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Disseminated Acanthamebiasis in Patients With AIDS: A Report of Five Cases and a Review of the Literature

Disseminated Acanthamebiasis in Patients With AIDS: A Report of Five Cases and a Review of the... Abstract Background: Acanthamoeba and Leptomyxida are free-living amebae that cause granulomatous amebic encephalitis, a rare, slowly progressive, fatal neurologic process seen in immunosuppressed hosts. In addition, these organisms produce disseminated cutaneous lesions and involve other organs, particularly in patients with the acquired immunodeficiency syndrome (AIDS). Results: We report five cases of disseminated acanthamebiasis in patients with AIDS, each with cutaneous manifestations but lacking central nervous system involvement. The median CD4+ T-cell count was 0.024×109/L. Skin lesions included pustules, subcutaneous and deep dermal nodules, and ulcers, most often seen on the extremities and face. Histopathologically, both pustular and vasculitic changes were observed; in all cases, the microscopic identification of organisms was difficult because of the macrophagelike appearance of the microbes in routine sections. Conclusions: Skin lesions are the most commonly reported presentation of infections caused by Acanthamoeba and Leptomyxida organisms in patients with AIDS, a minority of whom have central nervous system manifestations. A high index of suspicion is necessary for both the dermatologist and the dermatopathologist. Prognosis is guarded, but early treatment using a combination of intravenous pentamidine and oral fluconazole, sulfadiazine, and flucytosine may be beneficial.(Arch Dermatol. 1995;131:1291-1296) References 1. Ma P, Visvesvara GS, Martinez AJ, et al. Naegleria and Acanthamoeba infections: review . Rev Infect Dis. 1990;12:490-513.Crossref 2. Visvesvara GS, Schuster FL, Martinez AJ. Balamuthia mandrillaris, n. g., n. sp., agent of amebic meningoencephalitis in humans and other animals . J Eukaryst Microbiol . 1993;40:504-514.Crossref 3. Cursons RTM, Brown TJ, Keys EA. Immunity to pathogenic free-living amoeba . Lancet. 1977;2:875-876.Crossref 4. Wang SS, Feldman HA. Isolation of Hartmannella species from human throats . N Engl J Med. 1967;27:1174-1179.Crossref 5. Newsome AL, Curtis FT, Culbertson CG, et al. Identification of Acanthamoeba in bronchoalveolar lavage specimens . Diagn Cytopathol. 1992;8:231-234.Crossref 6. Stehr-Green JK, Bailey TM, Visvesvara GS. The epidemiology of Acanthamoeba keratitis in the United States . Am J Ophthalmol. 1989;107:331-336. 7. Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections . J Protozool. 1990;37:25S-33S.Crossref 8. Visvesvara GS. Epidemiology of infections with free-living amebas and laboratory diagnosis of microsporidiosis . Mt Sinai J Med. 1993;60:283-288. 9. Martinez AJ, Guerra AE, Garcia-Tamayo J, et al. Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela . Acta Neuropathol. 1994;87:430-434.Crossref 10. Hunt SJ, Reed SL, Mathews WC, Torian B. Cutaneous Acanthamoeba infection in the acquired immunodeficiency syndrome: response to multidrug therapy . Cutis . In press. 11. Park CH, lyengar V, Hefter L, et al. Cutaneous Acanthamoeba infection associated with acquired immunodeficiency syndrome . Lab Med. 1994;25:386-388. 12. Sison J, Kemper C, McShane D, et al. Disseminated Acanthamoeba infection in AIDS . In: Program and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14,1992 ; Anaheim, Calif. Abstract 1086. 13. Helton J, Loveless M, White CR. Cutaneous Acanthamoeba infection associated with leukocytoclastic vasculitis in an AIDS patient . Am J Dermatopathol. 