Cure of Acanthamoeba Cerebral Abscess in a Liver Transplant Patient
|
|
- Percival Dalton
- 5 years ago
- Views:
Transcription
1 LIVER TRANSPLANTATION 14: , 2008 ORIGINAL ARTICLE Cure of Acanthamoeba Cerebral Abscess in a Liver Transplant Patient Konrad Tang-Tat Fung, 1 Amar Paul Dhillon, 2 James E. McLaughlin, 2 Sebastian B. Lucas, 3 Brian Davidson, 4 Keith Rolles, 4 David Patch, 1 and Andrew K. Burroughs 1 1 Liver Transplantation and Hepatobiliary Medicine and 2 Department of Histopathology, Royal Free Hospital, London, United Kingdom; 3 Department of Histopathology, King s College London School of Medicine, St. Thomas Hospital, London, United Kingdom; and 4 University Department of Surgery, Royal Free & University College School of Medicine, London, United Kingdom Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up. Liver Transpl 14: , AASLD. Received June 7, 2007; accepted September 17, Central nervous system (CNS) infections by free-living amoebae, including Acanthamoeba species, Balamuthia mandrillaris, and Naegleria fowleri, have been recognized only in recent decades. The first two amoebae cause chronic granulomatous encephalitis, whereas the last one causes acute fulminant meningitis. Acanthamoeba-related infection is usually limited to immunocompromized patients, although infection in healthy children has been reported. 1 Unfortunately, most of the infections are fatal and are diagnosed at autopsy. 2,3 We report the first case of successfully treated Acanthamoeba cerebral infection following liver transplantation. CASE REPORT A 41-year-old male had liver transplantation with a cadaveric donor graft in our hospital in September 1994 for end-stage alcoholic liver cirrhosis. He had a previous history of abdominal tuberculosis in 1986 and was an insulin-dependent diabetic. He recovered well after the operation and was given maintenance immunosuppression of cyclosporine, azathioprine, and prednisolone. He received fluconazole and acyclovir prophylaxis, which he continued for 6 weeks after discharge, which took place 3 weeks after the operation. At 3 months after transplantation, his prednisolone was tailed off completely. He developed depression and resumed drinking alcohol about 9 months after transplantation without affecting his graft function. He was followed up by a psychiatrist specializing in alcohol and substance abuse. Azathioprine was also stopped at the same time because of neutropenia, which subsequently recovered fully. At 14 months after transplantation, the patient was admitted as an emergency because of pyrexia, sore throat, and green sputum for 2 days. Physical examination was normal apart from the abdominal scar of his surgery. Chest X-ray showed elevated right hemidiaphragm but was otherwise normal. Cytomegalovirus polymerase chain reaction in blood was positive. Otherwise, no positive culture or serological positivity for bacteria or viruses was obtained. Ganciclovir was started on day 4 of admission. However, the patient continued to have a high unremitting fever. On day 6, Abbreviations: CNS, central nervous system; CT, computerized tomography. Address reprint requests to Andrew K. Burroughs, Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom. Telephone: ; FAX: ; andrew.burroughs@royalfree.nhs.uk DOI /lt Published online in Wiley InterScience ( American Association for the Study of Liver Diseases.
2 ACANTHAMOEBA IN LIVER TRANSPLANT 309 he developed several attacks of generalized tonic clonic convulsions and became drowsy. There was minimal neck stiffness. Subsequently, both left upper and lower limbs showed twitching. All 4 limbs withdrew to pain, and there were bilateral extensor plantar reflexes. Computerized tomography (CT) of the brain showed a suspicious low-attenuation lesion with mild ring enhancement in the left frontal lobe. No pressure effect was noted. Cerebrospinal fluid analysis revealed 152 cells/mm (90% mononuclear cells), 2.1 g/l protein, and 8.3 mmol/l glucose. No organism was grown or seen from the cerebrospinal fluid. Empirical sulfadiazine, pyrimethamine, cefotaxime, chloramphenicol, gentamicin, isoniazid, rifampicin, and pyrazinamide were given to cover toxoplasma, bacterial, and tuberculous infections. Phenytoin was given to control the seizures. A right (nondominant) frontal lobe biopsy on day 8 showed partly degenerate and inflamed cerebral tissue indicating encephalitis. No microorganism, viral inclusion, or granuloma was identified. Bacterial, viral, acid-fast-bacilli, and fungal cultures were negative. Acyclovir and amphotericin were added to cover herpes simplex virus and fungal infection, respectively. On day 10, the toxoplasma serology showed only low titers, so pyrimethamine was stopped, whereas sulfadiazine was continued to cover Nocardia infection. However, the patient did not improve. A CT scan of the brain on day 13 showed an increased extent of involvement in the right frontal lobe. His conscious level deteriorated further on day 29. An enlarged left frontal lobe lesion with corpus collosum involvement and midline shift was noted on the CT scan. Decompressive left frontal lobectomy was performed on day 31 with resection of a 5-cm diameter of the frontal lobe. The left lobectomy specimen showed diffuse hemorrhagic encephalitis with granulation tissue, scattered giant cells, focal acute inflammation, and areas of necrosis. Repeated bacterial and acid-fast-bacilli cultures were negative. The condition of the patient remained stable, although there was no further deterioration. On day 48, a CT