title: Granulomatous amebic encephalitis in a patient with AIDS: isolation of acanthamoeba sp. Group II from brain tissue and successful treatment with sulfadiazine and fluconazole.
abstract: A patient with AIDS, treated with highly active antiretroviral therapy and trimethoprim-sulfamethoxazole, presented with confusion, a hemifield defect, and a mass lesion in the right occipital lobe. A brain biopsy confirmed granulomatous amebic encephalitis (GAE) due to Acanthamoeba castellanii. The patient was treated with fluconazole and sulfadiazine, and the lesion was surgically excised. This is the first case of AIDS-associated GAE responding favorably to therapy. The existence of a solitary brain lesion, absence of other sites of infection, and intense cellular response in spite of a very low CD4 count conditioned the favorable outcome. We review and discuss the diagnostic microbiologic options for the laboratory diagnosis of infections due to free-living amebae.
authors.affiliation: Departments of Neurology, Complexo Hospitalario de Pontevedra, HospitalXeral-Cies, Vigo, Spain. mseijom@meditex.es
authors.forename: M
authors.initials: M
authors.lastname: Seijo Martinez
authors.forename: G
authors.initials: G
authors.lastname: Gonzalez-Mediero
authors.forename: P
authors.initials: P
authors.lastname: Santiago
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez De Lope
authors.forename: J
authors.initials: J
authors.lastname: Diz
authors.forename: C
authors.initials: C
authors.lastname: Conde
authors.forename: G S
authors.initials: GS
authors.lastname: Visvesvara
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy; D000328:Adult; D000562:Amebiasis / Q000175:diagnosis* / Q000188:drug therapy*; D000818:Animals; D019072:Antibiotic Prophylaxis; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D001921:Brain / Q000382:microbiology* / Q000473:pathology; D001922:Brain Abscess / Q000188:drug therapy / Q000469:parasitology* / Q000473:pathology; D016049:Didanosine / Q000627:therapeutic use; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D019258:Saquinavir / Q000627:therapeutic use; D013411:Sulfadiazine / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015725:Fluconazole; D016049:Didanosine; D019258:Saquinavir