1993;15:146-149.Crossref 14. Tan B, Weldon-Linne CM, Rhone DP, et al. Acanthamoeba infection presenting as skin lesions in patients with the acquired immunodeficiency syndrome . Arch Pathol Lab Med. 1993;117:1043-1046. 15. May LP, Sidhu GS, Buchness MR. Diagnosis of Acanthamoeba infection by cutaneous manifestations in a man seropositive to HIV . J Am Acad Dermatol. 1992;26:352-355.Crossref 16. Friedland LR, Raphael SA, Deutsch ES, et al. Disseminated Acanthamoeba infection in a child with symptomatic human immunodeficiency virus infection . Pediatr Infect Dis J. 1992;11:404-407.Crossref 17. Portnoy BL, Micheletti GA. Acanthamoeba infection of skin and sinuses in an AIDS patient, diagnosis and treatment . In: Proceedings of the VIII International Conference on AIDS/III Sexually Transmitted Diseases World Congress, July 19-24, 1992 ; Amsterdam, the Netherlands. Abstract 7450. 18. Anzil AP, Rao C, Wrzolek MA, et al. Amebic meningoencephalitis in a patient with AIDS caused by a newly recognized opportunistic pathogen: leptomyxid ameba . Arch Pathol Lab Med. 1991;115:21-25. 19. Wiley CA, Safrin RE, Davis CE. Acanthamoeba meningoencephalitis in a patient with AIDS . J Infect Dis. 1987;155:130-132.Crossref 20. Gonzalez MM, Gould E, Dickinson G, et al. Acquired immunodeficiency syndrome associated with Acanthamoeba infection and other opportunistic organisms . Arch Pathol Lab Med. 1986;110:749-750. 21. Gordon SM, Steinberg JP, DuPuis MH, et al. Culture isolation of Acanthamoeba species and leptomyxid amebas from patients with amebic meningoencephalitis, including two patients with AIDS . Clin Infect Dis. 1992;15:1024-1030.Crossref 22. Di Gregorio C, Rivasi F, Mongiardo N, et al. Acanthamoeba meningoencephalitis in a patient with acquired immunodeficiency syndrome . Arch Pathol Lab Med. 1992;116:1363-1365. 23. Gardner HAR, Martinez AJ, Visvesvara GS, et al. Granulomatous amebic encephalitis in an AIDS patient . Neurology. 1991;41:1993-1995.Crossref 24. Robinson G, Wilson SE, Williams RA. Surgery in patients with acquired immunodeficiency syndrome . Arch Surg. 1987;122:170-175.Crossref 25. Taratuto AL, Monges J, Acefe JC et al. Leptomyxid amoeba encephalitis: report of the first case in Argentina . Trans R Soc Trop Med Hyg. 1991;85: 77.Crossref 26. Culbertson CG, Holmes DH, Overton WM. Hartmannella castellani (Acanthamoeba sp): preliminary report on experimental chemotherapy . Am J Clin Pathol. 1965;43:361-364. 27. Casemore DP. Sensitivity of Hartmannella (Acanthamoeba) to 5-fluorocytosine, hydroxystilbamidine, and other substances . J Clin Pathol. 1970;23:649-652.Crossref 28. Das SR, Asiri S, El-Soofi A, et al. Protective and curative effects of rifampicin in Acanthamoeba meningitis of the mouse . J Infect Dis. 1991;163:916-917.Crossref 29. Osato MS, Robinson NM, Wilhelmus KR, et al. In vitro evaluation of antimicrobial compounds for cysticidal activity against Acanthamoeba . Rev Infect Dis. 1991;13:S431-S435.Crossref 30. Duma RJ, Finley R. In vitro susceptibility of pathogenic Naegleria and Acanthamoeba species to a variety of therapeutic agents . Antimicrob Agents Chemother. 1976;10:370-376.Crossref 31. Cleland PG, Lawande RV, Onyemelukwe G, et al. Chronic amebic meningoencephalitis . Arch Neurol. 1982;39:56-57.Crossref 32. Ofori-Kwakye SK, Sidebottom DG, Herbert J, et al. Granulomatous brain tumor caused by Acanthamoeba . J Neurosurg. 1986;64:505-509.Crossref 33. Slater CA, Sickel JZ, Visvesvara GS, et al. Successful treatment of disseminate Acanthamoeba infection in an immunocompromised patient . N Engl J Med. 1994;331:85-87.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Disseminated Acanthamebiasis in Patients With AIDS: A Report of Five Cases and a Review of the Literature

