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Sample records for primary amoebic meningoencephalitis

  1. Primary Amoebic Meningoencephalitis.

    PubMed

    Gupta, Ritu; Parashar, M K; Kale, Aditya

    2015-04-01

    Primary amoebic meningoencephalitis due to free living amoeba, also called 'brain eating amoeba', Naegleria fowleri, was detected in retroviral disease patient of 40 years who has history of using well water. Patient was admitted with severe headache, fever intermittent, nausea, vomiting and slurring of speech. CT scan and MRI scan findings were normal. CSF examination showed increased protein, low sugar and predominant lymphocytes. CSF was negative for cryptococcal antigen but wet mount preparation showed highly motile free living amoeba Naegleria fowleri. Patient was put on Amphotericin B, Metronidazole, Rifampicin in addition to ART and ATT and other supportive medications. His headache was relieved and patient improved and was discharged on request. Earlier eight cases have been reported from India of which four cases survived the acute episode. PMID:26591176

  2. Primary Amoebic Meningoencephalitis.

    PubMed

    Gupta, Ritu; Parashar, M K; Kale, Aditya

    2015-04-01

    Primary amoebic meningoencephalitis due to free living amoeba, also called 'brain eating amoeba', Naegleria fowleri, was detected in retroviral disease patient of 40 years who has history of using well water. Patient was admitted with severe headache, fever intermittent, nausea, vomiting and slurring of speech. CT scan and MRI scan findings were normal. CSF examination showed increased protein, low sugar and predominant lymphocytes. CSF was negative for cryptococcal antigen but wet mount preparation showed highly motile free living amoeba Naegleria fowleri. Patient was put on Amphotericin B, Metronidazole, Rifampicin in addition to ART and ATT and other supportive medications. His headache was relieved and patient improved and was discharged on request. Earlier eight cases have been reported from India of which four cases survived the acute episode.

  3. Primary amoebic (Naegleria) meningoencephalitis.

    PubMed

    Lam, A H; de Silva, M; Procopis, P; Kan, A

    1982-06-01

    The computed tomographic (CT) appearance of a case of primary meningoencephalitis due to the free living amoeba Naegleria fowleri is presented. The cisterns around and above the midbrain and the subarachnoid spaces were obliterated on precontrast CT. Marked enhancement in these regions was seen after intravenous contrast medium administration. The sulci and adjacent grey matter were also strongly enhanced. The ventricular size was normal. Pathological findings were those of arachnoiditis and invasion of the leptomeninges and brain substance by amoebae, especially at the base of the brain and cerebellum. PMID:7096709

  4. Primary amoebic meningoencephalitis in Britain.

    PubMed

    Symmers, W C

    1969-11-22

    Primary amoebic meningoencephalitis is caused by amoebae of the genera Naegleria and Hartmannella (Acanthamoeba), which ordinarily are free-living saprophytes. The infection may be acquired from fresh water-for example, while bathing-the amoebae invading the nasal mucosa and reaching the meninges and brain along the olfactory nerve filaments. The disease is designated "primary" to distinguish it from meningocerebral infection caused by the parasitic amoebae, particularly Entamoeba histolytica, which invade the central nervous system only as a result of dissemination in the blood stream from lesions in other parts of the body.During histological reappraisal of old specimens in a medical museum in London an instance of amoebic meningoencephalitis histologically indistinguishable from the published cases has been found. The specimen dates from 1909. The patient was said to be from Essex. What may have been another case, seen in Northern Ireland in 1937, is also described briefly. These observations may indicate that this disease occurs in the British Isles.Primary amoebic meningoencephalitis should be considered in the differential diagnosis of every case of acute meningitis. PMID:5354833

  5. Primary Amoebic Meningoencephalitis in Britain

    PubMed Central

    Apley, J.; Clarke, S. K. R.; Roome, A. P. C. H.; Sandry, S. A.; Saygi, G.; Silk, B.; Warhurst, D. C.

    1970-01-01

    Meningoencephalitis proved to be due to an amoeba (Naegleria) has been diagnosed in Great Britain for the first time. The first patient (a boy of 2) survived longer than any previously recorded cases, but in spite of early diagnosis and treatment he died 15 days after the onset of meningeal symptoms. Two other children who were exposed to the same possible source of infection (a warm, muddy puddle) had similar symptoms and developed mild meningitis. A naegleria was isolated from the cerebrospinal fluid of one of them. Both recovered after treatment with amphotericin. ImagesFIG. 1p597-b PMID:5440234

  6. Primary amoebic meningoencephalitis in an Iranian infant.

    PubMed

    Movahedi, Zahra; Shokrollahi, Mohammad Reza; Aghaali, Mohammad; Heydari, Hosein

    2012-01-01

    Introduction. Naegleria fowleri, a free living amoeba, can cause devastating and deadly diseases in humans. This is the first report of primary amoebic meningoencephalitis from Iran. Case report. A five-month-old male infant presented with the history of fever and eye gaze for three days, after beginning of bacterial meningitis, a plain and contrast CT revealed communicated hydrocephalus. In the repeat of CSF analysis on microscopic examination of wet preparation of CSF, Naegleria Fowleri was seen. Then, Amphotericin B and Rifampin were started. On followup, two months later, the patient was totally asymptomatic. Conclusion. Though occurrence of PAM is rare, this unusual disease has grave prognosis, so infection with free living amoebas must be considered in differential diagnosis of pediatric patients of purulent meningitis without evidence of bacteria on Gram's stain and imaging findings, nonspecific brain edema on CT or hydrocephalus even without history of contact. PMID:22899941

  7. Primary Amoebic Meningoencephalitis in an Iranian Infant

    PubMed Central

    Movahedi, Zahra; Shokrollahi, Mohammad Reza; Aghaali, Mohammad; Heydari, Hosein

    2012-01-01

    Introduction. Naegleria fowleri, a free living amoeba, can cause devastating and deadly diseases in humans. This is the first report of primary amoebic meningoencephalitis from Iran. Case report. A five-month-old male infant presented with the history of fever and eye gaze for three days, after beginning of bacterial meningitis, a plain and contrast CT revealed communicated hydrocephalus. In the repeat of CSF analysis on microscopic examination of wet preparation of CSF, Naegleria Fowleri was seen. Then, Amphotericin B and Rifampin were started. On followup, two months later, the patient was totally asymptomatic. Conclusion. Though occurrence of PAM is rare, this unusual disease has grave prognosis, so infection with free living amoebas must be considered in differential diagnosis of pediatric patients of purulent meningitis without evidence of bacteria on Gram's stain and imaging findings, nonspecific brain edema on CT or hydrocephalus even without history of contact. PMID:22899941

  8. Primary Amoebic Meningoencephalitis in an Infant due to Naegleria fowleri

    PubMed Central

    Khanna, Vinay; Khanna, Ruchee; Hebbar, Shrikiran; Shashidhar, V.; Mundkar, Sunil; Munim, Frenil; Annamalai, Karthick; Nayak, Deepak; Mukhopadhayay, Chiranjay

    2011-01-01

    Primary amoebic meningoencephalitis (PAM) caused by free-living amebae Naegleria fowleri is a rare and fatal condition. A fatal case of primary amoebic meningoencephalitis was diagnosed in a 5-month-old infant who presented with the history of decrease breast feeding, fever, vomiting, and abnormal body movements. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and infant was put on amphotericin B and ceftazidime. Patient condition deteriorated, and he was discharged against medical advice and subsequently expired. We also reviewed previously reported 8 Indian cases of primary amoebic meningoencephalitis (PAM) and observed that for the last 5 years, none of the patients responded to amphotericin B. Has an era of amphotericin B-resistant Naegleria fowleri been emerged? Management strategy of PAM needs to be reviewed further. PMID:22937346

  9. Primary Amoebic Meningoencephalitis: Neurochemotaxis and Neurotropic Preferences of Naegleria fowleri.

    PubMed

    Baig, Abdul Mannan

    2016-08-17

    Naegleria fowleri causes one of the most devastating necrotic meningoencephalitis in humans. The infection caused by this free-living amoeba is universally fatal within a week of onset of the signs and symptoms of the disease called primary amoebic meningoencephalitis (PAM). In all the affected patients, there is always a history of entry of water into the nose. Even though the diagnostic and treatment protocols have been revised and improved, the obstinate nature of the disease can be gauged by the fact that the mortality rate has persisted around ∼95% over the past 60 years. Some of the unanswered questions regarding PAM are is there a neurochemical basis of the chemotaxis of N. fowleri to the brain? What immune evasion means occurs preceding the neurotropic invasion? What is the contribution of the acute inflammatory response in the fatal cases? Can a combination of anti-amoebic drugs with antagonism of the acute inflammation help save the patient's life? As prevention remains the most valuable safeguard against N. fowleri, a quicker diagnosis, better understanding of the pathogenesis of PAM coupled with testing of newer and safer drugs could improve the chances of survival in patients affected with PAM. PMID:27447543

  10. Primary Amoebic Meningoencephalitis: Neurochemotaxis and Neurotropic Preferences of Naegleria fowleri.

    PubMed

    Baig, Abdul Mannan

    2016-08-17

    Naegleria fowleri causes one of the most devastating necrotic meningoencephalitis in humans. The infection caused by this free-living amoeba is universally fatal within a week of onset of the signs and symptoms of the disease called primary amoebic meningoencephalitis (PAM). In all the affected patients, there is always a history of entry of water into the nose. Even though the diagnostic and treatment protocols have been revised and improved, the obstinate nature of the disease can be gauged by the fact that the mortality rate has persisted around ∼95% over the past 60 years. Some of the unanswered questions regarding PAM are is there a neurochemical basis of the chemotaxis of N. fowleri to the brain? What immune evasion means occurs preceding the neurotropic invasion? What is the contribution of the acute inflammatory response in the fatal cases? Can a combination of anti-amoebic drugs with antagonism of the acute inflammation help save the patient's life? As prevention remains the most valuable safeguard against N. fowleri, a quicker diagnosis, better understanding of the pathogenesis of PAM coupled with testing of newer and safer drugs could improve the chances of survival in patients affected with PAM.

  11. Primary amoebic meningoencephalitis: first reported case from Rohtak, North India.

    PubMed

    Gupta, Naveen; Bhaskar, Hemlata; Duggal, Shalini; Ghalaut, Pratap S; Kundra, Shailja; Arora, Des R

    2009-06-01

    A fatal case of primary amoebic encephalitis (PAM) in a 20 year old boy, a proven case of acute leukemic leukemia (ALL) type L2, in remission is described. No history of swimming could be elicited. The clinical presentation, the isolation of the amoeba from the cerebrospinal fluid (CSF), the poor response to amphotericin B, and the ultimately fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperature 42 degrees C and 45 degrees C, morphology of trophozoite, and the presence of flagellate forms in CSF, the amoeba was identified as Naegleria fowleri. Other drugs used in combination with amphotericin B are tetracycline, rifampicin, and miconazole. A possibility of PAM should always be considered in all cases of acute purulent meningoencephalitis in which no bacteria or fungus are found.

  12. Primary amoebic meningoencephalitis in North Queensland: the paediatric experience.

    PubMed

    Nicholls, Claire L; Parsonson, Fiona; Gray, Lawrence Ek; Heyer, Adele; Donohue, Steven; Wiseman, Greg; Norton, Robert

    2016-10-01

    Primary amoebic meningoencephalitis (PAM) is a fulminant, diffuse haemorrhagic meningoencephalitis caused by Naegleria fowleri, with an almost invariably fatal outcome. In Australia and the developed world, PAM remains a rare disease, although it is very likely that large numbers of cases go undetected in developing countries. N. fowleri is a thermophilic, free-living amoeba with a worldwide distribution. It is acquired when contaminated fresh water is flushed into the nose and penetrates the central nervous system via the cribriform plate. Clinical features are similar to those of bacterial meningitis, but it does not respond to standard therapy and rapid progression to death occurs in most cases. Some survivors have been reported; these patients received early treatment with amphotericin B in combination with a variety of other medications. Our review describes the local and worldwide experience of this disease and its clinical features, and discusses the associated diagnostic challenges. We hope that by detailing the local response to a recent case, and the outcomes of our public health campaign, we can improve the knowledge of this rare disease for doctors working in rural and remote Australia. PMID:27681975

  13. Primary amoebic meningoencephalitis with subsequent organ procurement: a case study.

    PubMed

    Tuppeny, Misti

    2011-10-01

    Primary amoebic meningoencephalitis (PAM) is a rare and rapidly fatal disease caused by the Naegleria fowleri amoeba. It is a diagnosis rarely seen by medical personnel, yet this amoeba is frequently encountered by people who frequent freshwater bodies of water in certain states. The disease primarily affects children and young adults who swim or take part in water sports in the waters in which the amoeba thrive. The disease presents with symptomatology similar to bacterial meningitis: headache, stiff neck, altered mental status, seizures, and coma with a quick progression to death. Rapid diagnosis is imperative to facilitate prompt treatment, although PAM has 95% mortality. There have been only 10 survivors reported in medical literature. This disease is a public-health risk to those living in affected areas of the country. Healthcare providers need to be cognizant of the disease as well, and, although recovery is rare, focus on prevention and risk reduction strategies is imperative. It is not completely understood why, of the millions of people are exposed to freshwater with the amoeba, only a few become infected with it. The Centers for Disease Control and Prevention have suggested that all freshwater areas should always assume a level of risk in waters, even when signage is not posted. This case study will review a fatal case of Naegleria fowleri infection in a young patient and will include the pathophysiology, diagnosis, treatment, nursing and public health implications, and organ procurement that occurred with the patient.

  14. Characterization of brain inflammation during primary amoebic meningoencephalitis.

    PubMed

    Cervantes-Sandoval, Isaac; Serrano-Luna, José de Jesús; García-Latorre, Ethel; Tsutsumi, Víctor; Shibayama, Mineko

    2008-09-01

    Naegleria fowleri is a free-living amoeba and the etiologic agent of primary amoebic meningoencephalitis (PAM). Trophozoites reach the brain by penetrating the olfactory epithelium, and invasion of the olfactory bulbs results in an intense inflammatory reaction. The contribution of the inflammatory response to brain damage in experimental PAM has not been delineated. Using both optical and electron microscopy, we analyzed the morphologic changes in the brain parenchyma due to inflammation during experimental PAM. Several N. fowleri trophozoites were observed in the olfactory bulbs 72 h post-inoculation, and the number of amoebae increased rapidly over the next 24 h. Eosinophils and neutrophils surrounding the amoebae were then noted at later times during infection. Electron microscopic examination of the increased numbers of neutrophils and the interactions with trophozoites indicated an active attempt to eliminate the amoebae. The extent of inflammation increased over time, with a predominant neutrophil response indicating important signs of damage and necrosis of the parenchyma. These data suggest a probable role of inflammation in tissue damage. To test the former hypothesis, we used CD38-/- knockout mice with deficiencies in chemotaxis to compare the rate of mortality with the parental strain, C57BL/6J. The results showed that inflammation and mortality were delayed in the knockout mice. Based on these results, we suggest that the host inflammatory response and polymorphonuclear cell lysis contribute to a great extent to the central nervous system tissue damage. PMID:18374627

  15. Primary amoebic meningoencephalitis with subsequent organ procurement: a case study.

    PubMed

    Tuppeny, Misti

    2011-10-01

    Primary amoebic meningoencephalitis (PAM) is a rare and rapidly fatal disease caused by the Naegleria fowleri amoeba. It is a diagnosis rarely seen by medical personnel, yet this amoeba is frequently encountered by people who frequent freshwater bodies of water in certain states. The disease primarily affects children and young adults who swim or take part in water sports in the waters in which the amoeba thrive. The disease presents with symptomatology similar to bacterial meningitis: headache, stiff neck, altered mental status, seizures, and coma with a quick progression to death. Rapid diagnosis is imperative to facilitate prompt treatment, although PAM has 95% mortality. There have been only 10 survivors reported in medical literature. This disease is a public-health risk to those living in affected areas of the country. Healthcare providers need to be cognizant of the disease as well, and, although recovery is rare, focus on prevention and risk reduction strategies is imperative. It is not completely understood why, of the millions of people are exposed to freshwater with the amoeba, only a few become infected with it. The Centers for Disease Control and Prevention have suggested that all freshwater areas should always assume a level of risk in waters, even when signage is not posted. This case study will review a fatal case of Naegleria fowleri infection in a young patient and will include the pathophysiology, diagnosis, treatment, nursing and public health implications, and organ procurement that occurred with the patient. PMID:21926523

  16. Primary amoebic meningoencephalitis after swimming in the Rio Grande.

    PubMed

    DeNapoli, T S; Rutman, J Y; Robinson, J R; Rhodes, M M

    1996-10-01

    We report a case of fatal primary amoebic meningoencephalitis (PAM) with Naegleria fowleri in a 13-year-old male, and review the clinical course and diagnostic autopsy findings. The boy developed the infection after swimming with relatives in the Rio Grande and in a holding tank containing water pumped from the river. The clinical and neuropathologic features of PAM are presented. The microscopic features of motile unicellular organisms with pathognomonic broad, lobate pseudopodia are diagnostic and, if recognized before death, allow for timely treatment. A public health investigation into this case implicated river water from the Rio Grande polluted with sewage as the infection source. Exposure to polluted river water from some areas of the Rio Grande may represent a risk factor for infection with Naegleria fowerli, because the high levels of coliform bacteria found in sewage and the warm, sluggish water of the river are favorable growth conditions for the amoebae. Because the Rio Grande is an international border, this case illustrates the importance of international cooperation in pollution control in the prevention of a potentially fatal infectious disease.

