RESEARCH PAPER
Human infections caused by free-living amoebae
 
More details
Hide details
1
Chair and Department of Medical Microbiology, Medical University of Lublin, Poland
 
 
Corresponding author
Katarzyna Król-Turmińska   

Chair and Department of Medical Microbiology, Medical University of Lublin, Poland
 
 
Ann Agric Environ Med. 2017;24(2):254-260
 
KEYWORDS
ABSTRACT
Introduction:
Among free-living amoebae that are widely distributed in nature only four genera/species are known as agents of human infections: Acanthamoeba spp., Naegleriafowleri, Balamuthia mandrillaris and Sappiniapedata. These amoebae are not well adapted to parasitism, and could exist in the human environment without the need for a host. Infections due to these amoebae, despite low morbidity, are characterized by relatively high mortality rate and pose serious clinical problems.

Objectve:
This review study presents and summarizes current knowledge about infections due to pathogenic and opportunistic free-living amoebae focused on epidemiology, clinical manifestations, diagnosis and treatment based on global literature.

State of knowledge:
All four genera have been recognized as etiologic factors of fatal central nervous system infections and other serious diseases in humans. N. fowleri causes an acute fulminating meningoencephalitis in children and young adults. Acanthamoeba spp. and B.mandrillaris are opportunistic pathogens causing granulomatous amoebic encephalitis and disseminated or localized infections which could affect the skin, sinuses, lungs, adrenals and/or bones. Acanthamoeba spp. is also the main agent of acute eye infection – Acanthamoeba keratitis, mostly in contact lens wearers. However, there is only one recognized case of encephalitis caused by S. pedata.

Conclusions:
Amoebic diseases are difficult to diagnose which leads to delayed treatment, and result in a high mortality rate. Considering those issues, there is an urgent need to draw more attention to this type of diseases.

 
REFERENCES (62)
1.
Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleriafowleri and Sappiniadiploidea. FEMS Immunol Med Mic. 2007; 50(1): 1–26.
 
2.
Diaz JH. Increasing intracerebral infections caused by free-living amebae in the United States and Worldwide. J Neuroparasitol. 2010; 1(1): 1–10.
 
3.
Schuster FL, Visvesvara GS. Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals. Int J Parasitol. 2004; 34: 1001–1027.
 
4.
da Rocha-Azevedo B, Tanowitz HB, Marciano-Cabral F. Diagnosis of Infections Caused by Pathogenic Free-Living Amoebae. InterdiscipPerspect Infect Dis 2009; 2009: 1–14.
 
5.
Visvesvara GS. Free-living amebae as opportunistic agents of human disease. J Neuroparasitol. 2010; 1: doi: 10.403/jnp/N100802.
 
6.
Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962–2008. Epidemiol Infect. 2010; 138(7): 968–975.
 
7.
Yoder SJ, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, et al. Primary Amebic Meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012; 55: 79–85.
 
8.
Niyyati M, Lasjerdi Z, Zarein-Dolab S, Nazar M, Behniafar H, Mahmoudi MR, NazemalhosseiniMojarad E. Morphological and Molecular Survey of Naegleria spp. in Water Bodies Used for Recreational Purposes in Rasht city, Northern Iran. Iran J Parasitol. 2015;10(4):523–529.
 
9.
Martinez AJ. Free-living amebas: natural history, prevention, diagnosis, pathology, and treatment of disease. CRC Press Inc. Boca Raton, Florida 1985.
 
10.
Capewell LG, Harris AM, Yoder JS, Cope JR, Eddy BA, Roy SL, Visvesvara GS, Fox LM, Beach MJ. Diagnosis, Clinical Course, and Treatment of Primary Amoebic Meningoencephalitis in the United States, 1937–2013. J Pediatric Infect Dis Soc. 2015; 4(4): 68–75.
 
11.
Trabelsi H, Dendana F, Sellami A, Sellami H, Cheikhrouhou F, Neji S, et al. Phatogenic free-living amoebae: Epidemiology and clinical review. PathologieBiologie. 2012; 60: 399–405.
 