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1995.01690230069011
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Abstract

Abstract Background: Acanthamoeba and Leptomyxida are free-living amebae that cause granulomatous amebic encephalitis, a rare, slowly progressive, fatal neurologic process seen in immunosuppressed hosts. In addition, these organisms produce disseminated cutaneous lesions and involve other organs, particularly in patients with the acquired immunodeficiency syndrome (AIDS). Results: We report five cases of disseminated acanthamebiasis in patients with AIDS, each with cutaneous manifestations but lacking central nervous system involvement. The median CD4+ T-cell count was 0.024×109/L. Skin lesions included pustules, subcutaneous and deep dermal nodules, and ulcers, most often seen on the extremities and face. Histopathologically, both pustular and vasculitic changes were observed; in all cases, the microscopic identification of organisms was difficult because of the macrophagelike appearance of the microbes in routine sections. Conclusions: Skin lesions are the most commonly reported presentation of infections caused by Acanthamoeba and Leptomyxida organisms in patients with AIDS, a minority of whom have central nervous system manifestations. A high index of suspicion is necessary for both the dermatologist and the dermatopathologist. Prognosis is guarded, but early treatment using a combination of intravenous pentamidine and oral fluconazole, sulfadiazine, and flucytosine may be beneficial.(Arch Dermatol. 1995;131:1291-1296) References 1. Ma P, Visvesvara GS, Martinez AJ, et al. Naegleria and Acanthamoeba infections: review . Rev Infect Dis. 1990;12:490-513.Crossref 2. Visvesvara GS, Schuster FL, Martinez AJ. Balamuthia mandrillaris, n. g., n. sp., agent of amebic meningoencephalitis in humans and other animals . J Eukaryst Microbiol . 1993;40:504-514.Crossref 3. Cursons RTM, Brown TJ, Keys EA. Immunity to pathogenic free-living amoeba . Lancet. 1977;2:875-876.Crossref 4. Wang SS, Feldman HA. Isolation of Hartmannella species from human throats . N Engl J Med. 1967;27:1174-1179.Crossref 5. Newsome AL, Curtis FT, Culbertson CG, et al. Identification of Acanthamoeba in bronchoalveolar lavage specimens . Diagn Cytopathol. 1992;8:231-234.Crossref 6. Stehr-Green JK, Bailey TM, Visvesvara GS. The epidemiology of Acanthamoeba keratitis in the United States . Am J Ophthalmol. 1989;107:331-336. 7. Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections . J Protozool. 1990;37:25S-33S.Crossref 8. Visvesvara GS. Epidemiology of infections with free-living amebas and laboratory diagnosis of microsporidiosis . Mt Sinai J Med. 1993;60:283-288. 9. Martinez AJ, Guerra AE, Garcia-Tamayo J, et al. Granulomatous amebic encephalitis: a review and report of a spontaneous case from Venezuela . Acta Neuropathol. 1994;87:430-434.Crossref 10. Hunt SJ, Reed SL, Mathews WC, Torian B. Cutaneous Acanthamoeba infection in the acquired immunodeficiency syndrome: response to multidrug therapy . Cutis . In press. 11. Park CH, lyengar V, Hefter L, et al. Cutaneous Acanthamoeba infection associated with acquired immunodeficiency syndrome . Lab Med. 1994;25:386-388. 12. Sison J, Kemper C, McShane D, et al. Disseminated Acanthamoeba infection in AIDS . In: Program and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy; October 11-14,1992 ; Anaheim, Calif. Abstract 1086. 13. Helton J, Loveless M, White CR. Cutaneous Acanthamoeba infection associated with leukocytoclastic vasculitis in an AIDS patient . Am J Dermatopathol. 