title: Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature.
abstract: Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.
authors.affiliation: School of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Max N
authors.initials: MN
authors.lastname: Brondfield
authors.affiliation: Division of Infectious Diseases, UCSF, San Francisco, CA, USA.
authors.forename: Michael J A
authors.initials: MJ
authors.lastname: Reid
authors.affiliation: Division of Infectious Diseases, UCSF, San Francisco, CA, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Rutishauser
authors.affiliation: Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Cope
authors.affiliation: Department of Infectious Diseases, Washington Hospital Healthcare System, Fremont, CA, USA.
authors.forename: Jevon
authors.initials: J
authors.lastname: Tang
authors.affiliation: Infectious Diseases Pathology Branch, CDC, Atlanta, GA, USA.
authors.forename: Jana M
authors.initials: JM
authors.lastname: Ritter
authors.affiliation: Epidemic Intelligence Service, CDC, Atlanta, GA, USA.
authors.forename: Almea
authors.initials: A
authors.lastname: Matanock
authors.affiliation: Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
authors.forename: Ibne
authors.initials: I
authors.lastname: Ali
authors.affiliation: Division of Infectious Diseases, UCSF, San Francisco, CA, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Doernberg
authors.affiliation: Department of Pharmaceutical Services, UCSF, San Francisco, CA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hilts-Horeczko
authors.affiliation: Department of Cardiology, UCSF, San Francisco, CA, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: DeMarco
authors.affiliation: Department of Cardiology, UCSF, San Francisco, CA, USA.
authors.forename: Liviu
authors.initials: L
authors.lastname: Klein
authors.affiliation: Division of Infectious Diseases, UCSF, San Francisco, CA, USA.
authors.forename: Jennifer M
authors.identifier: http://orcid.org/0000-0001-6914-4959
authors.initials: JM
authors.lastname: Babik
mesh_terms: D000048:Acanthamoeba / Q000302:isolation & purification*; D000562:Amebiasis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D000563:Amebicides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D009202:Cardiomyopathies / Q000601:surgery; D015507:Drugs, Investigational / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004724:Endoscopy; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D050279:Metacarpal Bones / Q000000981:diagnostic imaging / Q000469:parasitology / Q000473:pathology / Q000601:surgery; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D011859:Radiography; D012852:Sinusitis / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D012867:Skin / Q000469:parasitology / Q000473:pathology
chemical_list: D000563:Amebicides; D000900:Anti-Bacterial Agents; D000961:Antilymphocyte Serum; D015507:Drugs, Investigational; D007166:Immunosuppressive Agents; D010767:Phosphorylcholine; D008795:Metronidazole; C039128:miltefosine; D000666:Amphotericin B; D015725:Fluconazole; D005437:Flucytosine
keywords: 
  Acanthamoeba
  ; heart transplant; miltefosine