12.
Visvesvara GS, Maguire JH. Pathogenic and opportunistic free-living amebas. Acanthamoeba spp., Balamuthia mandrillaris, Naegleriafowleri, and Sappiniadiploidea. Tropical Infectious Diseases, Vol. 2 (GuerrantRL, WalkerDH&WellerPF, eds) Churchill Livingstone. 2006: 1114–1125.
 
13.
Kemble SK, Lynfield R, DeVries AS, Drehner DM, Pomputius WF, Beach MJ, et al. Fatal Naegleriafowleri infection acquired in Minnesota: possible expanded range of a deadly thermophilic organism. Clin Infect Dis. 2012; 54(6): 805.
 
14.
Seidel JS, Harmatz P, Visvesvara GS, Cohen A, Edwards J, Turner J. Successful treatment of primary amebic meningoencephalitis. N Engl J Med. 1982; 306: 346–348.
 
15.
Marciano-Cabral F, Cline ML, Bradley SG. Specificity of antibodies from human sera for Naegleriafowleri. J ClinMicrobiol. 1987; 25: 692–697.
 
16.
Pelandakis M, Pernin P. Use ofmultiplex PCR and PCR restriction enzyme analysis for detection and exploration of the variability in the free-living amoeba Naegleria in the environment. Appl Environ Microbiol. 2002; 68(4): 2061–2065.
 
17.
Régoudis E, Pélandakis M. Detection of the freeliving amoeba Naegleria fowleri by using conventional and real-time PCR based on a single copy DNA sequence. ExpParasitol. 2016; 161: 35–39.
 
18.
Qvarnstrom Y, Visvesvara GS, Sriram R, da Silva AJ. Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleriafowleri. J ClinMicrobiol. 2006; 44(10): 3589–3595.
 
19.
Schild M, Gianinazzi C, Gottstein B, Muller N. PCRbased diagnosis of Naegleria sp. infection in formalin-fixed and paraffin-embedded brain sections. J ClinMicrobiol. 2007; 45(2): 564–567.
 
20.
Schuster FL, Visvesvara GS. Opportunistic amoebae: challenges in prophylaxis and treatment. Drug Resist Update. 2004; 7: 41–51.
 
21.
Goswick SM, Brenner GM. Activities of therapeutic agents against Naegleriafowleri in vitro and in a mouse model of primary amebic meningoencephalitis. J Parasitol. 2003; 89: 837–842.
 
22.
Schuster FL, Guglielmo BJ, Visvesvara GS. In-vitroactivity of miltefosine and voriconazole on clinical isolates of free-living amebas Balamuthia mandrillaris, Acanthamoeba spp., and Naegleriafowleri. J EukaryotMicrobiol. 2006; 53: 121–126.
 
23.
Schuster FL, Honarmand S, Visvesvara GS, Glaser C. Detection of antibodies against free-living amoebae Balamuthia mandrillaris and Acanthamoeba species in a population of patients with encephalitis. Clin Infect Dis. 2006; 42: 1260–1265.
 
24.
Ahmad AF, Andrew PW, Kilvington S. Development of a nested PCR for environmental detection of the pathogenic free-living amoeba Balamuthia mandrillaris. J EukaryotMicrobiol. 2011; 58: 269–271.
 
25.
Reddy R, Vijayasaradhi M, Uppin MS, Challa S, Jabeen A, Borghain R. Acanthamoeba meningoencephalitis in an immunocompetent patient: an autopsy case report. Neuropathol. 2011; 31(2): 183–187.
 
26.
Latifi AR, Niyyati M, Lorenzo-Morales J, Haghighi A, SeyyedTabaei SJ, Lasjerdi Z.Presence of Balamuthia mandrillaris in hot springs from Mazandaran province, northern Iran. Epidemiol Infect. 2016; 18:1–6.
 
27.
Diaz JH. The public health threat from Balamuthia mandrillaris in the southern United States. J La State Med Soc. 2011; 163(4): 197–204.
 
28.
Gupte AA, Hocevar SN, Lea AS, et al. Transmission of Balamuthia mandrillaris through solid organ transplantation: utility of organ recipient serology to guide clinical management. Am J Transplant. 2014;14:1417–1424.
 