1993;15:146-149.Crossref 14. Tan B, Weldon-Linne CM, Rhone DP, et al. Acanthamoeba infection presenting as skin lesions in patients with the acquired immunodeficiency syndrome . Arch Pathol Lab Med. 1993;117:1043-1046. 15. May LP, Sidhu GS, Buchness MR. Diagnosis of Acanthamoeba infection by cutaneous manifestations in a man seropositive to HIV . J Am Acad Dermatol. 1992;26:352-355.Crossref 16. Friedland LR, Raphael SA, Deutsch ES, et al. Disseminated Acanthamoeba infection in a child with symptomatic human immunodeficiency virus infection . Pediatr Infect Dis J. 1992;11:404-407.Crossref 17. Portnoy BL, Micheletti GA. Acanthamoeba infection of skin and sinuses in an AIDS patient, diagnosis and treatment . In: Proceedings of the VIII International Conference on AIDS/III Sexually Transmitted Diseases World Congress, July 19-24, 1992 ; Amsterdam, the Netherlands. Abstract 7450. 18. Anzil AP, Rao C, Wrzolek MA, et al. Amebic meningoencephalitis in a patient with AIDS caused by a newly recognized opportunistic pathogen: leptomyxid ameba . Arch Pathol Lab Med. 1991;115:21-25. 19. Wiley CA, Safrin RE, Davis CE. Acanthamoeba meningoencephalitis in a patient with AIDS . J Infect Dis. 1987;155:130-132.Crossref 20. Gonzalez MM, Gould E, Dickinson G, et al. Acquired immunodeficiency syndrome associated with Acanthamoeba infection and other opportunistic organisms . Arch Pathol Lab Med. 1986;110:749-750. 21. Gordon SM, Steinberg JP, DuPuis MH, et al. Culture isolation of Acanthamoeba species and leptomyxid amebas from patients with amebic meningoencephalitis, including two patients with AIDS . Clin Infect Dis. 1992;15:1024-1030.Crossref 22. Di Gregorio C, Rivasi F, Mongiardo N, et al. Acanthamoeba meningoencephalitis in a patient with acquired immunodeficiency syndrome . Arch Pathol Lab Med. 1992;116:1363-1365. 23. Gardner HAR, Martinez AJ, Visvesvara GS, et al. Granulomatous amebic encephalitis in an AIDS patient . Neurology. 1991;41:1993-1995.Crossref 24. Robinson G, Wilson SE, Williams RA. Surgery in patients with acquired immunodeficiency syndrome . Arch Surg. 1987;122:170-175.Crossref 25. Taratuto AL, Monges J, Acefe JC et al. Leptomyxid amoeba encephalitis: report of the first case in Argentina . Trans R Soc Trop Med Hyg. 1991;85: 77.Crossref 26. Culbertson CG, Holmes DH, Overton WM. Hartmannella castellani (Acanthamoeba sp): preliminary report on experimental chemotherapy . Am J Clin Pathol. 1965;43:361-364. 27. Casemore DP. Sensitivity of Hartmannella (Acanthamoeba) to 5-fluorocytosine, hydroxystilbamidine, and other substances . J Clin Pathol. 1970;23:649-652.Crossref 28. Das SR, Asiri S, El-Soofi A, et al. Protective and curative effects of rifampicin in Acanthamoeba meningitis of the mouse . J Infect Dis. 1991;163:916-917.Crossref 29. Osato MS, Robinson NM, Wilhelmus KR, et al. In vitro evaluation of antimicrobial compounds for cysticidal activity against Acanthamoeba . Rev Infect Dis. 1991;13:S431-S435.Crossref 30. Duma RJ, Finley R. In vitro susceptibility of pathogenic Naegleria and Acanthamoeba species to a variety of therapeutic agents . Antimicrob Agents Chemother. 1976;10:370-376.Crossref 31. Cleland PG, Lawande RV, Onyemelukwe G, et al. Chronic amebic meningoencephalitis . Arch Neurol. 1982;39:56-57.Crossref 32. Ofori-Kwakye SK, Sidebottom DG, Herbert J, et al. Granulomatous brain tumor caused by Acanthamoeba . J Neurosurg. 1986;64:505-509.Crossref 33. Slater CA, Sickel JZ, Visvesvara GS, et al. Successful treatment of disseminate Acanthamoeba infection in an immunocompromised patient . N Engl J Med. 1994;331:85-87.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1995

References