  17. Characterization of brain inflammation during primary amoebic meningoencephalitis.

    PubMed

    Cervantes-Sandoval, Isaac; Serrano-Luna, José de Jesús; García-Latorre, Ethel; Tsutsumi, Víctor; Shibayama, Mineko

    2008-09-01

    Naegleria fowleri is a free-living amoeba and the etiologic agent of primary amoebic meningoencephalitis (PAM). Trophozoites reach the brain by penetrating the olfactory epithelium, and invasion of the olfactory bulbs results in an intense inflammatory reaction. The contribution of the inflammatory response to brain damage in experimental PAM has not been delineated. Using both optical and electron microscopy, we analyzed the morphologic changes in the brain parenchyma due to inflammation during experimental PAM. Several N. fowleri trophozoites were observed in the olfactory bulbs 72 h post-inoculation, and the number of amoebae increased rapidly over the next 24 h. Eosinophils and neutrophils surrounding the amoebae were then noted at later times during infection. Electron microscopic examination of the increased numbers of neutrophils and the interactions with trophozoites indicated an active attempt to eliminate the amoebae. The extent of inflammation increased over time, with a predominant neutrophil response indicating important signs of damage and necrosis of the parenchyma. These data suggest a probable role of inflammation in tissue damage. To test the former hypothesis, we used CD38-/- knockout mice with deficiencies in chemotaxis to compare the rate of mortality with the parental strain, C57BL/6J. The results showed that inflammation and mortality were delayed in the knockout mice. Based on these results, we suggest that the host inflammatory response and polymorphonuclear cell lysis contribute to a great extent to the central nervous system tissue damage.

  18. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

    PubMed

    Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

    2014-08-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries. PMID:25121759

  19. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

    PubMed

    Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

    2014-08-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries.

  20. Primary Amoebic Meningoencephalitis Caused by Naegleria fowleri: An Old Enemy Presenting New Challenges

    PubMed Central

    Siddiqui, Ruqaiyyah; Khan, Naveed Ahmed

    2014-01-01

    First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France). A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries. PMID:25121759

  1. Diagnosis of the primary amoebic meningoencephalitis due to Naegleria fowleri.

    PubMed

    Hara, Tatsuru; Fukuma, Toshihide

    2005-12-01

    Trophozoites of the free-living amoeba, Naegleria fowleri, were isolated from the cerebrospinal fluid of meningoencephalitis patient. The infecting agent was identified as N. fowleri based on morphologic, serologic and molecular techniques carried out on the isolated organisms.

  2. Diagnosis of the primary amoebic meningoencephalitis due to Naegleria fowleri.

    PubMed

    Hara, Tatsuru; Fukuma, Toshihide

    2005-12-01

    Trophozoites of the free-living amoeba, Naegleria fowleri, were isolated from the cerebrospinal fluid of meningoencephalitis patient. The infecting agent was identified as N. fowleri based on morphologic, serologic and molecular techniques carried out on the isolated organisms. PMID:16002330

  3. [Molecular diagnosis of a fatal primary amoebic meningoencephalitis in Guadeloupe (French West Indies)].

    PubMed

    Nicolas, M; De Jonckheere, J F; Pernin, P; Bataille, H; Le Bris, V; Herrmann-Storck, C

    2010-02-01

    We report the first case of primary amoebic meningoencephalitis in a 9-year-old boy in Guadeloupe. The outcome was rapidly fatal in 7 days. The patient presumably acquired the infection by swimming and diving in a basin supplied by natural thermal water 1 week before onset of the disease. The possibility of a free-living amoeba infection was suspected both on the negativity of all bacterial and viral initial tests and on the observation of peculiar cells in stained cerebrospinal fluid samples. Although the amoeba was not isolated, Naegleria fowleri could be identified by polymerase chain reaction with specific primers on DNA extracted from frozen cerebrospinal fluid samples. Furthermore, as the internal transcribed spacer (ITS1) region of DNA is variable in length between the different strains of N. fowleri, sequencing of the amplified ITS1 demonstrated that the responsible N. fowleri strain belongs to a common genotype present in the American and European continent. PMID:20099054

  4. Isolation of the etiological agent of primary amoebic meningoencephalitis from artifically heated waters.

    PubMed

    Stevens, A R; Tyndall, R L; Coutant, C C; Willaert, E

    1977-12-01

    To determine whether artificial heating of water by power plant discharges facilitates proliferation of the pathogenic free-living amoebae that cause primary amoebic meningoencephalitis, water samples (250 ml) were taken from discharges within 3,000 feet (ca. 914.4 m) of power plants and were processed for amoeba culture. Pathogenic Naegleria fowleri grew out of water samples from two of five lakes and rivers in Florida and from one of eight man-made lakes in Texas. Pathogenic N. fowleri did not grow from water samples taken from cooling towers and control lakes, the latter of which had no associated power plants. The identification of N. fowleri was confirmed by pathogenicity in mice and by indirect immunofluorescence analyses, by using a specific antiserum. PMID:596872

  5. Primary amoebic meningoencephalitis in Thailand: report of a case and review literatures.

    PubMed

    Sirinavin, S; Jariya, P; Lertlaituan, P; Chuahirun, S; Pongkripetch, M

    1989-01-01

    Primary amoebic meningoencephalitis (PAM) which is caused by free-living amoeba, Naegleria fowleri, is a rare disease. We report the fifth case in Thailand in order to add more information. The patient was a previously healthy 4 1/2-year-old girl from Nakhon Pathom province. For several weeks before this illness she had swum in a water supply canal. She developed high fever with change in consciousness. Her cerebrospinal fluid contained numerous Naegleria fowleri which grew in culture media and mice inoculation. She did not respond to treatment with intravenous and intraventricular amphotericin B, and oral rifampicin. She died on the fifth day of illness. Water sample from the canal also grew N. fowleri. All five reported cases in Thailand were reviewed. It was found that none of them had been exposed to a common source. Four of the five cases were male, and four cases occurred during the summer months, March to May. These findings agree with worldwide information. PMID:2659717

  6. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008.

    PubMed

    Yoder, J S; Eddy, B A; Visvesvara, G S; Capewell, L; Beach, M J

    2010-07-01

    Naegleria fowleri, a free-living, thermophilic amoeba ubiquitous in the environment, causes primary amoebic meningoencephalitis (PAM), a rare but nearly always fatal disease of the central nervous system. While case reports of PAM have been documented worldwide, very few individuals have been diagnosed with PAM despite the vast number of people who have contact with fresh water where N. fowleri may be present. In the USA, 111 PAM case-patients have been prospectively diagnosed, reported, and verified by state health officials since 1962. Consistent with the literature, case reports reveal that N. fowleri infections occur primarily in previously healthy young males exposed to warm recreational waters, especially lakes and ponds, in warm-weather locations during summer months. The annual number of PAM case reports varied, but does not appear to be increasing over time. Because PAM is a rare disease, it is challenging to understand the environmental and host-specific factors associated with infection in order to develop science-based, risk reduction messages for swimmers. PMID:19845995

  7. Characterization of Naegleria fowleri strains isolated from human cases of primary amoebic meningoencephalitis in Mexico.

    PubMed

    Cervantes-Sandoval, Isaac; de Serrano-Luna, José Jesús; Tapia-Malagón, José Luis; Pacheco-Yépez, Judith; Silva-Olivares, Angélica; Galindo-Gómez, Silvia; Tsutsumi, Victor; Shibayama, Mineko

    2007-01-01

    The protozoon Naegleria fowleri (N. fowleri) is a free-living amoeba that produces primary amoebic meningoencephalitis (PAM), which is an acute and frequently fatal infection of the central nervous system. We characterized the strains of N. fowleri isolated from the cerebrospinal fluid (CSF) of two cases presented in northwestern Mexico. The strains were isolated and cultured in 2% bactocasitone medium. Enflagellation assays, ultrastructural analysis, protein and protease electrophoresis patterns, and PCR were performed as confirmatory tests. Virulence tests were done using in Balb/c mice. Light microscopy analysis of brain tissue showed amoebae with abundant inflammatory reaction and extensive necrotic and hemorrhagic areas. The enflagellation assay was positive and the electron microscopy showed trophozoites with morphologic features typical of the genus. Protein and protease profiles of the isolated strains were identical to the reference strain. Finally, a 1500-bp PCR product was found in all three strains. Based on all the analyses performed, we concluded that the etiologic agent of both PAM cases was N. fowleri. The need for better epidemiological information and educational programs about basic clinical and pathological aspects of free-living amoebae provided by the health authorities are emphasized.

  8. Assessing the risk of primary amoebic meningoencephalitis from swimming in the presence of environmental Naegleria fowleri.

    PubMed

    Cabanes, P A; Wallet, F; Pringuez, E; Pernin, P

    2001-07-01

    Free-living Naegleria fowleri amoebae cause primary amoebic meningoencephalitis (PAM). Because of the apparent conflict between their ubiquity and the rarity of cases observed, we sought to develop a model characterizing the risk of PAM after swimming as a function of the concentration of N. fowleri. The probability of death from PAM as a function of the number of amoebae inhaled is modeled according to results obtained from animals infected with amoeba strains. The calculation of the probability of inhaling one or more amoebae while swimming is based on a double hypothesis: that the distribution of amoebae in the water follows a Poisson distribution and that the mean quantity of water inhaled while swimming is 10 ml. The risk of PAM for a given concentration of amoebae is then obtained by summing the following products: the probability of inhaling n amoebae x the probability of PAM associated with inhaling these n amoebae. We chose the lognormal model to assess the risk of PAM because it yielded the best analysis of the studentized residuals. Nonetheless, the levels of risk thereby obtained cannot be applied to humans without correction, because they are substantially greater than those indicated by available epidemiologic data. The curve was thus adjusted by a factor calculated with the least-squares method. This provides the PAM risk in humans as a function of the N. fowleri concentration in the river. For example, the risk is 8.5 x 10(-8) at a concentration of 10 N. fowleri amoebae per liter. PMID:11425704

  9. Review of Clinical Presentations in Thai Patients With Primary Amoebic Meningoencephalitis

    PubMed Central

    Wiwanitkit, Viroj

    2004-01-01

    Context: Primary amoebic meningoencephalitis (PAM) is a very rare but deadly infection of the central nervous system. Since the disease was first identified in 1965, fewer than 200 cases have been observed worldwide. Objective: The author performed a literature review of the reports of PAM in Thailand in order to study the clinical summary of PAM among Thai patients. Design: This study was designed as a descriptive retrospective study. A literature review of the papers concerning PAM in Thailand was performed. Results: According to this study, there have been at least 12 reports of PAM in Thailand, of which 2 cases were nonlethal. The mean age was 15.2 ± 16.1 years with a male:female ratio of about 2:1. History of risk behaviors such as suffocation of surface water during swimming was demonstrated in 6 cases. Also, 2 interesting cases involved possible water contact according to the Thai tradition and culture. Concerning the patients' clinical features, fever, headache, impaired consciousness, and stiff neck were seen in all cases. However, some unusual presentations such as intermittent abdominal pain and convulsion were also seen in this series. Similar to worldwide findings, most cases occurred during the summer months. Most of the cases involved young males from rural provinces in various regions of Thailand. Concerning the laboratory investigation, the cerebrospinal fluid (CSF) profile presented the polymorphonuclear (PMN) pleomorphic with hypoglycorhachia pattern. Trophozoite could be identified in all but 2 cases in this series. Conclusion: PAM is sporadically reported in Thailand but remains a public health issue. The clinical diagnosis of PAM is usually difficult as many clinicians are unfamiliar with the disease. The prognosis outcome is usually grave although broad medications are prescribed. PMID:15208515

  10. Assessing the Risk of Primary Amoebic Meningoencephalitis from Swimming in the Presence of Environmental Naegleria fowleri

    PubMed Central

    Cabanes, Pierre-André; Wallet, France; Pringuez, Emmanuelle; Pernin, Pierre

    2001-01-01

    Free-living Naegleria fowleri amoebae cause primary amoebic meningoencephalitis (PAM). Because of the apparent conflict between their ubiquity and the rarity of cases observed, we sought to develop a model characterizing the risk of PAM after swimming as a function of the concentration of N. fowleri. The probability of death from PAM as a function of the number of amoebae inhaled is modeled according to results obtained from animals infected with amoeba strains. The calculation of the probability of inhaling one or more amoebae while swimming is based on a double hypothesis: that the distribution of amoebae in the water follows a Poisson distribution and that the mean quantity of water inhaled while swimming is 10 ml. The risk of PAM for a given concentration of amoebae is then obtained by summing the following products: the probability of inhaling n amoebae × the probability of PAM associated with inhaling these n amoebae. We chose the lognormal model to assess the risk of PAM because it yielded the best analysis of the studentized residuals. Nonetheless, the levels of risk thereby obtained cannot be applied to humans without correction, because they are substantially greater than those indicated by available epidemiologic data. The curve was thus adjusted by a factor calculated with the least-squares method. This provides the PAM risk in humans as a function of the N. fowleri concentration in the river. For example, the risk is 8.5 × 10−8 at a concentration of 10 N. fowleri amoebae per liter. PMID:11425704

  11. The mitochondrial genome and a 60-kb nuclear DNA segment from Naegleria fowleri, the causative agent of primary amoebic meningoencephalitis.

    PubMed

    Herman, Emily K; Greninger, Alexander L; Visvesvara, Govinda S; Marciano-Cabral, Francine; Dacks, Joel B; Chiu, Charles Y

    2013-01-01

    Naegleria fowleri is a unicellular eukaryote causing primary amoebic meningoencephalitis, a neuropathic disease killing 99% of those infected, usually within 7-14 days. Naegleria fowleri is found globally in regions including the US and Australia. The genome of the related nonpathogenic species Naegleria gruberi has been sequenced, but the genetic basis for N. fowleri pathogenicity is unclear. To generate such insight, we sequenced and assembled the mitochondrial genome and a 60-kb segment of nuclear genome from N. fowleri. The mitochondrial genome is highly similar to its counterpart in N. gruberi in gene complement and organization, while distinct lack of synteny is observed for the nuclear segments. Even in this short (60-kb) segment, we identified examples of potential factors for pathogenesis, including ten novel N. fowleri-specific genes. We also identified a homolog of cathepsin B; proteases proposed to be involved in the pathogenesis of diverse eukaryotic pathogens, including N. fowleri. Finally, we demonstrate a likely case of horizontal gene transfer between N. fowleri and two unrelated amoebae, one of which causes granulomatous amoebic encephalitis. This initial look into the N. fowleri nuclear genome has revealed several examples of potential pathogenesis factors, improving our understanding of a neglected pathogen of increasing global importance.

  12. The Mitochondrial Genome and a 60-kb Nuclear DNA Segment from Naegleria fowleri, the Causative Agent of Primary Amoebic Meningoencephalitis

    PubMed Central

    Herman, Emily K.; Greninger, Alexander L.; Visvesvara, Govinda S.; Marciano-Cabral, Francine; Dacks, Joel B.; Chiu, Charles Y.

    2013-01-01

    Naegleria fowleri is a unicellular eukaryote causing primary amoebic meningoencephalitis, a neuropathic disease killing 99% of those infected, usually within 7–14 days. N. fowleri is found globally in regions including the US and Australia. The genome of the related non-pathogenic species Naegleria gruberi has been sequenced, but the genetic basis for N. fowleri pathogenicity is unclear. To generate such insight, we sequenced and assembled the mitochondrial genome and a 60-kb segment of nuclear genome from N. fowleri. The mitochondrial genome is highly similar to its counterpart in N. gruberi in gene complement and organization, while distinct lack of synteny is observed for the nuclear segments. Even in this short (60-kb) segment, we identified examples of potential factors for pathogenesis, including ten novel N. fowleri-specific genes. We also identified a homologue of cathepsin B; proteases proposed to be involved in the pathogenesis of diverse eukaryotic pathogens, including N. fowleri. Finally, we demonstrate a likely case of horizontal gene transfer between N. fowleri and two unrelated amoebae, one of which causes granulomatous amoebic encephalitis. This initial look into the N. fowleri nuclear genome has revealed several examples of potential pathogenesis factors, improving our understanding of a neglected pathogen of increasing global importance. PMID:23360210

  13. Naegleria fowleri That Induces Primary Amoebic Meningoencephalitis: Rapid Diagnosis and Rare Case of Survival in a 12-Year-Old Caucasian Girl.

