Acute Granulomatous Acanthamoeba Encephalitis in an Immunocompetent Patient
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PRACTICAL PEARL
Acute Granulomatous Acanthamoeba Encephalitis in an Immunocompetent Patient Peter Lackner • Ronny Beer • Gregor Broessner • Raimund Helbok • Bettina Pfausler • Christian Brenneis Herbert Auer • Julia Walochnik • Erich Schmutzhard
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Published online: 22 October 2009 Ó Humana Press Inc. 2009
Abstract Background Acanthamoeba sp. are known to cause fatal granulomatous Acanthamoeba encephalitis (GAE) in immunocompromised patients. Methods The case of a 17 year old immunocompetent patient with acute purulent meningoencephalitis is reported. Results After substantial improvement of cerebrospinal fluid under conventional antimicrobial treatment the patient was suffering several relapses. The causative agent was identified as Acanthamoeba lenticulata T5 which entered the CNS through a bone dehiscence of ethmoidal cells. Due to severe vasospasm the patient developed multiple strokes, which led to marked neurologic sequels. Conclusions This case report demonstrates successful treatment of usually lethal GAE in an immunocompetent patient with high dose meropenem, linezolid, moxifloxacin and fluconazole followed by a partially adapted antimicrobial combination therapy. Keywords GAE Granulomatous Acanthamoeba encephalitis Meningoencephalitis
Peter Lackner and Ronny Beer have contributed equally. P. Lackner (&) R. Beer G. Broessner R. Helbok B. Pfausler C. Brenneis E. Schmutzhard Department of Neurology, Innsbruck Medical University, 6020 Innsbruck, Anichstrasse 35, Austria, Europe e-mail: [email protected] H. Auer J. Walochnik Department of Medical Parasitology, Clinical Institute of Hygiene and Medical Microbiology, Medical University of Vienna, Vienna, Austria
Case Report A 17-year-old Caucasian male patient was admitted to a primary care hospital in Austria in late June 2007 presenting with high fever, impaired consciousness, and meningism. Three weeks prior to admission pan-sinusitis had been diagnosed and had been treated with amoxicillin/ clavulanate. After admission, rapidly decreasing level of consciousness necessitated emergency intubation and mechanical ventilation. The patient was transferred to the neuro-critical care unit of Innsbruck University Medical Center for further treatment. Medical history of the patient showed obesity and bilateral hip surgery due to hipdysplasia in early childhood. The initial lumbar puncture revealed cerebrospinal fluid (CSF) pleocytosis with 7866 cells/mm3—mainly neutrophils—and a serum/CSF glucose ratio (GR) of
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