29.
Pietrucha-Dilanchian P, Chan JC, Castellano-Sanchez A, Hirzel A, Laowansiri P, Tuda C, et al. Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection. J ClinMicrobiol. 2012; 50(3): 1128–1131.
 
30.
Satlin MJ, Graham JK, Visvesvara GS, et al. Fulminant and fatal encephalitis caused by Acanthamoeba in a kidney transplant recipient: case report and literature review. Transpl Infect Dis. 2013;15:619–626.
 
31.
Siddiqui R, Khan NA. Balamuthia amoebic encephalitis: An emerging disease with fatal consequences. Microb Pathogenesis. 2008; 44: 89–97.
 
32.
Jung S, Schelper RL, Visvesvara GS, Chang HT. Balamuthia mandrillaris meningoencephalitis in an immunocompetent patient: an unusual clinical course and a favorable outcome. Arch Path Lab Med. 2004; 128: 466–468.
 
33.
Reed RP, Cooke-Yarborough CM, Jaquiery AL, Grimwood K, Kemp AS, Su JC, Forsyth JR. Fatal granulomatous amoebic encephalitis caused by Balamuthia mandrillaris. Med J Aust. 1997; 167(2): 82–84.
 
34.
Pritzker AS, Kim BK, Agrawal D, Southern PM Jr, Pandya AG. Fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris presenting as a skin lesion. J Am AcadDermatol. 2004; 50(2): 38–41.
 
35.
Marciano-Cabral F., Cabral G. Acanthamoeba spp. as agents of disease in humans. ClinMicrobiol Rev. 2003; 16: 273–307.
 
36.
Singhal T, Bajpai A, Kalra V, Kabra SK, Samantaray JC, Satpathy G, Gupta AK. Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials. Pediatr Infect Dis J. 2001; 20(6): 623–627.
 
37.
Martinez DY, Seas C, Bravo F, Legua P, Ramos C, Cabello AM, Gotuzzo E. Successful treatment of Balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement. Clin Infect Dis. 2010; 51(2): 7–11.
 
38.
Schuster FL, Yagi S, Gavali S, Michelson D, Raghavan R, Blomquist I, et al. Under the radar: balamuthia amebic encephalitis. Clin Infect Dis. 2009; 48(7): 879.
 
39.
Hajialilo E, Niyyati M, Solaymani M, Rezaeian M. Pathogenic Free-Living Amoebae Isolated From Contact Lenses of Keratitis Patients. Iran J Parasitol. 2015; 10(4): 541–546.
 
40.
Jackson BR, Kucerova Z, Roy SL, et al. Serologic survey for exposure following fatal Balamuthia mandrillaris infection. Parasitol Res. 2014;113:1305–1311.
 
41.
Doyle JS, Campbell E, Fuller A, Spelman DW, Cameron R, Malham G, et al. Balamuthia mandrillaris brain abscess successfully treated with complete surgical excision and prolonged combination antimicrobial therapy. J Neurosurg. 2011; 114(2): 458–462.
 
42.
Lobo SA, Patil K, Jain S, Marks S, Visvesvara GS, Tenner M, et al. Diagnostic challenges in Balamuthia mandrillaris infections. Parasitolo Res. 2013; 112(12): 4015–4019.
 
43.
Gelman BB, Rauf SJ, Nader R et al. Amoebic encephalitis due to Sappiniadiploidea. J Am Med Assoc. 2001; 285: 2450–2451.
 
44.
Seal DV. Acanthamoeba keratitis update—incidence, molecular epidemiology and new drugs for treatment. Eye. 2003; 17: 893–905.
 
45.
Fraser MN, Wong Q, Shah L, Holland SP, Morshed M, Isaac-Renton J, et al. Characteristics of an Acanthamoeba keratitis outbreak in British Columbia between 2003 and 2007. Ophthalmol. 2012; 119(6): 1120–1125.
 
