (66.7%) did not show growth. With the indices obtained in the present study, we concluded that 15.6% of the isolates were osmotolerant and thermotolerant. Our findings highlight a public health problem once these FLA are associated with harboring or being harbored by microorganisms responsible for diseases such as diarrhea and meningitis. Measures are required to improve food hygiene and so avoid FLA-related health problems.

Colitis amebiana fulminante con desenlace fatal en un paciente con probable infección por SARS-CoV-2 / Fulminant amebic colitis with fatal outcome in a patient with probable SARS-CoV-2 infection

RESUMEN Se reporta el caso de un varón de 62 años quien presentó tos y dolor abdominal por dos semanas, con hallazgos tomográficos pulmonares compatibles con probable infección por SARS-CoV-2, que recibió tempranamente corticoterapia a dosis altas y de manera ambulatoria. El paciente presentó evolución tórpida, fue hospitalizado y falleció en el posoperatorio inmediato por un cuadro de abdomen agudo quirúrgico. El estudio anatomopatológico mostró estructuras parasitarias con características compatibles con amebas, como causa de una colitis aguda fulminante complicada, con perforación múltiple y peritonitis aguda. La colitis aguda fulminante por amebiasis intestinal en el contexto de un paciente con probable COVID-19 no había sido reportada en el Perú. Resulta importante resaltar la presentación fulminante con desenlace fatal de esta infección parasitaria prevalente en nuestro medio, en el contexto del uso de corticoides ante una probable infección pulmonar por COVID-19.

ABSTRACT We report the case of a 62-year-old male with cough and abdominal pain for two weeks, associated with pulmonary tomographic findings compatible with probable infection by SARS-CoV-2, and who received high doses of early corticotherapy as an outpatient. The patient showed clinical deterioration, was hospitalized and died in the immediate postoperative period due to acute surgical abdomen. The anatomopathological study showed parasitic structures with characteristics compatible with amebae, which was pointed to as the cause of a complicated acute fulminant colitis, with multiple perforations and acute peritonitis. Acute fulminant colitis due to intestinal amebiasis in the context of a patient with probable COVID-19 had not been previously reported in Peru. It is important to highlight the fulminant presentation with fatal outcome of this prevalent parasitic infection, in the context of corticosteroids use in a probable SARS-CoV-2 pulmonary infection.

Naegleria fowleri-associated meningoencephalitis in a cow in Southern Brazil-first molecular detection of N. fowleri in Brazil.

Naegleria fowleri, a free-living and thermophilic ameba, is the etiological agent of primary amebic meningoencephalitis (PAM). PAM is a rare and highly fatal neurologic disease in humans, and has been rarely documented in animal species. This report describes the pathological and etiological findings of a fatal case of N. fowleri-associated meningoencephalitis in a cow in Southern Brazil. Microscopic findings were consistent with severe, multifocal, hemorrhagic, and necrosuppurative meningoencephalitis associated with a large number of amebic trophozoites compatible with N. fowleri. Brain samples subjected to molecular assays generated a 315 bp fragment, which presented 99% identity with a N. fowleri sequence previously deposited in GenBank. This is the first study reporting the molecular detection of N. fowleri in a case of cattle meningoencephalitis in Latin America, and the obtained sequence represents the first GenBank deposit of N. fowleri identified in Brazil to this day. Additionally, the case reported is the second occurrence of N. fowleri-associated disease in the same city, drawing attention to the local importance of infection by this ameba and potential risk for human infections.

Primer informe clínico de Balamuthia mandrillaris en el distrito de Camaná, Arequipa, Perú / First case report of the Balamuthia mandrillaris in the Camaná district of Arequipa, Peru

Resumen Las infecciones por amebas de vida libre causan compromiso cutáneo y neurológico. Estas afecciones presentan una baja frecuencia pero una alta letalidad, mayor al 98%. Gene ralmente el cuadro clínico es inespecífico y los exámenes de laboratorio no son de gran ayuda, por lo que representa un reto diagnóstico y terapéutico. En este informe presentamos el caso de un paciente de 21 años que fue hospitalizado por un síndrome convulsivo con tumoraciones cerebrales, además de una lesión cutánea en el muslo derecho. El análisis histopatológico, PCR y el cuadro clínico permitieron el diagnóstico de encefalitis amebiana granulomatosa. A pesar del tratamiento, el paciente tuvo un desenlace fatal.

Abstract Infections by free-living amoebas cause cutaneous and neurological compromise. These conditions have a low frequency, but a high lethality more than 98%. Generally, the clinical picture is nonspecific; the laboratory tests dont help, so it represents a diagnostic and therapeutic challenge. In this report, we present the case of a 21-year-old patient, who was hospitalized for a convulsive syndrome with brain tumors, in addition to a cutaneous lesion on the right thigh. Histopathological analysis, PCR and the clinical picture allowed the diagnosis of granulomatous amebic encephalitis. Despite the treatment, the patient had a fatal outcome.