title: Acanthamoeba encephalitis: A Case Report and Review of Therapy.
abstract: BACKGROUND
  Acanthamoeba is a rare cause of encephalitis yet is associated with high mortality. Treatment protocols vary greatly and generally include combination therapy across a wide spectrum of antiinfective classes.
  
  
  METHODS
  A 63-year-old male who underwent renal transplantation presented 6 months after transplantation with depressed level of consciousness. Imaging of the head with computerized tomography showed an enhancing lesion suspicious for brain abscess. Biopsy of the lesion showed Acanthamoeba cysts. The patient was treated with sulfadiazine, fluconazole, flucytosine, azithromycin, and miltefosine but without success. We review recently published cases of Acanthamoeba encephalitis with an emphasis on treatment protocols and outcomes.
  
  
  CONCLUSIONS
  Free-living protozoans such as Acanthamoeba are ubiquitous in the environment and should be suspected in immunosuppressed persons who present with central nervous system findings and brain abscess. Biopsy is critical to establish the etiology so that appropriate combination therapy can be deployed.
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, MS USA.
authors.forename: A
authors.initials: A
authors.lastname: Zamora
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, MS USA.
authors.forename: H
authors.initials: H
authors.lastname: Henderson
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, MS USA ; G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS USA.
authors.forename: E
authors.initials: E
authors.lastname: Swiatlo
keywords: Acanthamoeba; brain abscess; encephalitis; miltefosine