scan of the brain showed multiple low-density lesions in the remaining left frontal lobe. The dosage of cyclosporine was reduced on day 59 in view of persistent sepsis, with the plasma concentration dropping from 93 to 58 ng/ml. Lumbar puncture was repeated on day 66, but no positive result was obtained. Review of the lobectomy specimen on day 79 showed 10- to 15- m amoebic cysts in the areas of necrosis; the cyst walls were also stained with Grocott silver and periodic acid-schiff stains; and with immunocytochemistry, these were characterized as Acanthamoeba spp. (Figs. 1-3). Rifampicin was continued at 600 mg twice daily, and co-trimoxazole was added at 960 mg twice daily for a total treatment course of 3 months. All other antibiotics were stopped. The fever subsided, and his general condition improved. Seizures were further controlled after the switch from phenytoin to carbamazepine. He initially had tetraplegia with contracture of 4 limbs, failed to sit stably, and was disorientated and unable to Figure 1. Inflamed brain and necrosis. In the center is a single empty cyst (hematoxylin-eosin stain). Figure 2. Amoebic cyst with a crenated wall and vacuolated contents (hematoxylin-eosin mucicarmine). speak. A gastrostomy tube was inserted to improve nutrition. He received intensive rehabilitation with substantial restoration of his motor and higher cerebral function over time. The patient is currently alive 11 years after the initial Acanthamoeba infection, is able to speak, stand, eat and drink, and walk with aids, but does require help at home. He has no evidence of recurrent infection. He is maintained on cyclosporine (75 mg twice daily), lamotrigine (100 mg twice daily), phenobarbitone (60 mg
3 310 FUNG ET AL. Figure 3. Immunostain identifying the cysts as of Acanthamoeba spp. (the slide is courtesy of Dr. David Warhurst, London School of Hygiene and Tropical Medicine). daily), carbamazepine (100 mg three times a day), and sulpiride (200 mg twice daily). DISCUSSION Acanthamoeba infection usually occurs in immunocompromized patients, including those with acquired immunodeficiency syndrome 2 or those with chronic debilitating illness. 4 It has been reported in 6 patients with bone marrow, 5-7 renal, 8 or lung transplantation 9 but has not been reported in patients with liver transplantation. In addition, a series of 3 patients with alcoholism has been reported. 10 It may be that the return to alcoholism in our patient predisposed him to infection, particularly as it was acquired late after transplantation, when immunosuppression had been reduced. Acanthamoeba is ubiquitous in the environment and can be found in the soil, fresh water, sea water, and even air. It does not require a host and can exist in the forms of dormant resilient cysts and infective trophozoites. Although the free-living amoeba usually causes keratitis in contact lens wearers, it may also involve the skin and CNS in immunocompromized patients. 11 The higher incidence of Acanthamoeba keratitis in the United Kingdom has been attributed to the use of large standing rooftop storage tanks as a domestic water supply. 12 Such environmental conditions may have predisposed our patient to come into contact with Acanthamoeba. The infection may be acquired by inhaling the amoeba, which produces nasal and sinus infections. 13 The brain and lungs are involved via hematogeneous spread. 2 Acanthamoeba-related CNS infection includes encephalitis and cerebral abscess. There are no distinct clinical features sufficient to make a specific diagnosis. Patients may present with fever, headache, personality changes, seizures, and confusion, classically of subacute onset, which may persist up to 2 years. Physical signs include hemiparesis, cranial nerve palsies, ataxia, and meningeal signs. 1 Cerebrospinal fluid findings vary but usually show moderately elevated protein as in our patient, low to normal glucose, and lymphocytosis, although granulocytosis may be present; however, cerebrospinal fluid may be normal. Acanthamoeba is seldom isolated from cerebrospinal fluid by routine microscopy 12 or culture, and this was also the case in our patient. A CT scan of the brain may be normal or may show a solitary contrast-enhancing mass lesion or multiple contrast-enhancing mass lesions, hemorrhagic infarct, hydrocephalus, or meningeal enhancement. 1,2,5,14 Detection of antibodies against Acanthamoeba may be helpful, but its use currently remains investigational. 15 Histological examination of the brain biopsy may show granulomatous reaction with multinucleated giant cells, necrotizing vasculitis, and inflammatory perivascular infiltrate, although such an inflammatory reaction may be absent in immunocompromized patients. In our patient, cysts of Acanthamoeba were identified. Acanthamoeba is frequently missed, as evidenced by a retrospective slide review. 