Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment
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(2020) 20:669
CASE REPORT
Open Access
Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment Joaquin Alvaro Victoria-Hernández1, Anayansi Ventura-Saucedo2, Aurelio López-Morones3, Sandra Luz Martínez-Hernández4, Marina Nayeli Medina-Rosales4, Martín Muñoz-Ortega5, Manuel Enrique Ávila-Blanco4, Daniel Cervantes-García6,7, Luis Fernando Barba-Gallardo8 and Javier Ventura-Juárez4*
Abstract 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. Keywords: Cerebral amoebiasis, Entamoeba histolytica, NMRI, PCR, 140 kDa fibronectin receptor, Brain abscess
Background Entamoeba histolytica is the causal agent of amoebiasis, an emerging disease found worldwide [1]. This disease is prevented by improving sanitation. Although usually manifested in the human intestine [2], this agent can spread to the liver or brain and generate abscesses. Over 25 years ago, the molecular characterization of E. * Correspondence: [email protected] 4 Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Ed. 202 Av Universidad # 940, Ciudad Universitaria, CP 20131 Aguascalientes, AGS, Mexico Full list of author information is available at the end of the article
histolytica [3] provided an epidemiological pyramid in which 10% of the world population is infected by a noninvasive form of the parasite and 1% by an invasive form [2]. According to epidemiological evidence from PCR, amoebiasis ranks among the 20 most common causes of death
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