    PubMed

    Dunn, Andrew L; Reed, Tameika; Stewart, Charlotte; Levy, Rebecca A

    2016-05-01

    Primary amoebic meningoencephalitis (PAM) is a rare and almost always fatal disease that is caused by Naegleria fowleri, a freshwater thermophilic amoeba. Our case involves an adolescent female who presented with fever of unknown origin. A lumbar puncture was performed, and the Wright-Giemsa and Gram stained cerebrospinal fluid (CSF) cytospin slides showed numerous organisms. Experienced medical technologists in the microbiology and hematology laboratories identified the organisms as morphologically consistent with Naegleria species. The laboratory made a rapid diagnosis and alerted emergency department care providers within 75 minutes. The patient was treated for PAM with amphotericin, rifampin, azithromycin, fluconazole and aggressive supportive therapy including dexamethasone. The Centers for Disease Control and Prevention (CDC) was contacted, and miltefosine, an investigational medication, was started. Additional treatment included an intraventricular shunt and controlled hypothermia in order to mitigate potential cerebral edema. Our patient is a rare success story, as she was diagnosed swiftly, successfully treated, and survived PAM. PMID:26984830

  14. Naegleria fowleri That Induces Primary Amoebic Meningoencephalitis: Rapid Diagnosis and Rare Case of Survival in a 12-Year-Old Caucasian Girl.

    PubMed

    Dunn, Andrew L; Reed, Tameika; Stewart, Charlotte; Levy, Rebecca A

    2016-05-01

    Primary amoebic meningoencephalitis (PAM) is a rare and almost always fatal disease that is caused by Naegleria fowleri, a freshwater thermophilic amoeba. Our case involves an adolescent female who presented with fever of unknown origin. A lumbar puncture was performed, and the Wright-Giemsa and Gram stained cerebrospinal fluid (CSF) cytospin slides showed numerous organisms. Experienced medical technologists in the microbiology and hematology laboratories identified the organisms as morphologically consistent with Naegleria species. The laboratory made a rapid diagnosis and alerted emergency department care providers within 75 minutes. The patient was treated for PAM with amphotericin, rifampin, azithromycin, fluconazole and aggressive supportive therapy including dexamethasone. The Centers for Disease Control and Prevention (CDC) was contacted, and miltefosine, an investigational medication, was started. Additional treatment included an intraventricular shunt and controlled hypothermia in order to mitigate potential cerebral edema. Our patient is a rare success story, as she was diagnosed swiftly, successfully treated, and survived PAM.

  15. [Amoebic meningoencephalitis by "Eaegleria" and "Acanthamoeba" (author's transl)].

    PubMed

    de Carneri, I

    1977-01-01

    Primary amoebic meningoencephalitis (ME) by Naegleria fowleri a free-living protozoon found in fresh, warm waters, is a well known fatal disease lasting less than one week. It affects sporadically swimmers and children playing in mud puddles. Less than 100 cases have been described. Recently a more rare, distinct amoebic meningoencephalitis due to some species of free-living Acanthamoeba was identified, lasting some weeks or more but still with a fatal evolution. In this case the amoebae do not always enter the brain directly through the cribrous membranes but cause mild, primary infections of respiratory airways: exceptionally, mainly in immunodepressed subjects, they then reach the CNS causing a secondary ME. Naegleria is fairly sensitive in vitro to some drugs, but in vivo their efficacy is dramtically lowered for pharmacokinetic reasons. Acanthamoeba is in every respect less sensitive. Prophylaxis is almost impossible to achieve. Some diagnostic procedures are described and the importance of their use in diagnosis of the so called aseptic purulent ME is stressed. PMID:616244

  16. Fatal primary meningoencephalitis caused by Naegleria fowleri.

    PubMed

    Shariq, Ali; Afridi, Faisal Iqbal; Farooqi, Badar Jahan; Ahmed, Sumaira; Hussain, Arif

    2014-07-01

    Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection. PMID:25052979

  17. Fatal primary meningoencephalitis caused by Naegleria fowleri.

    PubMed

    Shariq, Ali; Afridi, Faisal Iqbal; Farooqi, Badar Jahan; Ahmed, Sumaira; Hussain, Arif

    2014-07-01

    Naegleria fowleri is a free living parasite which habitats in fresh water reservoirs. It causes a fatal nervous system infection known as primary amoebic meningoencephalitis by invading through cribriform plate of nose and gaining entry into brain. We report a case of primary amoebic meningoencephalitis caused by Naegleria fowleri in Karachi, Pakistan, in a 42 years old male poultry farm worker having no history of swimming. Clinical course was fulminant and death occurred within one week of hospital admission. Naegleria fowleri was detected by wet mount technique in the sample of cerebrospinal fluid collected by lumbar puncture of patient. This is a serious problem and requires immediate steps to prevent general population to get affected by this lethal neurological infection.

  18. Primary amebic meningoencephalitis.

    PubMed

    Seidel, J

    1985-08-01

    Primary amebic meningoencephalitis is a disease caused by the free-living amebae of the genera Naegleria or Acanthamoeba. The clinical course may result in death a few days after presentation or it may be insidious, with progressive neurologic deterioration and death after a chronic course. This article describes the organisms involved, the clinical course, pathology, diagnosis, and treatment of the disease. PMID:3895137

  19. Primary amebic meningoencephalitis.

    PubMed

    Rai, Ruchi; Singh, D K; Srivastava, A K; Bhargava, Anudita

    2008-12-01

    We report an 8 month-old infant with primary amebic meningoencephalitis (PAME) due to Naegleria fowleri. The child was treated with amphotericin B, chloramphenicol and rifampicin for 3 weeks. PAME is an almost universally fatal condition with very few survivors till date. Our patient was one of the rare survivors who recovered after treatment and was discharged without any residual neurological deficit.

  20. Primary amebic meningoencephalitis.

    PubMed

    Darby, C P; Conradi, S E; Holbrook, T W; Chatellier, C

    1979-10-01

    Primary amebic meningoencephalitis a rapidly fatal CNS infection caused by the free-living ameba Naegleria fowleri. The disease is acquired by swimming in fresh water and is being recognized with increasing frequency. Results of early diagnosis and treatment with amphotericin and other drugs suggest therapeutic optimism. Epidemiological surveys have shown the organism to be commonly present in fresh-water lakes in the warmer parts of the world. Prompt recognition and treatment is vital. PMID:495593

  1. Acute primary meningoencephalitis from entamoeba Naegleria Fowleri. Report of a clinical case with a favourable outcome.

    PubMed

    Loschiavo, F; Ventura-Spagnolo, T; Sessa, E; Bramanti, P

    1993-10-01

    The Authors describe a primary amoebic acute meningoencephalitis case from Naegleria Fowleri, where the parasite was found in the cerebrospinal fluid and in culture. The case had a favorable outcome after treatment with amphotericin B.

  2. Another case of canine amoebic meningoencephalitis--the challenges of reaching a rapid diagnosis.

    PubMed

    Hodge, Priscilla J; Kelers, Kylie; Gasser, Robin B; Visvesvara, Govinda S; Martig, Sandra; Long, Sam N

    2011-04-01

    A case of granulomatous amoebic meningoencephalitis in a previously healthy, mature, apparently immunocompetent dog, with a history of exposure to stagnant water, is reported. The case presented with ataxia and a tendency to fall to the left side. A computed tomography (CT) showed a ring-enhancing lesion within the cerebellum; an examination of cerebrospinal fluid (CSF) revealed nonspecific mixed-cell pleocytosis. Despite antibiotic and anti-inflammatory therapy, clinical signs progressed rapidly to decerebellate rigidity over 4 days, and the dog was euthanased. Significant post-mortem findings were restricted to the brain, with a localised lytic lesion in the deep cerebellar white matter. Histopathological examination of the brain showed focally extensive cavitation of the white matter and communication of the lesion with the fourth ventricle. The affected area contained structures consistent with amoebae and was infiltrated by neutrophils mixed with lower numbers of macrophages, plasma cells and lymphocytes. The amoebae were identified as Balamuthia mandrillaris, based on specific immunofluorescence detection. Amoebic meningoencephalitis should be considered in dogs with evidence of focal cavitary lesions in the brain, particularly in cases with a history of swimming in stagnant water. PMID:21161275

  3. Intranasal Coadministration of the Cry1Ac Protoxin with Amoebal Lysates Increases Protection against Naegleria fowleri Meningoencephalitis

    PubMed Central

    Rojas-Hernández, Saúl; Rodríguez-Monroy, Marco A.; López-Revilla, Rubén; Reséndiz-Albor, Aldo A.; Moreno-Fierros, Leticia

    2004-01-01

    Cry1Ac protoxin has potent mucosal and systemic adjuvant effects on antibody responses to proteins or polysaccharides. In this work, we examined whether Cry1Ac increased protective immunity against fatal Naegleria fowleri infection in mice, which resembles human primary amoebic meningoencephalitis. Higher immunoglobulin G (IgG) than IgA anti-N. fowleri responses were elicited in the serum and tracheopulmonary fluids of mice immunized by the intranasal or intraperitoneal route with N. fowleri lysates either alone or with Cry1Ac or cholera toxin. Superior protection against a lethal challenge with 5 × 104 live N. fowleri trophozoites was achieved for immunization by the intranasal route. Intranasal immunization of N. fowleri lysates coadministered with Cry1Ac increased survival to 100%; interestingly, immunization with Cry1Ac alone conferred similar protection to that achieved with amoebal lysates alone (60%). When mice intranasally immunized with Cry1Ac plus lysates were challenged with amoebae, both IgG and IgA mucosal responses were rapidly increased, but only the increased IgG response persisted until day 60 in surviving mice. The brief rise in the level of specific mucosal IgA does not exclude the role that this isotype may play in the early defense against this parasite, since higher IgA responses were detected in nasal fluids of mice intranasally immunized with lysates plus either Cry1Ac or cholera toxin, which, indeed, were the treatments that provided the major protection levels. In contrast, serum antibody responses do not seem to be related to the protection level achieved. Both acquired and innate immune systems seem to play a role in host defense against N. fowleri infection, but further studies are required to elucidate the mechanisms involved in protective effects conferred by Cry1Ac, which may be a valuable tool to improve mucosal vaccines. PMID:15271892

  4. Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan

    PubMed Central

    Shakoor, Sadia; Beg, Mohammad Asim; Bandea, Rebecca; Sriram, Rama; Noman, Fatima; Ali, Farheen; Visvesvara, Govinda S.; Zafar, Afia

    2011-01-01

    We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems. PMID:21291600

  5. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan.

    PubMed

    Shakoor, Sadia; Beg, Mohammad Asim; Mahmood, Syed Faisal; Bandea, Rebecca; Sriram, Rama; Noman, Fatima; Ali, Farheen; Visvesvara, Govinda S; Zafar, Afia

    2011-02-01

    We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

  6. Amoebic meningo-encephalitis due to a free-living amoeba. A case report.

    PubMed

    Rutherfoord, G S

    1986-01-01

    A 47-year-old man developed an undiagnosed encephalitic illness and died within 12 days. Autopsy showed focal granulomatous lesions associated with a necrotizing vasculitis. Light microscopy revealed the presence of free-living amoebae morphologically resembling Acanthamoeba species. The pathology of this form of meningo-encephalitis is contrasted with that caused by Naegleria fowleri infection, and attention is drawn to its existence within the RSA. PMID:3941944

  7. Amoebic meningoencephalitis and disseminated infection caused by Balamuthia mandrillaris in a Western lowland gorilla (Gorilla gorilla gorilla).

    PubMed

    Gjeltema, Jenessa L; Troan, Brigid; Muehlenbachs, Atis; Liu, Lindy; Da Silva, Alexandre J; Qvarnstrom, Yvonne; Tobias, Jeremy R; Loomis, Michael R; De Voe, Ryan S

    2016-02-01

    CASE DESCRIPTION A 22-year-old male gorilla (Gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. CLINICAL FINDINGS Physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. A CBC and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a stress leukogram, and signs consistent with dehydration. Subsequent CSF analysis revealed lymphocytic pleocytosis and markedly increased total protein concentration. TREATMENT AND OUTCOME Despite treatment with antimicrobials, steroids, and additional supportive care measures, the gorilla's condition progressed to an obtunded mentation with grand mal seizures over the course of 10 days. Therefore, the animal was euthanized and necropsy was performed. Multifocal areas of malacia and hemorrhage were scattered throughout the brain; on histologic examination, these areas consisted of necrosis and hemorrhage associated with mixed inflammation, vascular necrosis, and intralesional amoebic trophozoites. Tan foci were also present in the kidneys and pancreas. Immunohistochemical testing positively labeled free-living amoebae within the brain, kidneys, eyes, pancreas, heart, and pulmonary capillaries. Subsequent PCR assay of CSF and frozen kidney samples identified the organism as Balamuthia mandrillaris, confirming a diagnosis of amoebic meningoencephalitis. CLINICAL RELEVANCE Infection with B mandrillaris has been reported to account for 2.8% of captive gorilla deaths in North America over the past 19 years. Clinicians working with gorillas should have a high index of suspicion for this diagnosis when evaluating and treating animals with signs of centrally localized neurologic disease.

  8. Amoebic meningoencephalitis and disseminated infection caused by Balamuthia mandrillaris in a Western lowland gorilla (Gorilla gorilla gorilla).

    PubMed

    Gjeltema, Jenessa L; Troan, Brigid; Muehlenbachs, Atis; Liu, Lindy; Da Silva, Alexandre J; Qvarnstrom, Yvonne; Tobias, Jeremy R; Loomis, Michael R; De Voe, Ryan S

    2016-02-01

    CASE DESCRIPTION A 22-year-old male gorilla (Gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. CLINICAL FINDINGS Physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. A CBC and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a stress leukogram, and signs consistent with dehydration. Subsequent CSF analysis revealed lymphocytic pleocytosis and markedly increased total protein concentration. TREATMENT AND OUTCOME Despite treatment with antimicrobials, steroids, and additional supportive care measures, the gorilla's condition progressed to an obtunded mentation with grand mal seizures over the course of 10 days. Therefore, the animal was euthanized and necropsy was performed. Multifocal areas of malacia and hemorrhage were scattered throughout the brain; on histologic examination, these areas consisted of necrosis and hemorrhage associated with mixed inflammation, vascular necrosis, and intralesional amoebic trophozoites. Tan foci were also present in the kidneys and pancreas. Immunohistochemical testing positively labeled free-living amoebae within the brain, kidneys, eyes, pancreas, heart, and pulmonary capillaries. Subsequent PCR assay of CSF and frozen kidney samples identified the organism as Balamuthia mandrillaris, confirming a diagnosis of amoebic meningoencephalitis. CLINICAL RELEVANCE Infection with B mandrillaris has been reported to account for 2.8% of captive gorilla deaths in North America over the past 19 years. Clinicians working with gorillas should have a high index of suspicion for this diagnosis when evaluating and treating animals with signs of centrally localized neurologic disease. PMID:26799111

  9. A rare case of survival from primary amebic meningoencephalitis

    PubMed Central

    Gautam, Parshotam Lal; Sharma, Shruti; Puri, Sandeep; Kumar, Raj; Midha, Vandana; Bansal, Rajinder

    2012-01-01

    Primary amebic meningoencephalitis (PAM) is a rare and fatal disease of central nervous system (CNS) caused by Naegleria fowleri, an ameba found in soils and warm waters. It enters the CNS after insufflation of infected water by attaching itself to the olfactory nerves. The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics. PMID:22557831

  10. Primary amebic meningoencephalitis: a case report and literature review.

    PubMed

    Lopez, Christina; Budge, Phillip; Chen, Jimmy; Bilyeu, Suzanne; Mirza, Ayesha; Custodio, Haidee; Irazuzta, Jose; Visvesvara, Govinda; Sullivan, Kevin J

    2012-03-01

    Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Cases of N. fowleri infection have been reported from many of the southern-tier states in the United States, with Florida and Texas disproportionately represented among them. Primary amebic meningoencephalitis presents clinically in a fashion that may be indistinguishable from bacterial and viral meningitis. Unfortunately, because the disease is so rare, PAM is often excluded from the differential diagnosis of children with meningitis resulting in delayed diagnostic and therapeutic efforts.Pediatric acute care practitioners in emergency departments, general pediatric wards, and critical care units, especially those practicing in the southern United States, should be familiar with the risk factors for acquisition of PAM, its clinical presentation, and the fact that common empiric treatment of bacterial meningitis will not treat N. fowleri. Herein, we present the case of an adolescent who died of PAM and review the (a) epidemiology, (b) pathophysiology, (c) available diagnostic modalities, (d) treatment options, and (e) outcomes of patients treated for N. fowleri infection of the central nervous system. PMID:22391923

  11. Primary amebic meningoencephalitis--Arizona, Florida, and Texas, 2007.

    PubMed

    2008-05-30

    Primary amebic meningoencephalitis (PAM) is a rare but nearly always fatal disease caused by infection with Naegleria fowleri, a thermophilic, free-living ameba found in freshwater environments. Infection results from water containing N. fowleri entering the nose, followed by migration of the amebae to the brain via the olfactory nerve. In 2007, six cases of PAM in the United States were reported to CDC; all six patients died. This report summarizes the investigations of the cases, which occurred in three southern tier states (Arizona, Florida, and Texas) during June-September and presents preliminary results from a review of PAM cases during 1937-2007. Because deaths from PAM often prompt heightened concern about the disease among the public, an updated and consistent approach to N. fowleri risk reduction messages, diagnosis and treatment, case reporting, and environmental sampling is needed. PMID:18509301

  12. Identification and significance of Naegleria fowleri isolated from the hot spring which related to the first primary amebic meningoencephalitis (PAM) patient in Taiwan.