7 It is not possible to differentiate Acanthamoeba from B. mandrillaris by light microscopy. It is therefore necessary to perform indirect immunostaining as various species of Acanthamoeba and B. mandrillaris are antigenically distinct. Electron microscopy is also useful as the cyst wall of Acanthamoeba has 2 layers, whereas that of Balamuthia has 3. In addition, Acanthamoeba will grow in coculture with bacteria such as Escherichia coli or Enterobacter aerogenes, but B. mandrillaris will not. 2 Unfortunately, most patients have their diagnosis made at autopsy examination, probably because of the difficulty in identifying the amoeba in microscopy, the special requirements in culture, and the poor awareness of this rare but fatal disease. There is no established treatment for Acanthamoeba-related CNS infection. The outcomes of most of the patients have been uniformly fatal, despite various treatment regimens. Table 1 summarizes the results of transplanted patients with Acanthamoeba-related CNS infection identified from a Pubmed literature search from 1966 using the keywords Acanthamoeba, transplant, and transplantation. It is clear that there has been no significant advance in the management of Acanthamoeba-related CNS infection over these 4 decades as all 6 patients reported died from the disease. Among the patients with acquired immunodeficiency syndrome, the mortality rate is also high: just 1 of the 7 patients survived as identified from a Pubmed literature search from 1966 using the keywords Acanthamoeba and AIDS. 2,16-20 Our patient survived, without recurrence of the disease over 11 years of follow-up, after being treated by surgical excision of the abscess followed by rifampicin and co-trimoxazole for 3 months. These 2 antibiotics have been used successfully in immunocompetent or acquired immunodeficiency syndrome patients with Acanthamoeba-related CNS infection, although ketoconazole, fluconazole, metronidazole, sulfadiazine, and pyrimethamine have been added to their regimens. 1,2,21 Successful treatment in our patient could also be attributed to the relatively low dose of the immunosuppression that was
4 ACANTHAMOEBA IN LIVER TRANSPLANT 311 TABLE 1. Outcomes of Transplanted Patients with Acanthamoeba-Related CNS Infection Patient Year of (Reference) Occurrence 1 (8) Not reported (before 2006) Age Organ Transplanted 2 (5) Allogenic 3 (4) Autologous stem cell 4 (6) Not reported (before 1994) 5 (6) Not reported (before 1994) Type of CNS Infection Time of Establishing the Diagnosis Treatment Received Outcome 60 Lung Encephalitis Postmortem Amphotericin, itraconazole, imipenem, ciprofloxacin, vancomycin Encephalitis Postmortem Amphotericin stem cell 39 Autologous bone marrow 32 Allogenic bone marrow Encephalitis, myelitis Postmortem Rifampicin, isoniazid, pyrazinamide, pyrimethamine, sulfadiazine, ceftriaxone Meningoencephalitis Postmortem Amphotericin, fluconazole, cotrimoxazole, metronidazole, doxycycline Meningoencephalitis Postmortem Amphotericin, fluconazole, cotrimoxazole, pyrimethamine, isoniazid, rifampicin, pyrazinamide 6 (7) Kidney Cerebral abscess Antemortem (brain biopsy) Not reported used during therapy of the infection and subsequently during maintenance as compared to the other transplanted patients who had fatal outcomes. REFERENCES 1. Singhal T, Bajpai A, Kalra V, Kabra SK, Samantaray JC, Satpathy G, et al. Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials. Pediatr Infect Dis J 2001;20: Martinez MS, Gonzalez-Mediero G, Santiago P, Rodriguez de Lope A, Diz J, Conde C, et al. Granulomatous amebic encephalitis in a patient with AIDS: isolation of Acanthamoeba sp. group II from brain tissue and successful treatment with sulfadiazine and fluconazole. J Clin Microbiol 2000;38: White JM, Barker RD, Salisbury JR, Fife AJ, Lucas SB, Warhurst DC, et al. Granulomatous amoebic encephalitis. Lancet 2004;364: Cha JH, Furie K, Kay J, Walensky RP, Mullins ME, Hedley- Whyte ET. Case records of the Massachusetts General Hospital (case ). N Engl J Med 2006;355: Feingold JM, Abraham J, Bilgrami S, Ngo N, Visvesara GS, Edwards RL, et al. Acanthamoeba meningoencephalitis following autologous peripheral stem cell transplantation. Bone Marrow Transplant 1998;22: Castellano-Sanchez A, Popp AC, Nolte FS, Visvesvara GS, Thigpen M, Reedy I, et al. Acanthamoeba castellani encephalitis following partially mismatched related donor peripheral stem cell transplantation. Transpl Infect Dis 2003;5: Anderlini P, Przepiorka D, Luna M, Langford L, Andreeff M, Claxton D, et al. Acanthamoeba meningoencephalitis after bone marrow transplantation. Bone Marrow Transplant 1994;14: Martinez AJ. Acanthamoebiasis and immunosuppression. Case report. J Neuropathol Exp Neurol 1982;41: Duarte AG, Sattar F, Granwehr B, Aronson JF, Wang Z, Lick S. Disseminated acanthamoebiasis after lung transplantation. J Heart Lung Transplant 2006;25: Martinez AJ. Is Acanthamoeba encephalitis an opportunistic infection? Neurology 1980;30: Awwad ST, Petroll WM, McCulley JP, Cavanagh HD. Updates in Acanthamoeba keratitis. Eye Contact Lens 2007; 33: Kilvington S, Gray T, Dart J, Morlet N, Beeching JR, Frazer DG, et al. Acanthamoeba keratitis: the role of domestic tap water contamination in the United Kingdom. Invest Ophthalmol Vis Sci 2004;45: Vernon SE, Acar BC, Pham SM, Fertel D. Acanthamoeba infection in lung transplantation: report of a case and review of the literature. Transpl Infect Dis 2005;7: Singh P, Kochhar R, Vashishta RK, Khandelwal N, Prabhakar S, Mohindra S, et al. Amebic meningoencephalitis: spectrum of imaging findings. Am J Neuroradiol 2006;27: Schuster FL, Honarmand S, Visvesvara GS, Glaser CA. Detection of antibodies against free-living amoebae Balamuthia mandrillaris and Acanthamoeba species in a population of patients with encephalitis. Clin Infect Dis 2006; 42: Calore EE, Cavaliere MJ, Calore NM. Cerebral amebiasis
