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Infection

pp 1–5 | Cite as

Non-granulomatous cerebellar infection by Acanthamoeba spp. in an immunocompetent host

  • Sara Modica
  • Clelia Miracco
  • Maria Grazia Cusi
  • Giacinta Tordini
  • Vitaliano Francesco Muzii
  • Francesco Iacoangeli
  • Claudia Nocentini
  • Ibne Karim M. Ali
  • Shantanu Roy
  • Alfonso Cerase
  • Giacomo Zanelli
  • Andrea De Luca
  • Francesca Montagnani
Case Report

Abstract

Acanthamoeba spp. is a free-living amoeba, frequently involved in keratitis by contact lens in immunocompetent hosts. Anecdotal reports associate Acanthamoeba spp. as a cause of severe granulomatous encephalitis in immunocompromised and, less frequently, in immunocompetent subjects. Data regarding clinical and therapeutic management are scanty and no defined therapeutic guidelines are available. We describe an unusual case of non-granulomatous Acanthamoeba cerebellitis in an immunocompetent adult male, with abrupt onset of neurological impairment, subtle hemorrhagic infarction at magnetic resonance imaging, and initial suspicion of cerebellar neoplasm. Histopathological findings of excised cerebellar mass revealed the presence of necrosis and inflammation with structure resembling amoebic trophozoites, but without granulomas. Polymerase chain reaction from cerebellar tissue was positive for Acanthamoeba T4 genotype. Due to gastrointestinal intolerance to miltefosine, the patient was treated with long-term course of fluconazole and trimethoprim/sulphamethoxazole, obtaining complete clinical and neuroradiological resolution.

Keywords

Acanthamoeba Free-living amoebas Encephalitis Immunocompetent host 

Notes

Acknowledgements

We thank Marguerite Kelly Keating, formerly Infectious Disease Pathology Branch, Centers for Disease Control and Prevention (CDC), for critical revision of the manuscript.

Compliance with ethical standards

Conflict of interest

SM, CM, MGC, GC, VFM, FI, CN, IKMA, SR, AC, GZ: no conflict. ADL reports research grants to his Institutions by ViiV Healthcare, Gilead Sciences (fellowship program) and MSD Italy; he has received consultant fees from ViiV Healthcare, Gilead Sciences, MSD Italy, Janssen, Bristol-Myers Squibb and Abbvie; all outside the submitted work. FM has received non-financial support from Angelini and Astellas, outside the submitted work. She has done contract research for Novartis Vaccine and Diagnostic S.rl. (now GSK Vaccine S.r.l.) on behalf of the University Hospital of Siena; she is Infectious Diseases Consultant for GSK (consultancy fee on behalf of University of Siena).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sara Modica
    • 1
    • 8
  • Clelia Miracco
    • 2
  • Maria Grazia Cusi
    • 3
    • 8
  • Giacinta Tordini
    • 3
    • 8
  • Vitaliano Francesco Muzii
    • 4
  • Francesco Iacoangeli
    • 4
  • Claudia Nocentini
    • 5
  • Ibne Karim M. Ali
    • 6
  • Shantanu Roy
    • 6
  • Alfonso Cerase
    • 7
  • Giacomo Zanelli
    • 1
    • 8
  • Andrea De Luca
    • 1
    • 8
  • Francesca Montagnani
    • 1
    • 8
  1. 1.Hospital Department of Specialized and Internal Medicine, Infectious Diseases UnitUniversity Hospital of SienaSienaItaly
  2. 2.Pathological Anatomy Division, Department of Medicine, Surgery and NeuroscienceUniversity of SienaSienaItaly
  3. 3.Hospital Department of Emergency Urgency and Diagnostic Services, Microbiology and Virology UnitUniversity Hospital of SienaSienaItaly
  4. 4.Department of Medicine, Surgery and Neurosciences, Section of NeurosurgeryUniversity of SienaSienaItaly
  5. 5.Radiology Unit, “Santa Maria la Gruccia” HospitalMontevarchi (AR)Italy
  6. 6.Free-Living and Intestinal Amebas (FLIA) LabWaterborne Disease Prevention Branch Centers for Disease Control and PreventionAtlantaUSA
  7. 7.Department of Neurological and Sensorineural Sciences, Neuroimaging and Neurointervention UnitUniversity Hospital of SienaSienaItaly
  8. 8.Department of Medical BiotechnologiesUniversity of SienaSienaItaly

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