    PubMed

    Tung, Min-Che; Hsu, Bing-Mu; Tao, Chi-Wei; Lin, Wei-Chen; Tsai, Hsiu-Feng; Ji, Dar-Der; Shen, Shu-Min; Chen, Jung-Sheng; Shih, Feng-Cheng; Huang, Yu-Li

    2013-08-01

    Naegleria fowleri can cause primary amoebic meningoencephalitis, a rapidly developing and highly lethal infectious disease. The first confirmed case of primary amoebic meningoencephalitis in Taiwan was reported in November 2011, in which the patient visited a thermal spring recreational area 1 week prior to hospitalisation. Water sampling was performed to verify the presence of Naegleria at the facility. According to our results, 32% and 20% of recreational water samples were contaminated with Naegleria spp. and Acanthamoeba spp., respectively. The genotypes of Naegleria identified at the hot spring included N. fowleri, Naegleria australiensis and Naegleria lovaniensis. Using PCR, it was determined that the strain of N. fowleri in one sample possessed the same genotype 2 as the clinical isolate. Thus, the thermal spring was suggested to be the likely source of infection. This is the first known instance of simultaneously isolating N. fowleri from both a patient as well as from a hot spring in Taiwan. Following this initial study, the pools at the thermal spring recreational area were drained, scrubbed and disinfected, and a follow-up study was performed 1 month later. Naegleria fowleri was not detected in follow-up testing; however, other Naegleria spp. were identified. We postulate that the biofilm in the waterlines may have provided a reservoir for free-living amoebae. The presence/absence of Acanthamoeba and Naegleria spp. did not differ significantly with any measured parameters related to water quality; however, a high percentage of the thermal water pool samples were contaminated with Naegleria or Acanthamoeba. Thus, amoebic contamination may present a serious threat to the health of humans who engage in leisure activities at thermal springs. PMID:23665128

  13. Identification and significance of Naegleria fowleri isolated from the hot spring which related to the first primary amebic meningoencephalitis (PAM) patient in Taiwan.

    PubMed

    Tung, Min-Che; Hsu, Bing-Mu; Tao, Chi-Wei; Lin, Wei-Chen; Tsai, Hsiu-Feng; Ji, Dar-Der; Shen, Shu-Min; Chen, Jung-Sheng; Shih, Feng-Cheng; Huang, Yu-Li

    2013-08-01

    Naegleria fowleri can cause primary amoebic meningoencephalitis, a rapidly developing and highly lethal infectious disease. The first confirmed case of primary amoebic meningoencephalitis in Taiwan was reported in November 2011, in which the patient visited a thermal spring recreational area 1 week prior to hospitalisation. Water sampling was performed to verify the presence of Naegleria at the facility. According to our results, 32% and 20% of recreational water samples were contaminated with Naegleria spp. and Acanthamoeba spp., respectively. The genotypes of Naegleria identified at the hot spring included N. fowleri, Naegleria australiensis and Naegleria lovaniensis. Using PCR, it was determined that the strain of N. fowleri in one sample possessed the same genotype 2 as the clinical isolate. Thus, the thermal spring was suggested to be the likely source of infection. This is the first known instance of simultaneously isolating N. fowleri from both a patient as well as from a hot spring in Taiwan. Following this initial study, the pools at the thermal spring recreational area were drained, scrubbed and disinfected, and a follow-up study was performed 1 month later. Naegleria fowleri was not detected in follow-up testing; however, other Naegleria spp. were identified. We postulate that the biofilm in the waterlines may have provided a reservoir for free-living amoebae. The presence/absence of Acanthamoeba and Naegleria spp. did not differ significantly with any measured parameters related to water quality; however, a high percentage of the thermal water pool samples were contaminated with Naegleria or Acanthamoeba. Thus, amoebic contamination may present a serious threat to the health of humans who engage in leisure activities at thermal springs.

  14. Meningoencephalitis caused by Naegleria fowleri in cattle of northeast Brazil.

    PubMed

    Pimentel, Luciano A; Dantas, Antônio Flávio M; Uzal, Francisco; Riet-Correa, Franklin

    2012-10-01

    Primary amoebic meningoencephalitis is an acute disease of the central nervous system of humans and animals caused by Naegleria fowleri. This report describes a case of meningoencephalitis caused by N. fowleri in a crossbred, one-year-old bovine with progressive neurological signs. At necropsy there was thickening of the meninges and multifocal areas of malacia in the thalamus, caudal and rostral colliculi, parietal and occipital cortex, and cerebellum. Histologically there was multifocal necrosupurative meningoencephalitis associated with areas of malacia containing amoebic trophozoites. Immunohistochemistry of the brain was positive for N. fowleri. The disease should be included among the differential diagnosis of diseases of the central nervous system in cattle in areas where animals are exposed to hot, stagnant water.

  15. Five cases of primary amebic meningoencephalitis in Mexicali, Mexico: study of the isolates.

    PubMed Central

    Lares-Villa, F; De Jonckheere, J F; De Moura, H; Rechi-Iruretagoyena, A; Ferreira-Guerrero, E; Fernandez-Quintanilla, G; Ruiz-Matus, C; Visvesvara, G S

    1993-01-01

    Five Naegleria strains isolated from patients with primary amebic meningoencephalitis and one strain isolated from the water of an artificial canal were investigated. All strains were pathogenic for mice when instilled intranasally and showed cytopathic effects in Vero cell cultures. Their growth characteristics (isolation and subculture at 45 degrees C), serological results, and isoenzyme patterns permitted us to identify the six strains as Naegleria fowleri. This is the first time that Naegleria fowleri has been isolated from patients with primary amebic meningoencephalitis in Mexico. Images PMID:8458963

  16. [Amebic meningoencephalitis].

    PubMed

    Fukuma, Toshihide

    2009-02-01

    It has been reported that amebic meningoencephalitis is caused by some rhizopods, which are taxonomically different from Entamoeba histolytica which is well known as the causative agent of amebic dysentery. Different types of human meningoencephalitis have been reported to be caused by amphizoic amebae, which are not obligatorily parasitic (endozoic) but are usually free-living (exozoic) in nature, i.e., in environmental water and soil: Naegleria fowleri causes acute primary amebic meningoencephalitis (PAM). Acanthamoeba spp. and Balamuthia mandrillaris produce chronic and opportunistic granulomatous amebic (meningo) encephalitis (GAE). Further, most recently, Sappinia diploidea has been identified as an agent that causes comparatively acute type of encephalitis.

  17. Seasonal meningoencephalitis in Holstein cattle caused by Naegleria fowleri.

    PubMed

    Daft, Barbara M; Visvesvara, Govinda S; Read, Deryck H; Kinde, Hailu; Uzal, Francisco A; Manzer, Michael D

    2005-11-01

    Primary amoebic meningoencephalitis is a fulminant infection of the human central nervous system caused by Naegleria fowleri, a free-living amoeba that thrives in artificially or naturally heated water. The infection usually is acquired while bathing or swimming in such waters. The portal of entry is the olfactory neuroepithelium. This report describes fatal meningoencephalitis caused by N. fowleri in Holstein cattle that consumed untreated surface water in an area of California where summer temperatures at times exceed 42 degrees C. In the summers of 1998 and 1999, severe multifocal necrosuppurative hemorrhagic meningoencephalitis was observed in brain samples from nine 10-20-month-old heifers with clinical histories of acute central nervous system disease. Olfactory lobes and cerebella were most severely affected. Lesions were also evident in periventricular and submeningeal neuropil as well as olfactory nerves. Naegleria fowleri was demonstrated by immunohistochemistry in brain and olfactory nerve lesions and was isolated from one brain. Even though cultures of drinking water did not yield N. fowleri, drinking water was the likely source of the amoeba. The disease in cattle closely resembles primary amoebic meningoencephalitis in humans. Naegleria meningoencephalitis should be included among differential diagnoses of central nervous system disease in cattle during the summer season in areas with high ambient temperatures. PMID:16475525

  18. Seasonal meningoencephalitis in Holstein cattle caused by Naegleria fowleri.

    PubMed

    Daft, Barbara M; Visvesvara, Govinda S; Read, Deryck H; Kinde, Hailu; Uzal, Francisco A; Manzer, Michael D

    2005-11-01

    Primary amoebic meningoencephalitis is a fulminant infection of the human central nervous system caused by Naegleria fowleri, a free-living amoeba that thrives in artificially or naturally heated water. The infection usually is acquired while bathing or swimming in such waters. The portal of entry is the olfactory neuroepithelium. This report describes fatal meningoencephalitis caused by N. fowleri in Holstein cattle that consumed untreated surface water in an area of California where summer temperatures at times exceed 42 degrees C. In the summers of 1998 and 1999, severe multifocal necrosuppurative hemorrhagic meningoencephalitis was observed in brain samples from nine 10-20-month-old heifers with clinical histories of acute central nervous system disease. Olfactory lobes and cerebella were most severely affected. Lesions were also evident in periventricular and submeningeal neuropil as well as olfactory nerves. Naegleria fowleri was demonstrated by immunohistochemistry in brain and olfactory nerve lesions and was isolated from one brain. Even though cultures of drinking water did not yield N. fowleri, drinking water was the likely source of the amoeba. The disease in cattle closely resembles primary amoebic meningoencephalitis in humans. Naegleria meningoencephalitis should be included among differential diagnoses of central nervous system disease in cattle during the summer season in areas with high ambient temperatures.

  19. [Primary amebic meningoencephalitis caused by Naegleria fowleri in an adolescent from Huetamo, Michoacan, Mexico].

    PubMed

    López-Corella, E; De León, B; de Jonckheere, J F

    1989-09-01

    A 13 year old boy died after a three day illness with severe headache, explosive vomiting, fever and progressive loss of consciousness. The autopsy revealed purulent and necrotizing meningoencephalitis mainly involving the basal regions and posterior fossa and on microscopic examination numerous trophozoites of Naegleria were seen in the meninges and necrotic brain tissue. The trophozoites were identified as Naegleria fowleri by immunoperoxidase staining. This case as well as others previously reported in Mexico and the documented presence of Naegleria species from several sources indicate that primary amebic meningoencephalitis should be considered in the differential diagnosis of cases with neurological symptoms of sudden onset.

  20. Primary amebic meningoencephalitis due to Naegleria fowleri: an autopsy case in Japan.

    PubMed

    Sugita, Y; Fujii, T; Hayashi, I; Aoki, T; Yokoyama, T; Morimatsu, M; Fukuma, T; Takamiya, Y

    1999-05-01

    Free-living amebas represented by Naegleria fowleri, Acanthamoeba and Balamutia have been known to cause fatal meningoencephalitis since Fowler and Carter (1965) reported the first four human cases. An autopsy case of a 25-year-old female with primary amebic meningoencephalitis (PAM) due to Naegleria fowleri is described. Headache, lethargy and coma developed in this patient, and her condition progressed to death 8 days after the onset of clinical symptoms. Cerebral spinal fluid examination confirmed clusters of amebas, which were grown in culture and identified as Naegleria fowleri. At autopsy, lesions were seen in the central nervous system (CNS) and the ethmoid sinus. The CNS had severe, suppurative meningoencephalitis with amebic trophozoites mingled with macrophages. This case is the first report of PAM due to Naegleria fowleri in Japan.

  1. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis.

    PubMed

    Linam, W Matthew; Ahmed, Mubbasheer; Cope, Jennifer R; Chu, Craig; Visvesvara, Govinda S; da Silva, Alexandre J; Qvarnstrom, Yvonne; Green, Jerril

    2015-03-01

    Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury. PMID:25667249

  2. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis.

    PubMed

    Linam, W Matthew; Ahmed, Mubbasheer; Cope, Jennifer R; Chu, Craig; Visvesvara, Govinda S; da Silva, Alexandre J; Qvarnstrom, Yvonne; Green, Jerril

    2015-03-01

    Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury.

  3. Successful Treatment of an Adolescent with Naegleria fowleri Primary Amebic Meningoencephalitis

    PubMed Central

    Linam, W. Matthew; Ahmed, Mubbasheer; Cope, Jennifer R.; Chu, Craig; Visvesvara, Govinda S.; da Silva, Alexandre J.; Qvarnstrom, Yvonne; Green, Jerril

    2015-01-01

    Naegleria fowleri is a thermophilic free-living ameba that causes primary amebic meningoencephalitis. Infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. Survival most likely resulted from a combination of early identification and treatment, use of a combination of antimicrobials including miltefosine and management of elevated intracranial pressure based on traumatic brain injury principles. PMID:25667249

  4. [Primary amebic meningoencephalitis: two new cases report from Venezuela].

    PubMed

    Petit, Fátima; Vilchez, Varinka; Torres, Gustavo; Molina, Omaira; Dorfman, Saúl; Mora, Eduardo; Cardozo, José

    2006-12-01

    Primary amebic menigoencephalitis (PAM) is rare. Two cases of PAM in Venezuelan patients are described. Case 1, a 10 year-old male with headache, fever, vomiting. The patient swam in a water reservoir before the onset of his disease. He died during his third hospital day. Case 2, a 23 year-old male with a history of headache, fever, vomiting, drowsiness, and behavioral disturbances. The patient died on his second hospital day. The diagnosis in both cases was PAM due to Naegleria fowleri. Central nervous system infection by free-living amebas should be considered in meningoencephalitides with bacterial-free cerebro-spinal fluid.

  5. An experimental model for Naegleria fowleri-induced primary amebic meningoencephalitis in rabbits.

    PubMed

    Smego, R A; Durack, D T

    1984-02-01

    A new model was developed in rabbits for primary amebic meningoencephalitis, a rare disease caused by the free-living ameba, Naegleria fowleri. Naegleria fowleri was cultured in a liquid axenic medium, and then injected intracisternally into New Zealand White rabbits. Inocula of 10(3) or 10(5) trophozoites consistently produced a sanguinopurulent meningitis; duration of survival of rabbits was 57 or 45 hr, respectively. Counts of cells in cerebrospinal fluid were proportional to the size of inoculum used; white blood cell counts ranged from 30 to 1,055 cells/mm3, and red blood cell counts from five to 8,640 cells/mm3. Necropsies revealed severe basilar meningoencephalitis with extensive hemorrhagic necrosis and polymorphonuclear cell infiltration. Trophozoites of N. fowleri were seen within the meningeal exudate and the brain parenchyma. Potential applications of this model include studies of the host response to amebae in the CSF, evaluation of the optimal route of administration of amphotericin B, and in vivo studies of other chemotherapeutic agents that show in vitro efficacy. PMID:6737174

  6. Primary amebic meningoencephalitis due to Naegleria fowleri in a South American tapir.

    PubMed

    Lozano-Alarcón, F; Bradley, G A; Houser, B S; Visvesvara, G S

    1997-05-01

    Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris are known to cause fatal central nervous system (CNS) disease in human beings. N. fowleri causes acute, fulminating primary amebic meningoencephalitis (PAM), which generally leads to death within 10 days. Acanthamoeba spp. and B. mandrillaris cause chronic granulomatous amebic encephalitis, which may last for 8 weeks. Acanthamoeba spp. and B. mandrillaris also cause CNS disease in animals. N. fowleri, however, has been described only in human beings. This report is the first of PAM in an animal, a South American tapir. Dry cough, lethargy, and coma developed in the animal, and its condition progressed to death. At necropsy, lesions were seen in the cerebrum, cerebellum, and lungs. The CNS had severe, suppurative meningoencephalitis with many neutrophils, fibrin, plasma cells, and amebas. Amebas were 6.5 microns to 9 microns in diameter and had a nucleus containing a large nucleolus. Amebas in the sections reacted with a monoclonal antibody specific for N. fowleri in the immunofluorescent assay and appeared bright green.