5 312 FUNG ET AL. in the acquired immunodeficiency syndrome. Acta Neurol Belg 1997;97: Gordon SM, Steinberg JP, DuPuis MH, Kozarsky PM, Nickerson JF, Visvesvara GS. Culture isolation of Acanthamoeba species and leptomyxid amebas from patients with amebic meningoencephalitis, including two patients with AIDS. Clin Infect Dis 1992;15: Di Gregorio C, Rivasi F, Mongiardo N, De Rienzo B, Wallace S, Visvesvara GS. Acanthamoeba meningoencephalitis in a patient with acquired immunodeficiency syndrome. Arch Pathol Lab Med 1992;116: Gardner HA, Martinez AJ, Visvesvara GS, Sotrel A. Granulomatous amebic encephalitis in an AIDS patient. Neurology 1991;41: Wiley CA, Safrin RE, Davis CE, Lampert PW, Braude AI, Martinez AJ, et al. Acanthamoeba meningoencephalitis in a patient with AIDS. J Infect Dis 1987;155: Petry F, Torzewski M, Bohl J, Wilhelm-Schwenkmezger T, Scheid P, Walochnik J, et al. Early diagnosis of Acanthamoeba infection during routine cytological examination of cerebrospinal fluid. J Clin Microbiol 2006;44:
Unusual Presentation of Multiple Nerve Palsies with Granulomatous encephalitis Due to Acanthamoeba Species
Human Parasitic Diseases Case report Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Unusual Presentation of Multiple Nerve Palsies with Granulomatous encephalitis
More informationEducational Introduction and Protocol for Molecular diagnosis of Acanthamoeba infection
Educational Introduction and Protocol for Molecular diagnosis of Acanthamoeba infection Introduction: Acanthamoeba spp. are a family of free-living protozoans ubiquitously distributed in the environment,
More informationLASOP Case Presentation. Andrea D Auria, D.O. University of Southern California Department of Pathology
LASOP Case Presentation Andrea D Auria, D.O. University of Southern California Department of Pathology Clinical Presentation 62 year old male With a history of idiopathic pulmonary fibrosis 2 months status
More informationGranulomatous amebic encephalitis in a child with acute. lymphoblastic leukemia successfully treated with
JCM Accepts, published online ahead of print on 17 November 2010 J. Clin. Microbiol. doi:10.1128/jcm.01456-10 Copyright 2010, American Society for Microbiology and/or the Listed Authors/Institutions. All
More informationPathogenic Free-Living Amebae
Pathogenic Free-Living Amebae Naegleria fowleri primary amebic meningoencephalitis (PAM) Acanthamoeba spp. granulomatous amebic encephalitis (GAE) granulomatous skin and lung lesions (primarily immunocompromised)
More informationPARASITOLOGY CASE HISTORY 8 (HISTOLOGY) (Lynne S. Garcia)
PARASITOLOGY CASE HISTORY 8 (HISTOLOGY) (Lynne S. Garcia) A 12 year-old male presented with a one-day history of fever and headache on the right side. Two days after admission, he developed a stiff neck
More informationFREE-LIVING PROTOZOA. PAM GAE; skin or lung lesions amebic keratitis; GAE; skin or lung lesions
FREE-LIVING PROTOZOA Ameba Naegleria fowleri Acanthamoeba sp. Balamuthia mandrillaris Diseases PAM GAE; skin or lung lesions amebic keratitis; GAE; skin or lung lesions Naegleria fowleri ubiquitous in
More informationDownloaded from:
Phu, NH; Hoang Mai, NT; Nghia, HD; Chau, TT; Loc, PP; Thai, leh; Phuong, TM; Thai, CQ; Man, DN; Van Vinh Chau, N; Nga, TV; Campbell, J; Baker, S; Whitehorn, J (2013) Fatal consequences of freshwater pearl
More informationCNS Infections in the Pediatric Age Group
CNS Infections in the Pediatric Age Group Introduction CNS infections are frequently life-threatening In the Philippines, bacterial meningitis is one of the top leading causes of mortality in children
More informationCerebral Toxoplasmosis in HIV-Infected Patients. Ahmed Saad,MD,FACP
Cerebral Toxoplasmosis in HIV-Infected Patients Ahmed Saad,MD,FACP Introduction Toxoplasmosis: Caused by the intracellular protozoan, Toxoplasma gondii. Immunocompetent persons with primary infection
More informationCNS Infections. Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London. Hammersmith Acute Medicine 2011
CNS Infections Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London Hammersmith Acute Medicine 2011 Case 1 HISTORY 27y man Unwell 3 days Fever Headache Photophobia Previously
More informationCNS parasitic infections. Jarmila Klieščiková, MD 1.LF UK
CNS parasitic infections Jarmila Klieščiková, MD 1.LF UK Cosmopolite distribution Low prevalence Interference with underlying diseases (immunocompromised state) Treatment not always available Main pathogens
More informationVascular Disorders. Nervous System Disorders (Part B-1) Module 8 -Chapter 14. Cerebrovascular disease S/S 1/9/2013
Nervous System Disorders (Part B-1) Module 8 -Chapter 14 Overview ACUTE NEUROLOGIC DISORDERS Vascular Disorders Infections/Inflammation/Toxins Metabolic, Endocrinologic, Nutritional, Toxic Neoplastic Traumatic
More informationNasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa
Nasreen A. Syed, MD F.C. Blodi Eye Pathology Laboratory University of Iowa No financial interest in any of the material discussed in this presentation There will be discussion of off label use of medications,
More informationSuccessful Treatment of Granulomatous Amoebic Encephalitis with Combination Antimicrobial Therapy
CASE REPORT Successful Treatment of Granulomatous Amoebic Encephalitis with Combination Antimicrobial Therapy Hideki Kato 1, Shigehisa Mitake 1, Hiroyuki Yuasa 1, Shigemasa Hayashi 2, Tatsuru Hara 3 and
More informationFungal Meningitis. Stefan Zimmerli Institute for infectious diseases University of Bern Friedbühlstrasse Bern
Fungal Meningitis Stefan Zimmerli Institute for infectious diseases University of Bern Friedbühlstrasse 51 3010 Bern Death due to infectious diseases in sub-saharan Africa Park BJ. Et al AIDS 2009;23:525
More informationPathogenic amoebae and ciliate. Dr. Narissara Jariyapan Department of Parasitology Faculty of Medicine Chiang Mai University