46.
Parmar DN, Awwad ST, Petroll WM, Bowman RW, McCulley JP, Cavanagh HD. Tandem scanningconfocal corneal microscopy in the diagnosis of suspected Acanthamoeba Keratitis. Ophthalmol. 2006; 113(4): 538–547.
 
47.
Page MA, William DM. Acanthamoeba Keratitis: A 12-Year Experience Covering a Wide Spectrum of Presentations, Diagnoses, and Outcomes. J Ophthalmol. 2013; 2013: 1–6.
 
48.
Tu E, Joslin CE. Recent Outbreaks of Atypical Contact Lens-Related Keratitis: What Have We Learned? Am J Ophthalmol. 2010; 150: 602–608.
 
49.
Morrison AO, Morris R, Shannon A, Lauer SR, Guarner J, Kraft CS. Disseminated Acanthamoeba Infection Presenting With Cutaneous Lesions in an Immunocompromised Patient: A Case Report, Review of Histomorphologic Findings, and Potential Diagnostic Pitfalls. Am J ClinPathol. 2016; 145(2): 266–270.
 
50.
Patel DV, Rayner SC. Resurgence of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation and outcomes. Clin. Exp. Ophthalmol. 2010; 38: 15–20.
 
51.
Verani JR, Lorick SA, Yoder JS, et al. National outbreak of Acanthamoeba keratitis associated with use of a contact lens solution, United States. Emerg Infect Dis. 2009;15:1236–1242.
 
52.
Wilhelmus KR, Jones DB, Matoba AY, Hamill MB, Pfugfelder SC, Weikert MP. Bilateral Acanthamoeba Keratitis. Am J Ophthalmol. 2008; 145: 193–197.
 
53.
Mannis MJ, Tamaru R, Roth AM, Burns M, Thirkill C. Acanthamoebasclerokeratitis: determining diagnostic criteria. Arch Ophthalmol. 1986; 104: 1313–1317.
 
54.
Illingworth CD, Cook SD, Karabatsas CH, Easty DL. Acanthamoeba keratitis: risk factors and outcome. Br J Ophthalmol. 1995; 9(12): 1078–1082.
 
55.
Khan NA, Tareen NK. Genotypic, phenotypic, biochemical, physiological and pathogenicity-based categorization of Acanthamoeba strains. Folia Parasitol. 2003; 50: 97–104.
 
56.
Prasher P, Sachdeva P, Ravinder NB, Sachin W. Acanthamoeba keratitis: a review. NZOS 2004; 14(1): 1–7.
 
57.
Galarza C, Ramos W, Gutierrez EL, Ronceros G, Teran M, Uribe M, et al. Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients. Int J Dermatol. 2009; 48(12): 1324–1329.
 
58.
Walia R, Montoya JG, Visvesvera GS, Booton GC, Doyle RL. A case of successful treatment of cutaneous Acanthamoeba infection in a lung transplant recipient. Transpl Infect Dis. 2007; 9: 51–54.
 
59.
Vargas-Zepeda J, Gómez-Alcalá AV, Vásquez-Morales JA, Licea-Amaya L, De Jonckheere JF, Lares-Villa F. Successful treatment of Naegleriafowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin. Arch Med Res. 2005; 36(1): 83–86.
 
60.
Yagi S, Schuster FL, Visvesvara GS. Demonstration of Balamuthia and Acanthamoeba mitochondrial DNA in sectioned archival brain and other tissues by the polymerase chain reaction. Parasitol Res. 2008; 102(2): 211–217.
 
61.
Selby DM, Chandra RS, Rakusan TA, Loechelt B, Markle BM, Visvesvara GS. Amebic Osteomyelitis in a Child with Acquired Immunodeficiency Syndrome: A Case Report. Fetal PediatrPathol. 1998; 18(1): 89–95.
 
62.
Kaul DR, Lowe L, Visvesvara GS, Farmen S, Khaled YA, Yanik GA. Acanthamoeba infection in a patient with chronic graft-versus-host disease occurring during treatment with voriconazole. Transpl Infect Dis. 2008; 6: 437–441.
 
eISSN:1898-2263
ISSN:1232-1966
Journals System - logo
Scroll to top