  7. An experimental model for Naegleria fowleri-induced primary amebic meningoencephalitis in rabbits.

    PubMed

    Smego, R A; Durack, D T

    1984-02-01

    A new model was developed in rabbits for primary amebic meningoencephalitis, a rare disease caused by the free-living ameba, Naegleria fowleri. Naegleria fowleri was cultured in a liquid axenic medium, and then injected intracisternally into New Zealand White rabbits. Inocula of 10(3) or 10(5) trophozoites consistently produced a sanguinopurulent meningitis; duration of survival of rabbits was 57 or 45 hr, respectively. Counts of cells in cerebrospinal fluid were proportional to the size of inoculum used; white blood cell counts ranged from 30 to 1,055 cells/mm3, and red blood cell counts from five to 8,640 cells/mm3. Necropsies revealed severe basilar meningoencephalitis with extensive hemorrhagic necrosis and polymorphonuclear cell infiltration. Trophozoites of N. fowleri were seen within the meningeal exudate and the brain parenchyma. Potential applications of this model include studies of the host response to amebae in the CSF, evaluation of the optimal route of administration of amphotericin B, and in vivo studies of other chemotherapeutic agents that show in vitro efficacy.

  8. Activities of azithromycin and amphotericin B against Naegleria fowleri in vitro and in a mouse model of primary amebic meningoencephalitis.

    PubMed

    Goswick, Shannon M; Brenner, George M

    2003-02-01

    Inhalation of fresh water containing the free-living ameba Naegleria fowleri may lead to a potentially fatal infection known as primary amebic meningoencephalitis. Amphotericin B is the only agent with established clinical efficacy in the treatment of primary amebic meningoencephalitis in humans, but therapy with this drug is often associated with adverse effects on the kidneys and other organs, and not all persons treated with amphotericin B have survived. We investigated the in vitro activity and in vivo efficacy of newer therapeutic agents in an attempt to identify other useful agents for treating primary amebic meningoencephalitis. Azithromycin has shown in vitro activity against Acanthamoeba spp. and in vivo activity against experimental toxoplasmosis. In our study, the MIC of azithromycin against N. fowleri was 13.4 micro M (10 micro g/ml), which was 123 times greater than the MIC of amphotericin B, which was 0.108 micro M (0.1 micro g/ml). Azithromycin protected 100% of mice infected with N. fowleri at a dose of 75 mg/kg/day for 5 days, whereas amphotericin B protected only 50% of mice at a dose of 7.5 mg/kg/day for 5 days, and all control mice died during the 28-day observation period. We conclude that azithromycin has both in vitro and in vivo activity versus N. fowleri and may be a useful addition to therapy for primary amebic meningoencephalitis.

  9. Primary Amebic Meningoencephalitis: What Have We Learned in the Last 5 Years?

    PubMed

    Cope, Jennifer R; Ali, Ibne K

    2016-09-01

    Primary amebic meningoencephalitis (PAM) is a devastating infection of the brain caused by the thermophilic free-living ameba, Naegleria fowleri. Infection can occur when water containing the ameba enters the body through the nose, usually during recreational water activities such as swimming or diving. Historically, in the USA, cases were mostly reported from the warmer southern-tier states. In the last 5 years, several notable changes have been documented in PAM epidemiology including a northward expansion of infections and new types of water exposures. The recent reports of two PAM survivors provide hope for improved outcomes with early diagnosis and aggressive treatment. Advanced molecular laboratory tools such as genome sequencing might provide more insight into the pathogenicity of N. fowleri. Clinicians treating patients with meningitis and warm freshwater exposure are encouraged to consider PAM in their differential diagnoses. PMID:27614893

  10. Primary meningoencephalitis by Naegleria fowleri: first reported case from Mangalore, South India.

    PubMed

    Shenoy, Shalini; Wilson, Godwin; Prashanth, H V; Vidyalakshmi, K; Dhanashree, B; Bharath, R

    2002-01-01

    A fatal case of primary amebic meningoencephalitis (PAM) in a 5-month-old infant is described. The disease may have been contracted during bathing. The source of water was from an artificial well. The clinical presentation, the isolation of the ameba from the cerebrospinal fluid, the poor response to amphotericin B, and the ultimate fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperatures above 30 degrees C, the morphology of the trophozoite, and the presence of flagellate forms, the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri amebae were recovered from samples of water from the well. To our knowledge this case represents the second case of PAM in an infant in the absence of the history of swimming.

  11. Acanthamoeba meningoencephalitis

    PubMed Central

    Chandra, S. R.; Adwani, Sikandar; Mahadevan, Anitha

    2014-01-01

    Report of a case of young immunocompetent male adult with autopsy proven acanthamoeba meningoencephalitis. The patient presented with a protracted febrile illness of 3 months duration with features of meningoencephalitis, this was followed by rapid deterioration while on anti tuberculous therapy and steroids and ended fatally. His magnetic resonance imaging showed features of hemorrhagic meningoencephalitis and magnetic resonance spectroscopy showed choline peak. Autopsy revealed necrotizing meningoencephalitis and intraocular colonization due to acanthamoeba. PMID:24753675

  12. Seasonal primary amebic meningoencephalitis (PAM) in the south: summertime is PAM time.

    PubMed

    Diaz, James

    2012-01-01

    Primary amebic meningoencephalitis (PAM), a typically fatal, free-living amebic infection of the central nervous system (CNS), is caused by the thermophilic, freshwater protozoan, Naegleria fowleri. More than 145 cases of PAM have been reported worldwide, with most reported cases in the United States (US). Since annual PAM case clusters in the US and worldwide have demonstrated recent increases over background cases, the objectives of this investigation included (1) an epidemiological and statistical analysis of a 2007 cluster of six PAM cases in the southern US, nested in a retrospective review of 121 confirmed US cases of PAM over the period, 1937 to 2007; and (2) a statistical analysis of all existing demographic, temporal, and behavioral risk factors for PAM. Significant risk factors for PAM in the United States included male sex and warm recreational freshwater exposures in seasonal patterns (July - August) in southern tier states, including Louisiana. Although there have been a few recent survivors of PAM treated with combinations of intensive critical care, antifungals, and synergistic antibiotics, case fatality rates for PAM remain very high. PAM is best prevented by combinations of public health educational and behavioral modification strategies. Further investigations will be required to determine the significance of freshwater wakeboarding as a significant risk factor for PAM and to determine any dose-response effects of global warming on rising freshwater temperatures and the growth of aquatic Naegleria fowleri.

  13. Amoebic dysentery

    PubMed Central

    2011-01-01

    Introduction Amoebic dysentery is caused by the protozoan parasite Entamoeba histolytica. It is transmitted in areas where poor sanitation allows contamination of drinking water and food with faeces. In these areas, up to 40% of people with diarrhoea may have amoebic dysentery. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of drug treatments for amoebic dysentery in endemic areas? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 6 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: diiodohydroxyquinoline (iodoquinol), diloxanide, emetine, metronidazole, nitazoxanide, ornidazole, paromomycin, secnidazole, and tinidazole. PMID:21477391

  14. Amoebic dysentery

    PubMed Central

    2013-01-01

    Introduction Amoebic dysentery is caused by the protozoan parasite Entamoeba histolytica. It is transmitted in areas where poor sanitation allows contamination of drinking water and food with faeces. In these areas, up to 40% of people with diarrhoea may have amoebic dysentery. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of drug treatments for amoebic dysentery in endemic areas? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 6 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: diiodohydroxyquinoline (iodoquinol), diloxanide, emetine, metronidazole, nitazoxanide, ornidazole, paromomycin, secnidazole, and tinidazole. PMID:23991750

  15. An Unusual Case of Primary Human Immunodeficiency Virus Infection Presenting as Mononucleosis-like Syndrome and Acute Aseptic Meningoencephalitis. Report of a Case and Review of the Literature.

    PubMed

    Corti, Marcelo; Gilardi, Leonardo

    2014-07-01

    Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.

  16. An Unusual Case of Primary Human Immunodeficiency Virus Infection Presenting as Mononucleosis-like Syndrome and Acute Aseptic Meningoencephalitis. Report of a Case and Review of the Literature

    PubMed Central

    Corti, Marcelo; Gilardi, Leonardo

    2014-01-01

    Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection. PMID:25374871

  17. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case.

    PubMed

    Cope, Jennifer R; Conrad, Dennis A; Cohen, Naiomi; Cotilla, Manuel; DaSilva, Alexandre; Jackson, Jonathan; Visvesvara, Govinda S

    2016-03-15

    Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine. PMID:26679626

  18. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case.

    PubMed

    Cope, Jennifer R; Conrad, Dennis A; Cohen, Naiomi; Cotilla, Manuel; DaSilva, Alexandre; Jackson, Jonathan; Visvesvara, Govinda S

    2016-03-15

    Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine.

  19. Notes from the Field: Primary Amebic Meningoencephalitis Associated with Exposure to Swimming Pool Water Supplied by an Overland Pipe - Inyo County, California, 2015.

    PubMed

    Johnson, Richard O; Cope, Jennifer R; Moskowitz, Marvin; Kahler, Amy; Hill, Vincent; Behrendt, Kaleigh; Molina, Louis; Fullerton, Kathleen E; Beach, Michael J

    2016-01-01

    On June 17, 2015, a previously healthy woman aged 21 years went to an emergency department after onset of headache, nausea, and vomiting during the preceding 24 hours. Upon evaluation, she was vomiting profusely and had photophobia and nuchal rigidity. Analysis of cerebrospinal fluid was consistent with meningitis.* She was empirically treated for bacterial and viral meningoencephalitis. Her condition continued to decline, and she was transferred to a higher level of care in another facility on June 19, but died shortly thereafter. Cultures of cerebrospinal fluid and multiple blood specimens were negative, and tests for West Nile, herpes simplex, and influenza viruses were negative. No organisms were seen in the cerebrospinal fluid; however, real-time polymerase chain reaction testing by CDC was positive for Naegleria fowleri, a free-living thermophilic ameba found in warm freshwater that causes primary amebic meningoencephalitis, an almost universally fatal infection. PMID:27123690

  20. Fatal Naegleria fowleri Meningoencephalitis, Italy

    PubMed Central

    Scaglia, Massimo; Gatti, Simonetta; Rossetti, Flavio; Alaggio, Rita; Laverda, Anna Maria; Zhou, Ling; Xiao, Lihua; Visvesvara, Govinda S.

    2004-01-01

    We report the first case of primary amebic meningoencephalitis in Italy, in a 9-year-old boy. Clinical course was fulminant, and diagnosis was made by identifying amebas in stained brain sections and by indirect immunofluorescence analysis. Naegleria fowleri was characterized as genotype I on the basis of polymerase chain reaction test results. PMID:15504272

  1. Fatal Naegleria fowleri meningoencephalitis, Italy.

    PubMed

    Cogo, Paola E; Scagli, Massimo; Gatti, Simonetta; Rossetti, Flavio; Alaggio, Rita; Laverda, Anna Maria; Zhou, Ling; Xiao, Lihua; Visvesvara, Govinda S

    2004-10-01

    We report the first case of primary amebic meningoencephalitis in Italy, in a 9-year-old boy. Clinical course was fulminant, and diagnosis was made by identifying amebas in stained brain sections and by indirect immunofluorescence analysis. Naegleria fowleri was characterized as genotype I on the basis of polymerase chain reaction test results.

  2. Meningoencephalitis due to the amoeboflagellate Naegleria fowleri in ruminants in Algeria.

    PubMed

    Benterki, Mohamed Seghir; Ayachi, Ammar; Bennoune, Omar; Régoudis, Estelle; Pélandakis, Michel

    2016-01-01

    Primary amoebic meningoencephalitis (PAM) is a fatal infection in most cases, caused by the amoeba flagellate Naegleria fowleri. This report describes the first cases of PAM in Algeria, in a cow and a ewe from Batna, north-eastern Algeria. The death of both ruminants occurred a week after the first clinical manifestations. The cerebrospinal fluid, after staining with May-Grünwald-Giemsa, showed the presence of amoebae cells. Histological sections revealed numerous amoebae in all parts of the brain. The presence of N. fowleri was confirmed using a species-specific real-time PCR in histological tissue sections. The two PAM cases were reported during the hot season, and the source of infection is very likely the water where the cattle came to drink. Particular attention should be focused on this type of infection in aquatic environments when the temperature is high and preventive measures must be taken to avoid the proliferation of N. fowleri. PMID:26979770

  3. Meningoencephalitis due to the amoeboflagellate Naegleria fowleri in ruminants in Algeria.

    PubMed

    Benterki, Mohamed Seghir; Ayachi, Ammar; Bennoune, Omar; Régoudis, Estelle; Pélandakis, Michel

    2016-01-01

    Primary amoebic meningoencephalitis (PAM) is a fatal infection in most cases, caused by the amoeba flagellate Naegleria fowleri. This report describes the first cases of PAM in Algeria, in a cow and a ewe from Batna, north-eastern Algeria. The death of both ruminants occurred a week after the first clinical manifestations. The cerebrospinal fluid, after staining with May-Grünwald-Giemsa, showed the presence of amoebae cells. Histological sections revealed numerous amoebae in all parts of the brain. The presence of N. fowleri was confirmed using a species-specific real-time PCR in histological tissue sections. The two PAM cases were reported during the hot season, and the source of infection is very likely the water where the cattle came to drink. Particular attention should be focused on this type of infection in aquatic environments when the temperature is high and preventive measures must be taken to avoid the proliferation of N. fowleri.

  4. Meningoencephalitis due to the amoeboflagellate Naegleria fowleri in ruminants in Algeria

    PubMed Central

    Benterki, Mohamed Seghir; Ayachi, Ammar; Bennoune, Omar; Régoudis, Estelle; Pélandakis, Michel

    2016-01-01

    Primary amoebic meningoencephalitis (PAM) is a fatal infection in most cases, caused by the amoeba flagellate Naegleria fowleri. This report describes the first cases of PAM in Algeria, in a cow and a ewe from Batna, north-eastern Algeria. The death of both ruminants occurred a week after the first clinical manifestations. The cerebrospinal fluid, after staining with May-Grünwald-Giemsa, showed the presence of amoebae cells. Histological sections revealed numerous amoebae in all parts of the brain. The presence of N. fowleri was confirmed using a species-specific real-time PCR in histological tissue sections. The two PAM cases were reported during the hot season, and the source of infection is very likely the water where the cattle came to drink. Particular attention should be focused on this type of infection in aquatic environments when the temperature is high and preventive measures must be taken to avoid the proliferation of N. fowleri. PMID:26979770

  5. Effect of therapeutic chemical agents in vitro and on experimental meningoencephalitis due to Naegleria fowleri.

    PubMed

    Kim, Jong-Hyun; Jung, Suk-Yul; Lee, Yang-Jin; Song, Kyoung-Ju; Kwon, Daeho; Kim, Kyongmin; Park, Sun; Im, Kyung-Il; Shin, Ho-Joon

    2008-11-01

    Naegleria fowleri is a ubiquitous, pathogenic free-living amoeba; it is the most virulent Naegleria species and causes primary amoebic meningoencephalitis (PAME) in laboratory animals and humans. Although amphotericin B is currently the only agent available for the treatment of PAME, it is a very toxic antibiotic and may cause many adverse effects on other organs. In order to find other potentially therapeutic agents for N. fowleri infection, the present study was undertaken to evaluate the in vitro and in vivo efficacies of miltefosine and chlorpromazine against pathogenic N. fowleri. The result showed that the growth of the amoeba was effectively inhibited by treatment with amphotericin B, miltefosine, and chlorpromazine. When N. fowleri trophozoites were treated with amphotericin B, miltefosine, and chlorpromazine, the MICs of the drug were 0.78, 25, and 12.5 microg/ml, respectively, on day 2. In experimental meningoencephalitis of mice that is caused by N. fowleri, the survival rates of mice treated with amphotericin B, miltefosine, and chlorpromazine were 40, 55, and 75%, respectively, during 1 month. The average mean time to death for the amphotericin B, miltefosine, and chlorpromazine treatments was 17.9 days. In this study, the effect of drugs was found to be optimal when 20 mg/kg was administered three times on days 3, 7, and 11. Finally, chlorpromazine had the best therapeutic activity against N. fowleri in vitro and in vivo. Therefore, it may be a more useful therapeutic agent for the treatment of PAME than amphotericin B. PMID:18765686