Pathogenic amoebae and ciliate Dr. Narissara Jariyapan Department of Parasitology Faculty of Medicine Chiang Mai University Objectives After the lecture, students must know 1. General morphology of pathogenic
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 3/12/2011 Radiology Quiz of the Week # 11 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationClinical Aspect and Application of Laboratory Test in Herpes Virus Infection. Masoud Mardani M.D,FIDSA
Clinical Aspect and Application of Laboratory Test in Herpes Virus Infection Masoud Mardani M.D,FIDSA Shahidhid Bh BeheshtiMdi Medical lui Universityit Cytomegalovirus (CMV), Epstein Barr Virus(EBV), Herpes
More informationFree Living Ameba Case Report
Revised 1/27/2012 Free Living Ameba Case Report CDC USE ONLY Date of Report: Demographics Patient s Last Name First M.I. Age Gender: Ethnicity: Hispanic n-hispanic Race: White Black Asian/Pacific Islander
More informationUnit VIII Problem 6 Pathology: Meningitis
Unit VIII Problem 6 Pathology: Meningitis - Important terms: Meningitis: it is inflammation of meninges (coverings of the central nervous system) caused by infection. They are classified to: Pachymeningitis:
More informationGranulomatous Amebic Encephalitis Caused by Leptomyxid Amebae in an HIV-Infected Patient
Granulomatous Amebic Encephalitis Caused by Leptomyxid Amebae in an HIV-Infected Patient Michael T. Zagardo, Rudy J. Castellani, Gregg H. Zoarski, and Steven C. Bauserman Summary: MR images of granulomatous
More informationCryptococcal Meningitis
Cryptococcal Meningitis Dr N Thumbiran Infectious Diseases Department UKZN Index patient 27 year old female Presented to King Edward Hospital on 17/07/2005 with: Severe headaches Vomiting Photophobia X
More informationANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS Version 4.0 Date ratified February 2009 Review date February 2011 Ratified by Authors Consultation Evidence
More informationThe Pulmonary Pathology of Iatrogenic Immunosuppression. Kevin O. Leslie, M.D. Mayo Clinic Scottsdale
The Pulmonary Pathology of Iatrogenic Immunosuppression Kevin O. Leslie, M.D. Mayo Clinic Scottsdale The indications for iatrogenic immunosuppression Autoimmune/inflammatory disease Chemotherapy for malignant
More informationGeneral History. 林陳 珠 Female 69 years old 住院期間 : ~ Chief Complaint : sudden loss of conscious 5 minutes in the morning.
General History 林陳 珠 Female 69 years old 住院期間 : 93.5.8~93.5.15 Chief Complaint : sudden loss of conscious for 2-52 5 minutes in the morning. General History DM under regular medical control for 10 years.
More informationDISORDERS OF THE NERVOUS SYSTEM
DISORDERS OF THE NERVOUS SYSTEM Bell Work What s your reaction time? Go to this website and check it out: https://www.justpark.com/creative/reaction-timetest/ Read the following brief article and summarize
More informationSection 9: Amebic Meningitis/Encephalitis
Section 9: Amebic Meningitis/Encephalitis BASIC EPIDEMIOLOGY Infectious Agent Naegleria fowleri, Acanthamoeba spp. and Balamuthia are microscopic, free-living amebae (single-celled living organisms). Naegleria
More informationMay He Rest in Peace
May He Rest in Peace Neurologic Complications of AIDS Medical Knowledge Fiesta 2012 Paul K. King MD pkingmd@yahoo.com Objectives definition of HIV/AIDS what are the neurologic complications of AIDS how
More informationGUIDELINE FOR THE MANAGEMENT OF MENINGITIS. All children with suspected or confirmed meningitis
GUIDELINE FOR THE MANAGEMENT OF MENINGITIS Reference: Mennigitis Version No: 1 Applicable to All children with suspected or confirmed meningitis Classification of document: Area for Circulation: Author:
More informationSPONTANEOUS GRANULOMATOUS AMEBIC ENCEPHALITIS : REPORT OF FOUR CASES FROM THAILAND
SPONTANEOUS GRANULOMATOUS AMEBIC ENCEPHALITIS : REPORT OF FOUR CASES FROM THAILAND Tumtip Sangruchi 1, Augusto Julio Martinez 2, and Govinda S Visvesvara 3 1Department of Pathology, Siriraj Hospital Mahidol
More informationBacterial, viral, protoozal and fungal infections of the CNS
Bacterial, viral, protoozal and fungal infections of the CNS Prof. Isidro Ferrer, Institut Neuropatologia, Servei Anatomia Patològica, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona,
More informationCNS infections (1 of 2)
CNS infections (1 of 2) How can microbes enter the nervous system? Hematogenous the most common mostly arterial can be from facial veins (through anastomoses with venous sinuses of the skull) Direct implantation
More informationBrain abscess rupturing into the lateral ventricle causing meningitis: a case report
Brain abscess rupturing into the lateral ventricle causing meningitis: a case report Endry Martinez, and Judith Berger SBH Health System, 4422 Third Ave, Bronx, NY 10457 Key words: brain abscess, rupture
More informationMoath Darweesh. Zaid Emad. Anas Abu -Humaidan
3 Moath Darweesh Zaid Emad Anas Abu -Humaidan Introduction: First two lectures we talked about acute and chronic meningitis, which is considered an emergency situation. If you remember, CSF examination
More informationToxoplasma gondii. Jarmila Kliescikova, MD 1. LF UK
Toxoplasma gondii Jarmila Kliescikova, MD 1. LF UK Toxoplasma gondii Apicomplexa, Koccidia Obligate intracellular parasite Distribution: cosmopolite Transmission: alimentary transplacentary (transfusions,
More informationFever. National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital
Fever National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital Case 1 4-month-old well-appearing girl admitted for croup and respiratory distress.
