RESUMO
Granulomatous amebic encephalitis (GAE) caused by Acanthamoeba is a rare infection with central nervous system (CNS) involvement usually with fatal consequences. Currently, information regarding GAE in children is scarce and is limited only to case reports and case series. A 13-year-old immunocompetent male patient with a 6-month history of progressive and intermittent headaches presented to our institution. One week before hospital admission, the patient showed signs of CNS involvement. Magnetic resonance imaging revealed multiple lesions with supra- and infratentorial cerebral abscesses. An empiric treatment with combined antibiotics was given, but the patient died after 20 days of hospital stay. A postmortem diagnosis confirmed GAE. Although it is a rare disease in pediatric patients, GAE should be considered in children with a chronic history of fever, headache, and vomiting with CNS involvement.
Assuntos
Amebíase/patologia , Abscesso Encefálico/parasitologia , Encefalite/parasitologia , Granuloma/parasitologia , Acanthamoeba , Adolescente , Amebíase/tratamento farmacológico , Anti-Infecciosos/uso terapêutico , Abscesso Encefálico/patologia , Encefalite/tratamento farmacológico , Evolução Fatal , Granuloma/tratamento farmacológico , Granuloma/patologia , Humanos , Masculino , Metronidazol/uso terapêuticoRESUMO
BACKGROUND: The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. CASE PRESENTATION: We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. CONCLUSIONS: The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.
Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/parasitologia , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Entamebíase/diagnóstico , Idoso , Animais , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Ceftriaxona/administração & dosagem , Infecções Parasitárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Parasitárias do Sistema Nervoso Central/patologia , Infecções Parasitárias do Sistema Nervoso Central/cirurgia , Terapia Combinada , DNA de Protozoário/análise , Dexametasona/administração & dosagem , Quimioterapia Combinada , Entamoeba histolytica/genética , Entamoeba histolytica/imunologia , Entamoeba histolytica/isolamento & purificação , Entamebíase/tratamento farmacológico , Entamebíase/patologia , Entamebíase/cirurgia , Evolução Fatal , Feminino , Humanos , Metronidazol/administração & dosagem , Procedimentos Neurocirúrgicos , Testes SorológicosRESUMO
Although amebic brain abscess is a rare form of invasive amebiasis, when present, it is frequently lethal. This disorder always begins with the infection of the colon by Entamoeba histolytica trophozoites, which then travel to extra-intestinal tissues through the bloodstream. Amebic brain abscesses are produced when trophozoites invade the central nervous system. Computerized axial tomography scans can be used to diagnose the presence or absence of a brain abscess with a certainty of 100%. However, this diagnostic tool does not reveal the etiological agent of disease. By analyzing the clinical case of a patient that died due to untimely treatment of this malady, the present study aims to identify a diagnostic tool that can give a precise determination of the etiological agent and therefore permit adequate and opportune treatment. Currently, diagnosis of amebic brain abscess is often done by identification of the ameba in a biopsy or autopsy. By immunohistochemistry and immunofluorescence with specific antibodies, we identified the existence of E. histolytica, which presents proteins similar to Naegleria fowleri in its membrane.
Assuntos
Anticorpos Monoclonais , Abscesso Encefálico/diagnóstico , Infecções Protozoárias do Sistema Nervoso Central/diagnóstico , Entamoeba histolytica/isolamento & purificação , Entamebíase/diagnóstico , Amebíase , Anticorpos Monoclonais/imunologia , Anticorpos Antiprotozoários/imunologia , Abscesso Encefálico/parasitologia , Infecções Protozoárias do Sistema Nervoso Central/parasitologia , Entamoeba histolytica/imunologia , Entamebíase/parasitologia , Imunofluorescência , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Naegleria fowleri/imunologia , Trofozoítos/imunologiaRESUMO
A 51-year-old Japanese-Brazilian homosexual man was admitted to a hospital because of fever, headache and right epigastralgia. He had been homosexual for 20 years. An abdominal CT revealed a liver abscess and microscopic examination of the pus of the drainage revealed cystic forms of Entamoeba histolytica. Oral administration of metronidazole 2,250 mg/day was started for amebic liver abscess. He complained of severe throbbing headache, and magnetic resonance imaging (MRI) of the brain showed a brain mass of approximately 2 cm in diameter in the right parietooccipital lobe. An amebic brain abscess was suspected and he was transferred to our hospital. Continuous oral administration of metronidazole for 49 days instead of invasive procedures gradually improved headache, fever and right epigastralgia. On the follow-up MRIs, the brain mass was gradually encapsulated, reduced its size, and finally disappeared. A diagnosis of amebic brain abscess was made on the basis of coexistent amebic liver abscess, MRI findings and a dramatic effectiveness to metronidazole. One should pay attention to E. Histolytica infection in the differential diagnosis of the abscess of the liver and brain since it has been increasing in Japan in recent years.