  6. Therapeutic effect of rokitamycin in vitro and on experimental meningoencephalitis due to Naegleria fowleri.

    PubMed

    Kim, Jong-Hyun; Lee, Yang-Jin; Sohn, Hae-Jin; Song, Kyoung-Ju; Kwon, Daeho; Kwon, Myung-Hee; Im, Kyung-Il; Shin, Ho-Joon

    2008-11-01

    Inhalation of freshwater containing the free-living amoeba Naegleria fowleri leads to a potentially fatal infection known as primary amoebic meningoencephalitis (PAME). Amphotericin B is the only agent with clinical efficacy in the treatment of PAME in humans, however this drug is often associated with adverse effects on the kidney and other organs. In an attempt to select other useful therapeutic agents for treating PAME, the amoebicidal activities of antibacterial agents including clarithromycin, erythromycin, hygromycin B, neomycin, rokitamycin, roxithromycin and zeocin were examined. Results showed that the growth of amoeba was effectively inhibited by treatment with hygromycin B, rokitamycin and roxithromycin. Notably, when N. fowleri trophozoites were treated with rokitamycin, the minimal inhibitory concentration was 6.25 microg/mL on Day 2. In the treatment of experimental meningoencephalitis due to N. fowleri, survival rates of mice treated with roxithromycin and rokitamycin were 25% and 80%, respectively, over 1 month. The mean time to death for roxithromycin and rokitamycin treatment was 16.2 days and 16.8 days, respectively, compared with 11.2 days for control mice. Finally, rokitamycin showed both in vitro and in vivo therapeutic efficacy against N. fowleri and may be a candidate drug for the treatment of PAME. PMID:18762406

  7. Effect of therapeutic chemical agents in vitro and on experimental meningoencephalitis due to Naegleria fowleri.

    PubMed

    Kim, Jong-Hyun; Jung, Suk-Yul; Lee, Yang-Jin; Song, Kyoung-Ju; Kwon, Daeho; Kim, Kyongmin; Park, Sun; Im, Kyung-Il; Shin, Ho-Joon

    2008-11-01

    Naegleria fowleri is a ubiquitous, pathogenic free-living amoeba; it is the most virulent Naegleria species and causes primary amoebic meningoencephalitis (PAME) in laboratory animals and humans. Although amphotericin B is currently the only agent available for the treatment of PAME, it is a very toxic antibiotic and may cause many adverse effects on other organs. In order to find other potentially therapeutic agents for N. fowleri infection, the present study was undertaken to evaluate the in vitro and in vivo efficacies of miltefosine and chlorpromazine against pathogenic N. fowleri. The result showed that the growth of the amoeba was effectively inhibited by treatment with amphotericin B, miltefosine, and chlorpromazine. When N. fowleri trophozoites were treated with amphotericin B, miltefosine, and chlorpromazine, the MICs of the drug were 0.78, 25, and 12.5 microg/ml, respectively, on day 2. In experimental meningoencephalitis of mice that is caused by N. fowleri, the survival rates of mice treated with amphotericin B, miltefosine, and chlorpromazine were 40, 55, and 75%, respectively, during 1 month. The average mean time to death for the amphotericin B, miltefosine, and chlorpromazine treatments was 17.9 days. In this study, the effect of drugs was found to be optimal when 20 mg/kg was administered three times on days 3, 7, and 11. Finally, chlorpromazine had the best therapeutic activity against N. fowleri in vitro and in vivo. Therefore, it may be a more useful therapeutic agent for the treatment of PAME than amphotericin B.

  8. Therapeutic effect of rokitamycin in vitro and on experimental meningoencephalitis due to Naegleria fowleri.

    PubMed

    Kim, Jong-Hyun; Lee, Yang-Jin; Sohn, Hae-Jin; Song, Kyoung-Ju; Kwon, Daeho; Kwon, Myung-Hee; Im, Kyung-Il; Shin, Ho-Joon

    2008-11-01

    Inhalation of freshwater containing the free-living amoeba Naegleria fowleri leads to a potentially fatal infection known as primary amoebic meningoencephalitis (PAME). Amphotericin B is the only agent with clinical efficacy in the treatment of PAME in humans, however this drug is often associated with adverse effects on the kidney and other organs. In an attempt to select other useful therapeutic agents for treating PAME, the amoebicidal activities of antibacterial agents including clarithromycin, erythromycin, hygromycin B, neomycin, rokitamycin, roxithromycin and zeocin were examined. Results showed that the growth of amoeba was effectively inhibited by treatment with hygromycin B, rokitamycin and roxithromycin. Notably, when N. fowleri trophozoites were treated with rokitamycin, the minimal inhibitory concentration was 6.25 microg/mL on Day 2. In the treatment of experimental meningoencephalitis due to N. fowleri, survival rates of mice treated with roxithromycin and rokitamycin were 25% and 80%, respectively, over 1 month. The mean time to death for roxithromycin and rokitamycin treatment was 16.2 days and 16.8 days, respectively, compared with 11.2 days for control mice. Finally, rokitamycin showed both in vitro and in vivo therapeutic efficacy against N. fowleri and may be a candidate drug for the treatment of PAME.

  9. Meningoencephalitis by Naegleria fowleri: epidemiological study in Anzoategui state, Venezuela.

    PubMed

    Cermeño, Julman R; Hernández, Isabel; El Yasin, Helal; Tinedo, Rubén; Sánchez, Raúl; Pérez, Gladys; Gravano, Rosalía; Ruiz, Aida

    2006-01-01

    A case of primary amoebic meningoencephalitis produced by Naegleria fowleri was diagnosed in the Independencia county of Anzoategui State, Venezuela. This case motivated the realization of the present epidemiological study with the aim of identifying free-living amoebae in this area. Representative water samples were taken and physicochemical and microbiologic analyses were carried out. Trophozoites and cysts of Naegleria spp, were detected in 44.4% (n=4). An excellent concordance was found among the observations of free-living amoebae in smears and those of monoxenic cultures in non-nourishing agar with Klebsiella pneumoniae (Kappa=1; p= 0.003). A variable load of aerobic mesophils was obtained. Moulds and yeast averages presented 3.0 CFU/ml (SD +/- 2.0) and 102.9 CFU/ml (SD +/- 32.2), respectively. One hundred per cent of the samples presented a most probable number of total and fecal coliforms of 240,000 NMP/100mL. Naegleria spp was present in waters of the Independence county of Anzoategui state, which constitutes a risk for people that use these sources.

  10. The First Association of a Primary Amebic Meningoencephalitis Death with Culturable Naegleria fowleri in Tap Water from a U.S. Treated Public Drinking Water System

    PubMed Central

    Cope, Jennifer R.; Ratard, Raoult C.; Hill, Vincent R.; Sokol, Theresa; Causey, Jonathan Jake; Yoder, Jonathan S.; Mirani, Gayatri; Mull, Bonnie; Mukerjee, Kimberly A.; Narayanan, Jothikumar; Doucet, Meggie; Qvarnstrom, Yvonne; Poole, Charla N.; Akingbola, Olugbenga A.; Ritter, Jana; Xiong, Zhenggang; da Silva, Alexandre; Roellig, Dawn; Van Dyke, Russell; Stern, Harlan; Xiao, Lihua; Beach, Michael J.

    2015-01-01

    Background Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri–containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old child died of meningoencephalitis of unknown etiology in a Louisiana hospital. Methods Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures. Results Based on testing of CSF and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri were identified in water samples from both the home and the water distribution system. Conclusions This case is the first reported PAM death associated with culturable N. fowleri in tap water from a U.S. treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures. PMID:25595746

  11. Notes from the field: primary amebic meningoencephalitis associated with ritual nasal rinsing--St. Thomas, U.S. Virgin islands, 2012.

    PubMed

    2013-11-15

    On November 21, 2012, the U.S. Virgin Islands (USVI) Department of Health documented the first case and death from primary amebic meningoencephalitis (PAM) in the territory. PAM, a rare and almost universally fatal condition, results when Naegleria fowleri, a free-living thermophilic ameba found in warm freshwater, enters the nose and migrates to the brain. The patient was a man aged 47 years whose only reported freshwater exposures were the use of tap water for daily household activities and for ablution, a ritual cleansing that he practiced several times a day in preparation for Islamic prayer. Ablution can include nasal rinsing. On November 16, 2012, the patient had visited the emergency department with a headache; he was treated symptomatically and released. The following day, the patient returned to the emergency department by ambulance with fever, confusion, agitation, and a severe headache, for which he was admitted. Cerebrospinal fluid (CSF) studies were consistent with bacterial meningitis, and antibiotics were started. On November 18, neurologic findings included fixed nonresponsive pupils, no response in the upper or lower extremities, muted plantar responses, and no response to verbal commands. Microscopic examination of the CSF obtained from a second lumbar puncture revealed motile amebic trophozoites. CSF specimens sent to CDC for confirmatory testing were positive for N. fowleri by real-time polymerase chain reaction testing. On the morning of November 21, the patient was pronounced brain dead based on neurologic criteria. PMID:24226628

  12. Scrub typhus meningitis or meningoencephalitis.

    PubMed

    Kim, Dong-Min; Chung, Jong-Hoon; Yun, Na-Ra; Kim, Seok Won; Lee, Jun-Young; Han, Mi Ah; Lee, Yong-Bok

    2013-12-01

    Orientia tsutsugamushi induces vasculitis leading to symptoms of systemic organ invasion including meningitis and meningoencephalitis. We conducted a retrospective case-control study of scrub typhus patients to investigate the clinical and laboratory features of patients with scrub typhus meningitis or meningoencephalitis, and the therapeutic outcomes, and to determine the predictor factors. Cases were 22 patients with scrub typhus meningitis or meningoencephalitis, and controls were 303 patients without meningitis or meningoencephalitis. Multivariate analysis showed that the presence of pneumonitis was associated with the occurrence of scrub typhus meningitis and meningoencephalitis (odds ratio [OR] 8.9; P < 0.001; confidence interval [CI] 2.9-27.2). Although appropriate antimicrobials such as doxycycline agents were administered at an early stage, meningitis or meningoencephalitis still occurred in some cases. Physicians should be aware that meningitis or meningoencephalitis may develop during appropriate drug therapy such as doxycycline. Close observation and great care are essential for patients with risk factors, particularly pneumonitis.

  13. Amebic meningoencephalitis caused by Acanthamoeba castellani in a dog.

    PubMed

    Pearce, J R; Powell, H S; Chandler, F W; Visvesvara, G S

    1985-11-01

    A natural infection of Acanthamoeba castellani, a free-living ameba, was determined to be the cause of acute, hemorrhagic, necrotizing amebic meningoencephalitis in a dog. This case is unique because previous reports of infection by the Acanthamoeba spp in dogs have not indicated its presence in the brain. Naturally developing meningoencephalitis by Acanthamoeba spp in the dog may have a pathogenesis similar to that of human beings. The ameba in this case also was observed in the lungs and kidneys, which are believed to be the primary sites of lesions in human beings that develop amebic meningoencephalitis from Acanthamoeba spp. PMID:3932273

  14. A case of hartmannellid amebic meningoencephalitis in Zambia.

    PubMed

    Bhagwandeen, S B; Carter, R F; Naik, K G; Levitt, D

    1975-04-01

    A case of amebic meningoencephalitis recognized in an adult Zambian is described. This is the first authenticated case from Africa. The morphologic features of the organism, its ability to form cysts in tissue, and the granulomatous tissue response denote that the ameba is an hartmannellid rather than a Naegleria. Free-living amebas of the family Hartmannellidae have not been incriminated before as a cause of primary amebic meningoencephalitis in man. To our knowledge this is the only case where such an ameba was responsible for fulminating meningoencephalitis. The presence of the amebas in a cellulocutaneous abdominal lesion suggests hematogenous dissemination. PMID:1119442

  15. Effect of Therapeutic Chemical Agents In Vitro and on Experimental Meningoencephalitis Due to Naegleria fowleri▿

    PubMed Central

    Kim, Jong-Hyun; Jung, Suk-Yul; Lee, Yang-Jin; Song, Kyoung-Ju; Kwon, Daeho; Kim, Kyongmin; Park, Sun; Im, Kyung-Il; Shin, Ho-Joon

    2008-01-01

    Naegleria fowleri is a ubiquitous, pathogenic free-living amoeba; it is the most virulent Naegleria species and causes primary amoebic meningoencephalitis (PAME) in laboratory animals and humans. Although amphotericin B is currently the only agent available for the treatment of PAME, it is a very toxic antibiotic and may cause many adverse effects on other organs. In order to find other potentially therapeutic agents for N. fowleri infection, the present study was undertaken to evaluate the in vitro and in vivo efficacies of miltefosine and chlorpromazine against pathogenic N. fowleri. The result showed that the growth of the amoeba was effectively inhibited by treatment with amphotericin B, miltefosine, and chlorpromazine. When N. fowleri trophozoites were treated with amphotericin B, miltefosine, and chlorpromazine, the MICs of the drug were 0.78, 25, and 12.5 μg/ml, respectively, on day 2. In experimental meningoencephalitis of mice that is caused by N. fowleri, the survival rates of mice treated with amphotericin B, miltefosine, and chlorpromazine were 40, 55, and 75%, respectively, during 1 month. The average mean time to death for the amphotericin B, miltefosine, and chlorpromazine treatments was 17.9 days. In this study, the effect of drugs was found to be optimal when 20 mg/kg was administered three times on days 3, 7, and 11. Finally, chlorpromazine had the best therapeutic activity against N. fowleri in vitro and in vivo. Therefore, it may be a more useful therapeutic agent for the treatment of PAME than amphotericin B. PMID:18765686

  16. Amoebic antigen in immunodiagnosis and prognosis of amoebic liver abscess.

    PubMed

    Mahajan, R C; Ganguly, N K

    1980-01-01

    The detection of amoebic antigen by counterimmunoelectrophoresis is very useful and important in the immunodiagnosis of invasive hepatic amoebiasis. The antigen was demonstrated in 115 (92%) of 125 patients with amoebic liver abscess. All the 19 cases which showed Entamoeba histolytica in the 'pus' were positive for the antigen and 96 of 106 samples negative for the parasite by smear and culture were also positive for the antigen. In none of the controls was a falsepositive reaction obtained. 12 of 13 liver biopsy specimens were also positive for antigen. The persistence or disappearance of the antigen from the liver pus biopsy specimens was investigated: the antigen disappeared in eight of the 33 cases followed for intervals up to 60 days after cure, suggesting that this is also an important additional criterion for evaluating the prognosis of the disease. Further, it has been shown that amoebic infection is followed by the appearance of specific antigen or antigenic substances in the serum which were demonstrated in 23 of 89 proved cases of amoebic liver abscess cases. Its possible role in immune complex formation and the pathogenesis of the disease is discussed. PMID:6254216

  17. West Nile virus meningoencephalitis

    PubMed Central

    DeBiasi, Roberta L.; Tyler, Kenneth L.

    2013-01-01

    SUMMARY Since its first appearance in the US in 1999, West Nile virus (WNV) has emerged as the most common cause of epidemic meningoencephalitis in North America. In the 6 years following the 1999 outbreak, the geographic range and burden of the disease in birds, mosquitoes and humans has greatly expanded to include the 48 contiguous US and 7 Canadian provinces, as well as Mexico, the Caribbean islands and Colombia. WNV has shown an increasing propensity for neuroinvasive disease over the past decade, with varied presentations including meningitis, encephalitis and acute flaccid paralysis. Although neuroinvasive disease occurs in less than 1% of infected individuals, it is associated with high mortality. From 1999–2005, more than 8,000 cases of neuroinvasive WNV disease were reported in the US, resulting in over 780 deaths. In this review, we discuss epidemiology, risk factors, clinical features, diagnosis and prognosis of WNV meningoencephalitis, along with potential treatments. PMID:16932563

  18. [Mechanism of Cryptococcus Meningoencephalitis].