More informationHospital-acquired Pneumonia
Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired
More informationCentral nervous system
Central nervous system By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 7 th Lecture Lecture outline Review of structure & function. Symptoms, signs & tests. Specific diseases. Review of structure
More informationMENINGITIS CRYPTOCOCCAL. learn about the symptoms, diagnosing and treating this disease
CRYPTOCOCCAL MENINGITIS learn about the symptoms, diagnosing and treating this disease A PUBLICATION FROM Information, Inspiration and Advocacy for People Living With HIV/AIDS JANAURY 2007 Cryptococcal
More informationAcyclovir treatment of herpes simplex encephalitis: experience
Postgraduate Medical Journal (1987) 63, 1037-1041 Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital M.C. Gulliford, C.P. Chandrasekera, R.A. Cooper and R.P. Murphy Departments
More informationFever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center
Age: 0-28 Day Pathway - Emergency Department EXCLUSION CRITERIA Toxic appearing No fever Born < 37 weeks gestational age INCLUSION CRITERIA Non-toxic with temperature > 38 C (100.4 F) < 36 C (96.5 F) measured
More informationPneumococcal Meningitis Meningitis is an inflammation of the lining around the brain and spinal cord. Most severe cases
Pneumococcal Meningitis Meningitis is an inflammation of the lining around the brain and spinal cord. Most severe cases are caused by bacteria. Pneumococcal bacteria (Streptococcus pneumoniae) are the
More informationCOPYRIGHT 2012 THE TRANSVERSE MYELITIS ASSOCIATION. ALL RIGHTS RESERVED
The Transverse Myelitis Association...advocating for those with acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis and transverse myelitis ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM)
More informationProtozoa: Introduction and classification Amoebae I. Pathogenic amoebae: Entamoeba histolytica, Naegleria fowleri, Acanthamoeba spp.
Protozoa: Introduction and classification Amoebae I. Pathogenic amoebae: Entamoeba histolytica, Naegleria fowleri, Acanthamoeba spp. Nimit Morakote, Ph.D. 1 Protozoa-Simple classification Amoebapseudopodium(a)
More informationEmergency Neurological Life Support Meningitis and Encephalitis
Emergency Neurological Life Support Meningitis and Encephalitis Version: 2.0 Last Updated: 19-Mar-2016 Checklist & Communication Meningitis and Encephalitis Table of Contents Emergency Neurological Life
More informationNeuroradiology of AIDS
Neuroradiology of AIDS Frank Minja,, HMS IV Gillian Lieberman MD September 2002 AIDS 90% of HIV patients have CNS involvement 1 10% of AIDS patients present first with neurological symptoms 2 73-80% of
More informationCase Study. Andrew L. Dunn, MD, 1 Tameika Reed, MT (ASCP), 2 Charlotte Stewart, MT (ASCP), 2 Rebecca A. Levy, MD 1,2 * ABSTRACT
Naegleria fowleri That Induces Primary Amoebic Meningoencephalitis: Rapid Diagnosis and Rare Case of Survival in a 12-Year-Old Caucasian Girl Andrew L. Dunn, MD, 1 Tameika Reed, MT (ASCP), 2 Charlotte
More informationDisseminated Balamuthia mandrillaris infection. 1 Wake Forest University Health Sciences, 2 University of North Carolina at Chapel Hill, 3
JCM Accepted Manuscript Posted Online 1 July 2015 J. Clin. Microbiol. doi:10.1128/jcm.01549-15 Copyright 2015, American Society for Microbiology. All Rights Reserved. 1 Disseminated Balamuthia mandrillaris
More informationReverse Halo Sign in Pulmonary Mucormyosis
QJM Advance Access published February 6, 2014 Reverse Halo Sign in Pulmonary Mucormyosis Yu-Hsiang Juan MD 1,2, Sachin S Saboo, MD FRCR 1, Yu-Ching Lin MD 2, James R. Conner MD, Ph.D 3, Francine L. Jacobson
More informationDilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?
Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,
More informationMANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW 1980s: dramatically improved by aciclovir HSV encephalitis in adults Delays treatment(> 48h after hospital admission): associated with a
More informationProtozoa: Introduction and classification Amoebae I. Pathogenic amoebae: Entamoeba histolytica, Naegleria fowleri, Acanthamoeba spp.