Assuntos
Amebíase/complicações , Abscesso Encefálico/complicações , Entamoeba histolytica , Homossexualidade Masculina , Abscesso Hepático Amebiano/complicações , Administração Oral , Amebíase/diagnóstico , Amebíase/tratamento farmacológico , Amebíase/parasitologia , Animais , Antiprotozoários/administração & dosagem , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/parasitologia , Brasil/etnologia , Diagnóstico Diferencial , Entamoeba histolytica/isolamento & purificação , Humanos , Japão , Abscesso Hepático Amebiano/diagnóstico , Abscesso Hepático Amebiano/tratamento farmacológico , Abscesso Hepático Amebiano/parasitologia , Imageamento por Ressonância Magnética , Masculino , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , MigrantesRESUMO
Pulmonary amoebiasis without liver involvement occurs sporadically as a result of haematogenous spread from a primary site, the colon. The case history is presented of a patient who developed superior vena cava syndrome due to a pulmonary amoebic abscess without liver involvement. He was initially suspected of having a neoplasm but a combination of tests including histological examination of the H&E stained excised tissue, immunofluorescence using anti-Entamoeba histolytica antibodies, and serology confirmed the diagnosis of amoebiasis. To our knowledge this is the first description of pulmonary amoebiasis presenting as superior vena cava syndrome.
Assuntos
Amebíase/complicações , Pneumopatias Parasitárias/complicações , Síndrome da Veia Cava Superior/parasitologia , Adulto , Animais , Abscesso Encefálico/parasitologia , Entamoeba histolytica , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodosRESUMO
The authors retrospectively assess the autopsy findings of central nervous system (CNS) infections in marrow transplant recipients. From July 1987 to June 1998, 845 patients at our institution were submitted to bone marrow transplantation (BMT). The CNS of 180 patients was studied through autopsy and these patients had their medical records reviewed. Twenty-seven (15%) patients presented brain parenchyma infection. Fungi were isolated in approximately 60% of the cases. Mean survival time was 153 days (0-1,264 days) and the majority of the patients died during the first 3 months after BMT (18 cases; 67%). Aspergillus sp. were the most prevalent fungi (approximately 30%), followed by Candida sp. infection (approximately 18%). There was one case of Fusarium sp. infection and two cases of unidentified fungus. All patients with fungal infections had documented involvement at widespread sites. Toxoplasma gondii encephalitis was demonstrated in 8 patents (approximately 30%). Bacterial abscesses were responsible for approximately 11% of the findings. Eleven (41%) of the 27 patients died secondary to cerebral causes. These results show that infectious compromise of the CNS following BMT is a highly fatal event, caused mainly by fungi and T. gondii. Furthermore, they provide a likely guide to the possible causes of brain abscesses following BMT.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Infecções do Sistema Nervoso Central/etiologia , Adolescente , Adulto , Autopsia , Infecções Bacterianas/etiologia , Infecções Bacterianas/mortalidade , Transplante de Medula Óssea/mortalidade , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/parasitologia , Infecções Fúngicas do Sistema Nervoso Central/etiologia , Infecções Fúngicas do Sistema Nervoso Central/mortalidade , Infecções do Sistema Nervoso Central/microbiologia , Infecções do Sistema Nervoso Central/parasitologia , Criança , Pré-Escolar , Encefalite/etiologia , Encefalite/microbiologia , Feminino , Humanos , Masculino , Taxa de Sobrevida , Toxoplasmose/etiologia , Toxoplasmose/mortalidadeRESUMO
Cladophialophora bantiana (Cladosporium trichoides) is a black fungus recorded rarely as a cause of brain abscess. Only 21 cases have been reported in the literature world-wide. We describe the first case seen in Brazil. A 30 year old, previously healthy female, HIV negative, came to the hospital with a clinical diagnosis of brain tumor. After biopsy and culture of the lesion, it was found that she had an abscess due to Cladosporium trichoides. During the following five months, the patient underwent three more surgical brain interventions to totally remove the area of compromised tissue. In addition to surgery, amphotericin B, both intravenously and intrathecally, was used followed by itraconazole orally, without sucess. Six months after the first surgical intervention, the patient died. The worldwide experience with diagnosis and treatment of patients with this diseases is reviewed.
Assuntos
Humanos , Feminino , Adulto , Anfotericina B/uso terapêutico , Abscesso Encefálico/parasitologia , Abscesso Encefálico/patologia , Abscesso Encefálico/cirurgia , Cérebro/patologia , Cladosporium/patogenicidade , Evolução Fatal , Itraconazol/uso terapêutico , Micoses/tratamento farmacológico , Evolução FatalRESUMO
O Autor apresenta um caso muito raro de encéfalo préviamente lesado pela toxoplasmose ("locus minor resistentia") no qual se instalou ameba histolítica produzindo abscesso
Assuntos
Pessoa de Meia-Idade , Humanos , Feminino , Abscesso Encefálico/parasitologia , Toxoplasmose/complicações , Abscesso Encefálico/patologia , Entamoeba histolyticaRESUMO
A 31-year-old Frenchman had an acquired immunodeficiency syndrome (AIDS) with profound depression of cellular immunity and relative sparing of humoral immunity. The clinical picture included intractable secretory diarrhoea, vomiting, abdominal pain, and weight loss. Gastrointestinal cryptosporidiosis was present and a perfusion technique showed profuse secretion of fluid in the proximal small bowel. The patient also had recurrent Salmonella typhimurium septicaemia, cytomegalovirus infection, and cerebral toxoplasmosis and he died within 13 months. This patient did not belong to any of the groups known to be affected by this type of acquired immunodeficiency (homosexuals, drug addicts, haemophiliacs, Haitians) but had been transfused with Haitian blood 4 years before onset of symptoms. This case supports the notion that some forms of AIDS may be transmitted by blood, with a long incubation period.