    PubMed

    Miyazato, Akiko

    2016-01-01

    Cryptococcus neoformans and Cryptococcus gattii are fungal pathogens that cause diseases in humans. Cryptococcal species mainly enter the body by inhalation and in most cases are eliminated by host defense mechanisms. Some cases, however, progress to pneumonia and subsequent dissemination of the infection to the central nervous system (CNS), leading to meningoencephalitis. Cryptococcus can cross the blood-brain barrier transcellularly, paracellularly and through infected phagocytes (the Trojan horse mechanism). The reason for the tropism of Cryptococcus to the CNS could be partially explained by the abundance of inositol in the brain, which causes the hyaluronic acid in fungal cells to bind to host CD44 receptors. There are differences in the clinical characteristics of C. neoformans and C. gattii. HIV infection is the most common risk factor for cryptococcosis due to C. neoformans, whereas C. gattii infection with CNS involvement is frequently found in otherwise healthy individuals exposed to plant propagules found in tropical and subtropical regions. As the virulence traits of C. neoformans contributing to CNS disease, high macrophage uptake and laccase activity are associated with the fungal burden and the rate of clearance of the infection from the brain. Recent reports suggested that the C. gattii VGII strain suppresses host immune responses in the lung and causes more lung infections than CNS diseases. Furthermore, the anti-GM-CSF autoantibodies are a risk factor for CNS infection by the C. gattii VGI strain. To understand the mechanism by which Cryptococcus causes CNS disease, it is important to consider the specific characteristics of the species and the molecular types. PMID:26936349

  19. Necrotizing meningoencephalitis and pneumonitis in a simian immunodeficiency virus-infected rhesus macaque due to Acanthamoeba.

    PubMed

    Westmoreland, S V; Rosen, J; MacKey, J; Romsey, C; Xia, D-L; Visvesvera, G S; Mansfield, K G

    2004-07-01

    Free-living amoebae of the genus Acanthamoeba can cause a fatal disease of the brain in humans called granulomatous amoebic encephalitis. We present a case of meningoencephalitis and pneumonitis in a simian immunodeficiency virus (SIV)-infected rhesus macaque caused by Acanthamoeba sp. The animal became ill 176 days after intravenous inoculation with SIVmac251 after a short history of weight loss and a sudden onset of hind limb paresis and abnormal head movements. Histopathologic examination of hematoxylin and eosin-stained tissues revealed multifocal to coalescing necrotizing neutrophilic meningoencephalitis and pneumonitis. Immunofluorescence and polymerase chain reaction were used to identify the genus of amoeba as Acanthamoeba. Immunohistochemistry of immune cell markers was used to characterize the animal's immune response to the opportunistic amoebic infection with features of both innate and adaptive cell-mediated immunity. Although not previously reported, the potential transmission to humans, either through environmental contamination or contact with an infected animal, makes this disease a threat to laboratory animal care staff and pathologists. PMID:15232140

  20. Histopathologic spectrum and immunohistochemical diagnosis of amebic meningoencephalitis.

    PubMed

    Guarner, Jeannette; Bartlett, Jeanine; Shieh, Wun-Ju; Paddock, Christopher D; Visvesvara, Govinda S; Zaki, Sherif R

    2007-12-01

    Traditionally, Naegleria fowleri infections are labeled primary amebic meningoencephalitis because of prominent meningeal neutrophilic inflammation. Acanthamoeba spp. and Balamuthia mandrillaris are labeled granulomatous amebic encephalitis because of parenchymal granulomatous inflammation. We compared histopathologic and immunohistochemical features of 18 cases with central nervous system free-living ameba infections. Immunohistochemical assays using polyclonal antibodies that reacted specifically against each genus identified 11 patients with Balamuthia infection, four with N. fowleri, and three with Acanthamoeba. Immunohistochemical assays highlighted the presence of trophozoites that were difficult to identify with hematoxylin and eosin stains in areas of necrosis or where macrophages were abundant. Immunohistochemical assays also demonstrated the presence of granular antigens inside macrophages and blood vessel walls. Amebic cysts were observed in three patients with Acanthamoeba infection and in three with Balamuthia. Patients with Acanthamoeba infection showed granulomatous inflammation. Patients with Naegleria infection had neutrophilic inflammation. Balamuthia infections showed a spectrum of inflammation that ranged from primarily neutrophils to granulomas. Meningitis was present in 88% of cases. Immunohistochemical assays were useful to demonstrate the presence of granular antigens and confirmed the genus of the ameba. The spectrum of inflammation in cases of Balamuthia meningoencephalitis is broader than previously described. The term amebic meningoencephalitis describes better the histopathologic findings than the currently used classification of primary amebic meningoencephalitis and granulomatous amebic encephalitis. PMID:17932496

  1. Histopathologic spectrum and immunohistochemical diagnosis of amebic meningoencephalitis.

    PubMed

    Guarner, Jeannette; Bartlett, Jeanine; Shieh, Wun-Ju; Paddock, Christopher D; Visvesvara, Govinda S; Zaki, Sherif R

    2007-12-01

    Traditionally, Naegleria fowleri infections are labeled primary amebic meningoencephalitis because of prominent meningeal neutrophilic inflammation. Acanthamoeba spp. and Balamuthia mandrillaris are labeled granulomatous amebic encephalitis because of parenchymal granulomatous inflammation. We compared histopathologic and immunohistochemical features of 18 cases with central nervous system free-living ameba infections. Immunohistochemical assays using polyclonal antibodies that reacted specifically against each genus identified 11 patients with Balamuthia infection, four with N. fowleri, and three with Acanthamoeba. Immunohistochemical assays highlighted the presence of trophozoites that were difficult to identify with hematoxylin and eosin stains in areas of necrosis or where macrophages were abundant. Immunohistochemical assays also demonstrated the presence of granular antigens inside macrophages and blood vessel walls. Amebic cysts were observed in three patients with Acanthamoeba infection and in three with Balamuthia. Patients with Acanthamoeba infection showed granulomatous inflammation. Patients with Naegleria infection had neutrophilic inflammation. Balamuthia infections showed a spectrum of inflammation that ranged from primarily neutrophils to granulomas. Meningitis was present in 88% of cases. Immunohistochemical assays were useful to demonstrate the presence of granular antigens and confirmed the genus of the ameba. The spectrum of inflammation in cases of Balamuthia meningoencephalitis is broader than previously described. The term amebic meningoencephalitis describes better the histopathologic findings than the currently used classification of primary amebic meningoencephalitis and granulomatous amebic encephalitis.

  2. A light microscopy study of the migration of Naegleria fowleri from the nasal submucosa to the central nervous system during the early stage of primary amebic meningoencephalitis in mice.

    PubMed

    Jarolim, K L; McCosh, J K; Howard, M J; John, D T

    2000-02-01

    The migratory pathway of Naegleria fowleri from the nasal submucosa to the central nervous system (CNS) during the early stage of primary amebic meningoencephalitis (PAM) was investigated in mice. Twenty-one-day-old CD-1 mice were inoculated by intranasal instillation of 1 x 10(6) amebas. Animals were divided into 3 groups of 5 and, after being anesthetized, were killed at intervals of 24, 32, and 48 hr postinoculation by transcardial perfusion with formaldehyde, acetic acid, and methanol. The heads were decalcified, divided in the midsagittal plane, and the area of the cribriform plate removed and embedded in paraffin. Serial sections were cut at 8 microm and stained with a combination of celestin blue, Harris' hematoxylin, and acid fuchsin for light microscopy. Focal inflammation and amebas were observed in the submucosal nerve plexus, olfactory nerves penetrating the cribriform plate, and the olfactory bulb of the brain as early as 24 hr postinoculation. The time periods selected assured that the disease process would not obliterate soft tissue structures. Earlier studies used moribund mice in which the inflammation and the number of amebas were overwhelming. The present study provides convincing evidence that amebas gain initial access to the CNS through olfactory nerves within the cribriform plate during the early stages of PAM.

  3. Pathogenesis of amoebic encephalitis: Are the amoebae being credited to an 'inside job' done by the host immune response?

    PubMed

    Baig, Abdul Mannan

    2015-08-01

    Pathogenic free living amoeba like Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris are known to cause fatal "amoebic meningoencephalitis" by acquiring different route of entries to the brain. The host immune response to these protist pathogens differs from each another, as evidenced by the postmortem gross and microscopic findings from the brains of the affected patients. Cited with the expression of 'brain eating amoeba' when the infection is caused by N. fowleri, this expression is making its way into parasitology journals and books. The impression that it imparts is, as if the brain damage is substantially due to the enzymes and toxins produced by this amoeba. A detailed review of the literature, analysis of archived specimens and with our experimental assays, here we establish that with N. fowleri, Acanthamoeba and Balamuthia spp., the infections result in an extensive brain damage that in fact is substantially caused by the host immune response rather than the amoeba. Due to the comparatively larger sizes of these pathogens and the prior exposure of the amoebal antigen to the human body, the host immune system launches an amplified response that not only breaches the blood brain barrier (BBB), but also becomes the major cause of brain damage in Amoebic meningoencephalitis. It is our understanding that for N. fowleri the host immune response is dominated by acute inflammatory cytokines and that, in cases of Acanthamoeba and Balamuthia spp., it is the type IV hypersensitivity reaction that fundamentally not only contributes to disruption and leakiness of the blood brain barrier (BBB) but also causes the neuronal damage. The further intensification of brain damage is done by toxins and enzymes secreted by the amoeba, which causes the irreversible brain damage. PMID:25930186

  4. Pathogenesis of amoebic encephalitis: Are the amoebae being credited to an 'inside job' done by the host immune response?

    PubMed

    Baig, Abdul Mannan

    2015-08-01

    Pathogenic free living amoeba like Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris are known to cause fatal "amoebic meningoencephalitis" by acquiring different route of entries to the brain. The host immune response to these protist pathogens differs from each another, as evidenced by the postmortem gross and microscopic findings from the brains of the affected patients. Cited with the expression of 'brain eating amoeba' when the infection is caused by N. fowleri, this expression is making its way into parasitology journals and books. The impression that it imparts is, as if the brain damage is substantially due to the enzymes and toxins produced by this amoeba. A detailed review of the literature, analysis of archived specimens and with our experimental assays, here we establish that with N. fowleri, Acanthamoeba and Balamuthia spp., the infections result in an extensive brain damage that in fact is substantially caused by the host immune response rather than the amoeba. Due to the comparatively larger sizes of these pathogens and the prior exposure of the amoebal antigen to the human body, the host immune system launches an amplified response that not only breaches the blood brain barrier (BBB), but also becomes the major cause of brain damage in Amoebic meningoencephalitis. It is our understanding that for N. fowleri the host immune response is dominated by acute inflammatory cytokines and that, in cases of Acanthamoeba and Balamuthia spp., it is the type IV hypersensitivity reaction that fundamentally not only contributes to disruption and leakiness of the blood brain barrier (BBB) but also causes the neuronal damage. The further intensification of brain damage is done by toxins and enzymes secreted by the amoeba, which causes the irreversible brain damage.

  5. [Granulomatous amoebic meningoencephalitis by Balamuthia mandrillaris: case report and literature review].

    PubMed

    Cuevas P, Mónica; Smoje P, Gabriela; Jofré M, Leonor; Ledermann D, Walter; Noemí H, Isabel; Berwart C, Francisco; Latorre L, Juan J; González B, Sergio

    2006-09-01

    The free-living amebas Naegleria and Acanthamoeba are recognized as causal agents of central nervous system infections. Recently a third free-living ameba, Balamuthia mandrillaris, was identified as the causal agent of granulomatous encephalitis in humans. We report a case of Balamuthia encephalitis in an immunocompetent school-age girl who presented cutaneous lesions that compromised the central portion of the face. The skin biopsy revealed granulomatous lesion with positive PCR for non-tuberculous Mycobacterium. We started treatment for atypical extrapulmonary mycobacteriosis. Nevertheless, the child was readmitted six months later, with progressive neurological involvement, dying about one year after the onset of cutaneous symptoms. The brain necropsy showed the presence of B. mandrillaris cysts and trophozoites. Balamuthia mandrillaris infection should be considered in the differential diagnosis of a patient with chronic granulomatous disease with neurologic symptoms.

  6. [Granulomatous amoebic meningoencephalitis by Balamuthia mandrillaris: case report and literature review].

    PubMed

    Cuevas P, Mónica; Smoje P, Gabriela; Jofré M, Leonor; Ledermann D, Walter; Noemí H, Isabel; Berwart C, Francisco; Latorre L, Juan J; González B, Sergio

    2006-09-01

    The free-living amebas Naegleria and Acanthamoeba are recognized as causal agents of central nervous system infections. Recently a third free-living ameba, Balamuthia mandrillaris, was identified as the causal agent of granulomatous encephalitis in humans. We report a case of Balamuthia encephalitis in an immunocompetent school-age girl who presented cutaneous lesions that compromised the central portion of the face. The skin biopsy revealed granulomatous lesion with positive PCR for non-tuberculous Mycobacterium. We started treatment for atypical extrapulmonary mycobacteriosis. Nevertheless, the child was readmitted six months later, with progressive neurological involvement, dying about one year after the onset of cutaneous symptoms. The brain necropsy showed the presence of B. mandrillaris cysts and trophozoites. Balamuthia mandrillaris infection should be considered in the differential diagnosis of a patient with chronic granulomatous disease with neurologic symptoms. PMID:16896497

  7. Protective immunity to Naegleria fowleri in experimental amebic meningoencephalitis.

    PubMed

    Thong, Y H; Shepherd, C; Ferrante, A; Rowan-Kelly, B

    1978-03-01

    Naegleria fowleri, a free-living ameboflagellate, is the causative organism of primary amebic meningoencephalitis. Intranasal inoculation of N. fowleri in mice produces an infection similar to human disease. Mice immunized with live N. fowleri by intraperitoneal injection were found to be more resistant to subsequent intranasal challenge. These results may provide a lead to the development of immunotherapy for this virulent disease for which satisfactory chemotherapy is presently unavailable. PMID:646016

  8. Discovery of New Intracellular Pathogens by Amoebal Coculture and Amoebal Enrichment Approaches

    PubMed Central

    Jacquier, Nicolas; Aeby, Sébastien; Lienard, Julia; Greub, Gilbert

    2013-01-01

    Intracellular pathogens such as legionella, mycobacteria and Chlamydia-like organisms are difficult to isolate because they often grow poorly or not at all on selective media that are usually used to cultivate bacteria. For this reason, many of these pathogens were discovered only recently or following important outbreaks. These pathogens are often associated with amoebae, which serve as host-cell and allow the survival and growth of the bacteria. We intend here to provide a demonstration of two techniques that allow isolation and characterization of intracellular pathogens present in clinical or environmental samples: the amoebal coculture and the amoebal enrichment. Amoebal coculture allows recovery of intracellular bacteria by inoculating the investigated sample onto an amoebal lawn that can be infected and lysed by the intracellular bacteria present in the sample. Amoebal enrichment allows recovery of amoebae present in a clinical or environmental sample. This can lead to discovery of new amoebal species but also of new intracellular bacteria growing specifically in these amoebae. Together, these two techniques help to discover new intracellular bacteria able to grow in amoebae. Because of their ability to infect amoebae and resist phagocytosis, these intracellular bacteria might also escape phagocytosis by macrophages and thus, be pathogenic for higher eukaryotes. PMID:24192667

  9. [A case of meningoencephalitis caused by Acanthamoeba sp. in Dakar].

    PubMed

    Ndiaye, M; Diop, A G; Dieng, Y; Seydi, M; Diouf, F S; Diop, B M; Ndiaye, I P

    2005-01-01

    Primary meningoencephalitis caused by free-living soil ameba is rare. We report the first diagnosed case of meningoencephalitis due to Acanthamoeba sp. in Senegal. The patient was a 24-year-old Senegalese woman hospitalized in the neurology department of Fann Hospital. Diagnosis was made 6 months after the onset of symptoms based mainly on headache with fever usually occurring in the evening, chills, and lumbar puncture demonstrating turbid fluid. Parasitological examination of cool cerebrospinal fluid sediment revealed the presence of free-living ameba trophozoites of the Acanthamoeba genus. Species determination by culture on 1.5% agar-agar enriched with Escherichia coli failed. The patient died one month following initiation of treatment using amphotericine B. PMID:15903081

  10. A fatal case of Naegleria fowleri meningoencephalitis in Taiwan.

    PubMed

    Su, Mei-Yu; Lee, Ming-Shih; Shyu, Ling-Yuh; Lin, Wei-Chen; Hsiao, Pei-Ching; Wang, Chi-Ping; Ji, Dar-Der; Chen, Ke-Min; Lai, Shih-Chan

    2013-04-01

    After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later. PMID:23710088

  11. Risk of fatal amebic meningoencephalitis from waterborne Naegleria fowleri

    NASA Astrophysics Data System (ADS)

    Hallenbeck, William H.; Brenniman, Gary R.

    1989-03-01

    Primary amebic meningoencephalitis (PAM) is a fatal disease of the central nervous system caused primarily by the free-living ameba, Naegleria fowleri. PAM is primarily associated with swimming in various types of fresh water. World literature was reviewed in order to derive a risk analysis model that would be helpful in the management of PAM. The management of PAM risk is difficult, and the prevention of PAM is almost impossible. However, it is reassuring that the cases and risks estimated by the risk model are usually small, with individual annual risk on the order of 10-6.

