SWACM FREE-LIVING AMEBAE

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1 SWACM LYNNE S. GARCIA, MS, FAAM, CLS, BLM Medical Chemical Corporation FREE-LIVING AMEBAE

2 PATHOGENIC FREE-LIVING AMEBAE 2 Drinking water pipeline contamination confirmed in many countries; biofilms reduce chlorine efficacy

3 PATHOGENIC FREE-LIVING AMEBAE: Naegleria fowleri Environment Wet environments, domestic water sources, power plant cooling water, well water Isolated in Arctic and sub-antarctic regions (often associated with warmer temperatures) Infection; Primary amebic meningoencephalitis Healthy immunocompetent individuals, PAM Survival Only 7 out of approximately 300 prior to 2002; death within about a week; no development of immune response Therapy often ineffective; amphotericin B 3 Can occur northern latitudes climate change/warm

4 Naegleria fowleri Primary Amebic Meningoencephalitis (PAM) 10-year-old male developed PAM 1 week after swimming in irrigation canal Admitted 9 h after severe headache, vomiting, fever, ataxic gait, confusion, seizures CSF trophozoites seen Aggressive treatment with amphotericin B, fluconazole, rifampin By 3 rd day conscious, discharged on day 23; only 9 cured cases reported 4

5 Naegleria fowleri Primary Amebic Meningoencephalitis (PAM) Neti pot sinus irrigation 28-year-old male developed PAM after a history of irrigating sinuses daily with tap water and neti pot Admitted with severe headache, vomiting, fever, neck and back pain; CSF = bacterial meningitis; antibiotics Wet mount of CSF = amebae; patient expired 51-year-old female PAM after 3 days of altered mental status, nausea, vomiting, high fever 5 Died 4 days later; neti pot use; faucets PCR + Shift from obscure to mainstream use

6 Acanthamoeba Granulomatous amebic encephalitis (GAE) Environment Soil, air, fresh water, salt water, sewage Washing the face in pond water, sand/dust in eye, inhalation, traumatic injection, entry through existing wounds or lesions Disseminated Infections Skin, brain, bones Rhinosinusitis, keratitis, otitis, vasculitis, endophthalmitis in HIV infected persons Skin lesions present, no CNS involvement Immunocompromised AIDS, lung, kidney, or liver transplants 6

7 Acanthamoeba keratitis , Illinois Dept of Public Health investigating possible increase over 3 years in ophthalmology center January, 2007, CDC began retrospective survey of 22 ophthalmology centers nationwide Data from 13 centers demonstrated increase in cultureconfirmed cases Increases begun in 2004 associated with soft contact lens wearers using Complete MoisturePlus cleaning solution; voluntary recall begun : tap water, fresh lens solutions, do not add to lens case. 7

8 Disseminated Acanthamoeba Renal Transplant Recipient 8 36-year-old female renal transplant recipient; on immunosuppressives for 4 years Autopsy showed CNS with chronic granulomatous encephalitis Predominant perivascular infiltrate of amebic cysts, trophozoites, inflammatory cells Both lungs and pancreas also showed infiltration with Acanthamoeba

9 PATHOGENIC FREE-LIVING AMEBAE (1990) Balamuthia mandrillaris 100 cases Possible history of water exposure (Peru skin plaque); proven isolation from hot water springs (2016); lens case Similar to disease caused by Acanthamoeba (GAE) Headache, nausea, vomiting, confusion, fever, seizures, coma dissemination from cutaneous lesions Granulomatous Amebic Meningoencephalitis more chronic, typically fatal; unknown incubation period Inflammatory response, amebae surrounded by macrophages, lymphocytes, neutrophils CSF wet mounts, bacterial overlay culture NOT effective, IFA, PCR Rare, but usually fatal some cures; prolonged treatment; confirmed in lens case qpcr 9

10 Balamuthia mandrillaris Clinical Findings Found in immunocompromised or immunocompetent patients; prognosis poor (90% mortality) Clinical course slow; CNS symptoms weeks prior to diagnosis and treatment transplant cases Does not cause keratitis cutaneous lesions (face) Susceptibility increased in cancers, diabetes, drug abuse, alcoholism, organ transplantation, HIV Symptoms include fever, headache, nausea, vomiting, stiff neck, focal neurological signs, changes in personality and mental status, seizures, sleepiness Tissue: amebae resemble histiocytes (can be missed) 10

11 DIAGNOSIS - TISSUE Amebic Meningoencephalitis Cysts present; granulomatous inflammation Balamuthia: Amebic Meningoencephalitis + skin plaques (face, knee) Diagnostic Options PCR simultaneous detection of all three (High specificity within 5 h); also PCR from paraffin specimens 11

12 PATHOGENIC FREE-LIVING AMEBAE 12

13 PATHOGENIC FREE-LIVING AMEBAE AGAR PLATE CULTURE, PANELS?? 13

14 THANKS QUESTIONS?? 14

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