Protozoa: Introduction and classification Amoebae I. Pathogenic amoebae: Entamoeba histolytica, Naegleria fowleri, Acanthamoeba spp. Nimit Morakote, Ph.D. Protozoa-Simple classification Amoeba- pseudopodium(a)
More informationgranulomatous infectious disease in an immunosuppressed patient a case report with radiological and pathological correlation
DOWNLOAD OR READ : GRANULOMATOUS INFECTIOUS DISEASE IN AN IMMUNOSUPPRESSED PATIENT A CASE REPORT WITH RADIOLOGICAL AND PATHOLOGICAL CORRELATION PDF EBOOK EPUB MOBI Page 1 Page 2 correlation granulomatous
More informationCase Report. Herpes simplex virus encephalitis presenting as frontal lobe hemorrhage
1 Case Report Herpes simplex virus encephalitis presenting as frontal lobe hemorrhage Authors: Shila, MD, *Jessica Erfan, MPAS, PA-C, Ray Bogitch, MD, Jefferson T. Miley, MD Department of Neurology, Dell
More informationVasculitides in Surgical Neuropathology Practice
Vasculitides in Surgical Neuropathology Practice USCAP requires that all faculty in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS
More informationCritical Masses. MIDG October 2015 Myra Hardy, Jeremy Carr, Tony He, Nigel Curtis
Critical Masses MIDG October 2015 Myra Hardy, Jeremy Carr, Tony He, Nigel Curtis Case 2 16yo F 2 weeks focal seizures Intermittent left hemiparesis and sensory symptoms Headache PMHX: Asthma on Seretide
More informationOpportunistic infections in the era of cart, still a problem in resource-limited settings
Opportunistic infections in the era of cart, still a problem in resource-limited settings Cristiana Oprea Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania Assessment
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Scarborough M, Gordon SB, Whitty CJM, et al. Corticosteroids
More informationCase Report Primary Amoebic Meningoencephalitis in an Iranian Infant
Case Reports in Medicine Volume 2012, Article ID 782854, 4 pages doi:10.1155/2012/782854 Case Report Primary Amoebic Meningoencephalitis in an Iranian Infant Zahra Movahedi, 1 Mohammad Reza Shokrollahi,
More informationNeuropathology Inflammation, Infection, Demyelination in the CNS
Neuropathology Inflammation, Infection, Demyelination in the CNS PathoBasic 2016-09-20 Jürgen Hench Inflammation in the CNS inflammation generally as a reaction against pathogen, substance, necrotic, or
More informationID Emergencies. BGSMC Internal Medicine Edwin Yu
ID Emergencies BGSMC Internal Medicine Edwin Yu Learning Objectives Bacterial meningitis IDSA guidelines: Clin Infect Dis 2004; 39:1267-84 HSV encephalitis IDSA guidelines: Clin Infect Dis 2008; 47:303-27
More informationInduced encystment improves resistance to preservation and storage of Acanthamoeba castellanii
Induced encystment improves resistance to preservation and storage of Acanthamoeba castellanii 141 S. J. CAMPBELL 1,P.R.INGRAM 2, C. W. ROBERTS 2 and F. L. HENRIQUEZ 1 * 1 School of Engineering and Science,
More informationECMM Excellence Centers Quality Audit
ECMM Excellence Centers Quality Audit Person in charge: Department: Head of Department: Laboratory is accredited according to ISO 15189 (Medical Laboratories Requirements for quality and competence) Inspected
More informationFACTSHEET CICLOSPORIN. Introduction. How does ciclosporin work? When is ciclosporin used?
Introduction Ciclosporin is a potent immunosuppressant drug that requires supervision by a specialised doctor such as a dermatologist. It was originally used to prevent organ rejection in transplant patients.
More informationCentral Nervous System Immune Reconstitution Disease: Pathology
Central Nervous System Immune Reconstitution Disease: Pathology F.Gray, H.Adle-Biassette, F.Héran, G. Pialoux, A.Moulignier, APHP Hôpital Lariboisière Université Paris VII Introduction of HAART, which
More informationAseptic meningitis: inflammation of meninges with sterile CSF (without any causative organisms which can be grown on culture media).
You have to refer to the slides, since I have included the extra information only. Slide #1: Both illnesses aseptic meningitis and encephalitis can be caused by the same viruses; that viruses which cause
More informationHuman Herpes Virus-6 Limbic Encephalitis
Case Studies [1] March 19, 2013 Case history: A 32-year-old Caucasian female with newly diagnosed acute myeloid leukemia (AML) was treated with induction chemotherapy and attained complete remission. She
More informationhigher in CSF samples from patients infected with HSV type 2 (median, cells/l) than in samples from 6
MAJOR ARTICLE Clinical Features of Viral Meningitis in Adults: Significant Differences in Cerebrospinal Fluid Findings among Herpes Simplex Virus, Varicella Zoster Virus, and Enterovirus Infections Ugo
More informationENCEPHALITIS. Diana Montoya Melo
ENCEPHALITIS Diana Montoya Melo 4 yo female patient, brought to the ED after having a GTC seizure 30 mins ago, which lasted up to a min. Mom reports that he has a ho 3 days of fever and runny nose, associated
More informationEmerging Infections in Solid Organ Transplantation
Emerging Infections in Solid Organ Transplantation Sherif R. Zaki, MD, PhD Chief, Infectious Diseases Pathology Branch Division of High-consequence Pathogens and Pathology National Center of Emerging and
More informationThe exact cause of sarcoidosis is unknown. However, gender, race, and genetics can increase the risk of developing the condition:
What is sarcoidosis? Sarcoidosis is an inflammatory disease in which granulomas, or clumps of inflammatory cells, form in various organs. This causes organ inflammation. Sarcoidosis may be triggered by
More information3/25/2012. numerous micro-organismsorganisms
Congenital & Neonatal TB A Case of Tuberculosis Congenital or Acquired? Felicia Dworkin, MD NYC DOHMH Bureau TB Control World TB Day March 23, 2012 Congenital TB: acquired by the fetus during pregnancy
More informationMedical monitoring: tests available at central hospitals
medial monitoring: tests available at central hospitals: 1 medical monitoring: tests available at central hospitals Medical monitoring: tests available at central hospitals medial monitoring: tests available
More informationCryptococcosis of the Central Nervous System: Classical and Immune-Reconstitution Disease
Cryptococcosis of the Central Nervous System: Classical and Immune-Reconstitution Disease Assist Prof. Somnuek Sungkanuparph Division of Infectious Diseases Faculty of Medicine Ramathibodi Hospital Mahidol
More informationThe Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University
The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate
More informationGram Negative Bacillary Brain Abscess: Clinical Features And Therapeutic Outcome
ISPUB.COM The Internet Journal of Neurosurgery Volume 4 Number 2 Gram Negative Bacillary Brain Abscess: Clinical Features And Therapeutic Outcome F Huda, V Sharma, W Ali, M Rashid Citation F Huda, V Sharma,
More informationAcute neurological syndromes
Acute neurological syndromes Assoc.Prof. Murat Sayan Kocaeli Üniversitesi, Rutin PCR Lab. Sorumlu Öğt.Üyesi Yakın Doğu Üniversitesi, DESAM Kurucu Öğrt. Üyesi sayanmurat@hotmail.com 0533 6479020 Medical
More informationScottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) Health Protection Scotland (HPS) SSI Surveillance Protocol 7th Edition
1 Contents Female reproductive system operations (Abdominal hysterectomy and Caesarean section)... 3 Intra-abdominal infections... 3 Endometritis... 4 Other infections of the female reproductive tract...
More informationNervous System Defenses
Chapter 19 Infectious Diseases: Nervous System Topics - Nervous System Defenses - Nervous System Diseases Nervous System Defenses Nervous system Normal flora 1 2 Nervous system Central nervous system (CNS)
More informationFever in neonates (age 0 to 28 days)
Fever in neonates (age 0 to 28 days) INCLUSION CRITERIA Infant 28 days of life Temperature 38 C (100.4 F) by any route/parental report EXCLUSION CRITERIA Infants with RSV Febrile Infant 28 days old Ill
More informationFever in Lupus. 21 st April 2014
Fever in Lupus 21 st April 2014 Fever in lupus Cause of fever N= 487 % SLE fever 206 42 Infection in SLE 265 54.5 Active SLE and infection 8 1.6 Tumor fever 4 0.8 Miscellaneous 4 0.8 Crucial Question Infection
More informationUnderstanding general brain tumor pathology, Part I: The basics. Craig Horbinski, M.D., Ph.D. Department of Pathology University of Kentucky
Understanding general brain tumor pathology, Part I: The basics Craig Horbinski, M.D., Ph.D. Department of Pathology University of Kentucky plan of attack what IS a pathologist, anyway? what s so special
More informationAppendix E1. Epidemiology
Appendix E1 Epidemiology Viruses are the most frequent cause of human infectious diseases and are responsible for a spectrum of illnesses ranging from trivial colds to fatal immunoimpairment caused by
More informationGUIDELINE FOR THE MANAGEMENT OF TOXOPLASMOSIS ENCEPHALITIS
GUIDELINE FOR THE MANAGEMENT OF TOXOPLASMOSIS ENCEPHALITIS Full title of guideline Guideline for the management of toxoplasmosis encephalitis Author Dr P Venkatesan (ID consultant) Division and specialty
More informationFree living amoebae and human disease
Free living amoebae and human disease Evan Bursle Sullivan Nicolaides Pathology Whitmore Street Taringa, Qld 4068, Australia Email: evanbursle@gmail.com Jennifer Robson Sullivan Nicolaides Pathology Whitmore
More informationBRIEF COMMUNICATIONS and CASE REPORTS
Vet Pathol 41:506 510 (2004) BRIEF COMMUNICATIONS and CASE REPORTS Disseminated Infection with Balamuthia mandrillaris in a Dog O. FOREMAN, J. SYKES, L. BALL, N. YANG, AND H. DE COCK Abstract. Bilateral
More informationMANAGEMENT OF FEVER IN PEDIATRIC PATIENTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION
MANAGEMENT OF FEVER IN PEDIATRIC PATIENTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSP There are no translations available. MANAGEMENT OF FEVER IN PEDIATRIC PATIENTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANTATION
More informationOpportunistic infections
Opportunistic infections Opportunistic infections Decrease in number of CD4 lymphocytes is condition for development of opportunistic infections Risk is started, when number of CD4 lymphocytes drops to
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More informationIMAGING OF INTRACRANIAL INFECTIONS
IMAGING OF INTRACRANIAL INFECTIONS Dr Carolina Kachramanoglou LYSHOLM DEPARTMENT OF NEURORADIOLOGY NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY Plan Introduce MR sequences that are useful in the diagnosis
More informationAtlas of the Vasculitic Syndromes
CHAPTER e40 Atlas of the Vasculitic Syndromes Carol A. Langford Anthony S. Fauci Diagnosis of the vasculitic syndromes is usually based upon characteristic histologic or arteriographic findings in a patient
More informationImmunodeficiencies HIV/AIDS
Immunodeficiencies HIV/AIDS Immunodeficiencies Due to impaired function of one or more components of the immune or inflammatory responses. Problem may be with: B cells T cells phagocytes or complement
More informationTest Requested Specimen Ordering Recommendations
Microbiology Essentials Culture and Sensitivity (C&S) Urine C&S Catheter Surgical (excluding kidney aspirates) Voided Requisition requirements o Specific method of collection MUST be indicated o Indicate
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Carrera J-P, Forrester N, Wang E, et al. Eastern equine encephalitis
More informationAcanthamoeba Rhinosinusitis
CASE REPORTS Acanthamoeba Rhinosinusitis J. Matthew Dickson, MD, Peter J. Zetler, MD, Blair Walker, MD, and Amin R. Javer, MD A canthamoeba is a rare cause of infection in acquired immune deficiency syndrome
More informationHths 2231 Laboratory 7 Infection
Watch Movie: Meningitis Answer the movie questions on the worksheet. Complete activities 1-3. Activity #1: Go to the patho web page and click on activity 1. Click on Tutorials Click on Immunopathology
More informationMohammad HANAFIAH, 2 Azura Mohamed Mukhari SHAHIZON, 1,2 Mohd Farhan HAMDAN, 3 Sau Wei WONG, 3 Yoganathan KANAHESWARI
Neurology Asia 2018; 23(2) : 179 184 Acanthamoeba encephalitis in an immunocompetent child and review of the imaging features of intracranial acanthamoebic infections in immunocompetent patients 1,2 Mohammad
More informationSurgical indications: Non-malignant pulmonary diseases. Punnarerk Thongcharoen
Surgical indications: Non-malignant pulmonary diseases Punnarerk Thongcharoen Non-malignant Malignant as a pathological term: Cancer Non-malignant = not cancer Malignant as an adjective: Disposed to cause
More information