  12. A fatal case of Naegleria fowleri meningoencephalitis in Taiwan.

    PubMed

    Su, Mei-Yu; Lee, Ming-Shih; Shyu, Ling-Yuh; Lin, Wei-Chen; Hsiao, Pei-Ching; Wang, Chi-Ping; Ji, Dar-Der; Chen, Ke-Min; Lai, Shih-Chan

    2013-04-01

    After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.

  13. A Fatal Case of Naegleria fowleri Meningoencephalitis in Taiwan

    PubMed Central

    Su, Mei-Yu; Lee, Ming-Shih; Shyu, Ling-Yuh; Lin, Wei-Chen; Hsiao, Pei-Ching; Wang, Chi-Ping; Ji, Dar-Der; Chen, Ke-Min

    2013-01-01

    After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later. PMID:23710088

  14. An autopsy case of amebic meningoencephalitis. The first Japanese case caused by Balamuthia mandrillaris.

    PubMed

    Shirabe, Teruo; Monobe, Yasumasa; Visvesvara, Govinda S

    2002-09-01

    We report here the first case of amebic meningoencephalitis caused by Balamuthia mandrillaris in a 78-year-old Japanese woman with Sjögren's syndrome. Fourteen days before her death, she presented with high fever and lost consciousness and later developed neck stiffness and abducens palsy. Computed tomography scans of the brain demonstrated multiple low-density areas throughout the brain. Neuropathologically, hemorrhagic and necrotic lesions with many amebic trophozoites were scattered in the brain and spinal cord. Granulomatous lesions were only rarely found. The amebas were identified as Balamuthia mandrillaris based on immunofluorescence assay. Clinicopathologically, our case was thought to be an intermediate between primary amebic meningoencephalitis due to Negleria fowleri and granulomatous amebic encephalitis due to Acanthameba species. Essentially, the case was one of an elderly person with suspected immunodeficiency with fulminant necrotic meningoencephalitis and scanty granulomatous lesions of 14 days course. PMID:12416563

  15. [COMPLICATED AMOEBIC APENDICITIS.REPORT OF A CASE

    PubMed

    Casavilca Zambrano, Sandro; Gomez Anchante, Victor; Cisneros Gallegos, Eduardo

    2000-01-01

    We report a case of acute abdomen that is operated with the presumptive diagnosis of complicated acute appendicitis. In the histologic examination we make the diagnosis of complicated amoebic appendicitis. We discuss clinical manifestations and histopathologic findings of this unusual presentation of amoebic infection.

  16. Sarcocystis-associated meningoencephalitis in a bald eagle (Haliaeetus leucocephalus)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Protozoal meningoencephalitis is rare in raptors. An adult female bald eagle (Haliaeetus leucocephalus) with progressive neurological signs was euthanized after several months of treatment. The predominant histological lesion was lymphoplasmacytic and histiocytic meningoencephalitis involving the ...

  17. Unexpected postmortem diagnosis of acanthamoeba meningoencephalitis in an immunocompetent child

    PubMed Central

    Binesh, Fariba; Karimi, Mehran; Navabii, Hossein

    2011-01-01

    Meningoencephalitis caused by Acanthamoeba spp. is a rare opportunistic infection, difficult to diagnose and treat, which causes death in almost all cases. Here, the authors report a 5-year-old Iranian immunocompetent girl who died of fulminant acanthamoeba meningoencephalitis. To the authors’ knowledge, this is the first case of acanthamoeba meningoencephalitis in Iran. PMID:22679147

  18. [Mycoplasma pneumoniae meningoencephalitis in a young adult].

    PubMed

    Del Castillo, Marcelo; D'Giano, Carlos; Goicoechea, María Teresa; Morello, Fernando; Salsamendi, Paz; Mora, Andrea

    2005-01-01

    Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.

  19. Powassan Meningoencephalitis, New York, New York, USA

    PubMed Central

    Wurcel, Alysse G.; Whittier, Susan; Kulas, Karen; Kramer, Laura D.; Flam, Robin; Roberts, James Kirkland; Tsiouris, Simon

    2013-01-01

    Disease caused by Powassan virus (POWV), a tick-borne flavivirus, ranges from asymptomatic to severe neurologic compromise and death. Two cases of POWV meningoencephalitis in New York, USA, highlight diagnostic techniques, neurologic outcomes, and the effect of POWV on communities to which it is endemic. PMID:23969017

  20. Complications of Catheter Drainage for Amoebic Liver Abscess

    PubMed Central

    Sharma, Navneet; Kaur, Harpreet; Kalra, Naveen; Bhalla, Ashish; Kumar, Susheel; Singh, Virendra

    2015-01-01

    Per-cutaneously inserted catheter drainage is an accepted treatment modality for a large amoebic liver abscess. Complications that can arise are; secondary infection, bleeding into the abscess cavity, inadvertent catheter misplacement into the IVC and rupture of abscess with spillage into the peritoneal cavity. We report a case of a large amoebic liver abscess that presented with complications related to per-cutaneously inserted catheter drainage. PMID:26628843

  1. Listeria meningoencephalitis in an immunocompetent person.

    PubMed

    Drnda, Alija; Koluder, Nada; Hadzic, Amir; Bajramovic, Nermina; Baljic, Rusmir; Mulabdic, Velida

    2009-01-01

    Listeria monocytogenes is a small, aerobic or facultative anaerobic, non-sporulating gram positive bacillus that can be isolated from soil, vegetation or animal reservoirs. There are six species of Listeria, and only L. monocytogenes is pathogenic for humans. Human disease occurs mainly in immunocompromised people, neonates and in pregnancy, while the cases in immunocompetent people are rare. CNS manifestations of the disease can be in form of meningitis, encephalitis, and also cerebritis and abscess since L. monocytogenes shows tropism for brain and brain stem as well for the meninges. In this case we presented 55 year old male patient with etiologically confirmed listerial meningoencephalitis, transferred from regional hospital tothe Clinic for Infectious Diseases with diagnosis of acute meningoencephalitis. Disease started 4 days before the admission. Prior to this the patient was completely healthy. In his history he denied any preexisting disease. At admittance he was febrile, with altered consciousness, disoriented, showing ocular deviation, dystaxia, and with completely positive meningeal signs. Neurologist diagnosis was rhombencephalitis. CSF analysis showed mildly opalescent liquor with pleocytosis 546/mm3 and polymorphonuclear cell predominance >70%. CSF culture showed positive isolate of L. monocytogenes. Initial therapy was: Penicillin G and Chloramphenicol, together with all other supportive and symptomatic therapy. After initial therapy and based on antibiogram, ampicillin was administered for4 weeks, followed by imipenemum for 10 days. Control CSF analysis showed pleocytosis and increased protein level and the patient was discharged as recovered with diagnosis of acute meningoencephalitis PMID:19537672

  2. Fulminant amoebic enteritis that developed in the perinatal period.

    PubMed

    Goto, Mayako; Mizushima, Yasuaki; Matsuoka, Tetsuya

    2015-06-25

    We present a case of a 30-year-old postpartum woman who delivered by caesarean section at 34 weeks. On postoperative day 9, she was admitted to our hospital in shock. Emergency abdominal surgery was performed. Massive purulent ascites collected in the abdominal cavity and was associated with intestinal necrosis, which extended from the ascending colon to one-third of the descending colon. The necrotic lesion was excised, and an artificial anus was constructed at the ileum end. A histological finding on the 15th day indicated the possibility of amoebic enteritis, and the patient was started on metronidazole therapy. The diarrhoea improved dramatically after metronidazole treatment was started. The patient was able to walk unassisted on the 45th day and was subsequently discharged. Amoebic enteritis has been thought to be epidemic in developing countries, but today, the incidence of amoebic enteritis as a sexually transmitted disease is increasing in developed countries.

  3. Protection against Naegleria fowleri infection in mice immunized with Cry1Ac plus amoebic lysates is dependent on the STAT6 Th2 response.

    PubMed

    Carrasco-Yepez, M; Rojas-Hernandez, S; Rodriguez-Monroy, M A; Terrazas, L I; Moreno-Fierros, L

    2010-01-01

    We previously reported that intranasal administration of Cry1Ac protoxin alone or in combination with amoebic lysates increases protection against Naegleria fowleri meningoencephalitis in mice. Those results suggested that both antibody responses and innate immune mechanisms may be participating in the protective effects observed. The present study was aimed to investigate whether the STAT6-induced Th2 immune response is essential for the resistance to N. fowleri infection, conferred by immunization with amoebic lysates plus Cry1Ac. STAT6-deficient (STAT6-/-) and wild-type (STAT6+/+) BALB/c mice were immunized by the intranasal route with a combination of N. fowleri lysates plus Cry1Ac, and subsequently challenged with lethal doses of N. fowleri trophozoites. STAT6+/+ mice displayed 100% protection, while no protection was observed in STAT6-/- mice. Significantly higher titres of Th2-associated IgG1 as well as interleukin-4 (IL-4) were found in STAT6+/+ mice, whereas in STAT6-/- mice significantly more IL-12 and IFN-gamma as well as significantly higher titres of Th1-associated IgG2a were detected. Thus, whereas protected STAT6+/+-immunized mice elicited a Th-2 type inclined immune response that produced predominantly humoral immunity, unprotected STAT6-/- mice exhibited a polarized Th1 type cellular response. These findings suggest that the STAT6-signalling pathway is critical for defence against N. fowleri infection.

  4. Fatal Human Meningoencephalitis due to Halicephalobus Nematodes, Germany

    PubMed Central

    Monoranu, Camelia-Maria; Müllges, Wolfgang; Keppler, Marc; Brehm, Klaus; Ondrejka, Sarah L.; Muntau, Birgit; Tannich, Egbert; Müller-Hermelink, Hans Konrad; Tappe, Dennis

    2015-01-01

    Infections with Halicephalobus nematodes, causative agents of severe meningoencephalitis in horses, have rarely been reported in humans. In this study, the clinical, serological, cytokine, and histopathological findings of a rapidly progressive and eventually fatal meningoencephalitis in a previously healthy human are described. The helminth was finally diagnosed by specific polymerase chain reactions from post mortem tissue. PMID:26125032

  5. Detection of circulating antigen in amoebic liver abscess by counter-current immunoelectrophoresis.

    PubMed

    Parija, S C; Karki, B M

    1999-01-01

    Fifty serum samples from patients with amoebic liver abscess and 50 from subjects who had not suffered from the disease (25 from patients with other, chiefly parasitic, infections and 25 from healthy blood donors, staff or students) were tested for circulating amoebic antigen by counter-current immuno-electrophoresis (CIEP). Amoebic antigen was detected in 38 sera (76%) from cases of amoebic liver abscess, but in none of the other sera. Although CIEP is only moderately sensitive, the high specificity suggests that this simple test may be useful in the diagnosis of amoebic liver abscess.

  6. First report of Entamoeba histolytica infection from Timor-Leste--acute amoebic colitis and concurrent late development of amoebic liver abscess in returned travellers to Australia.

    PubMed

    Nourse, Clare B; Robson, Jennifer M; Whitby, Michael R; Francis, Josh R

    2016-02-01

    This communication reports invasive amoebic colitis and late onset amoebic liver abscess in three members of a group of 12 Australian travellers to Timor-Leste (TL). This is the first report of Entamoeba histolytica infection from TL. Clinicians in Australia need to consider amoebiasis in the differential diagnosis in travellers returning with colitis, abdominal pain and fever. Presentation with amoebic liver abscess months after exposure is rare but should be suspected in symptomatic individuals with a relevant history of travel. PMID:26858275

  7. First report of Entamoeba histolytica infection from Timor-Leste--acute amoebic colitis and concurrent late development of amoebic liver abscess in returned travellers to Australia.

    PubMed

    Nourse, Clare B; Robson, Jennifer M; Whitby, Michael R; Francis, Josh R

    2016-02-01

    This communication reports invasive amoebic colitis and late onset amoebic liver abscess in three members of a group of 12 Australian travellers to Timor-Leste (TL). This is the first report of Entamoeba histolytica infection from TL. Clinicians in Australia need to consider amoebiasis in the differential diagnosis in travellers returning with colitis, abdominal pain and fever. Presentation with amoebic liver abscess months after exposure is rare but should be suspected in symptomatic individuals with a relevant history of travel.

  8. Entamoeba histolytica antigenic protein detected in pus aspirates from patients with amoebic liver abscess.

    PubMed

    Othman, Nurulhasanah; Mohamed, Zeehaida; Yahya, Maya Mazuwin; Leow, Voon Meng; Lim, Boon Huat; Noordin, Rahmah

    2013-08-01

    Entamoeba histolytica is a causative agent of amoebic liver abscess (ALA) and is endemic in many underdeveloped countries. We investigated antigenic E. histolytica proteins in liver abscess aspirates using proteomics approach. Pus samples were first tested by real-time PCR to confirm the presence of E. histolytica DNA and the corresponding serum samples tested for E. histolytica-specific IgG by a commercial ELISA. Proteins were extracted from three and one pool(s) of pus samples from ALA and PLA (pyogenic liver abscess) patients respectively, followed by analysis using isoelectric focussing, SDS-PAGE and Western blot. Unpurified pooled serum samples from infected hamsters and pooled human amoebic-specific IgG were used as primary antibodies. The antigenic protein band was excised from the gel, digested and analysed by MALDI-TOF/TOF and LC-MS/MS. The results using both primary antibodies showed an antigenic protein band of ∼14kDa. Based on the mass spectrum analysis, putative tyrosine kinase is the most probable identification of the antigenic band. PMID:23680184

  9. Entamoeba histolytica antigenic protein detected in pus aspirates from patients with amoebic liver abscess.

    PubMed

    Othman, Nurulhasanah; Mohamed, Zeehaida; Yahya, Maya Mazuwin; Leow, Voon Meng; Lim, Boon Huat; Noordin, Rahmah

    2013-08-01

    Entamoeba histolytica is a causative agent of amoebic liver abscess (ALA) and is endemic in many underdeveloped countries. We investigated antigenic E. histolytica proteins in liver abscess aspirates using proteomics approach. Pus samples were first tested by real-time PCR to confirm the presence of E. histolytica DNA and the corresponding serum samples tested for E. histolytica-specific IgG by a commercial ELISA. Proteins were extracted from three and one pool(s) of pus samples from ALA and PLA (pyogenic liver abscess) patients respectively, followed by analysis using isoelectric focussing, SDS-PAGE and Western blot. Unpurified pooled serum samples from infected hamsters and pooled human amoebic-specific IgG were used as primary antibodies. The antigenic protein band was excised from the gel, digested and analysed by MALDI-TOF/TOF and LC-MS/MS. The results using both primary antibodies showed an antigenic protein band of ∼14kDa. Based on the mass spectrum analysis, putative tyrosine kinase is the most probable identification of the antigenic band.

  10. Prognostic indications of the failure to treat amoebic liver abscesses

    PubMed Central

    Sánchez-Aguilar, Martín; Morán-Mendoza, Onofre; Herrera-Hernández, Miguel F; Hernández-Sierra, Juan Francisco; Mandeville, Peter B; Tapia-Pérez, J Humberto; Sánchez-Reyna, Martín; Sánchez-Rodríguez, José Juan; Gordillo-Moscoso, Antonio

    2012-01-01

    Objectives To identify the variables that predict the failure to treat amoebic liver abscesses. Methods We prospectively carried out a case–control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. Results Of 40 patients with amoebic liver abscess, 24 (mean age: 36.7±11.2 years) responded to medical treatment and 16 (41.8±11.6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0.05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. Conclusions The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy. PMID:23265424

  11. A case of Balamuthia mandrillaris meningoencephalitis.

    PubMed

    Katz, J D; Ropper, A H; Adelman, L; Worthington, M; Wade, P

    2000-08-01

    Balamuthia mandrillaris is a newly described pathogen that causes granulomatous amebic encephalitis, an extremely rare clinical entity that usually occurs in immunosuppressed individuals. We report a case of pathologically proven Balamuthia encephalitis with unusual laboratory and radiologic findings. A 52-year-old woman with idiopathic seizures and a 2-year history of chronic neutropenia of unknown cause had a subacute illness with progressive lethargy, headaches, and coma and died 3 months after the onset of symptoms. Cerebrospinal fluid (CSF) glucose concentrations were extremely low or unmeasurable, a feature not previously described (to our knowledge). Cranial magnetic resonance imaging scans showed a single large temporal lobe nodule, followed 6 weeks later by the appearance of 18 ring-enhancing lesions in the cerebral hemispheres that disappeared after treatment with antibiotics and high-dose corticosteroids. The initial brain biopsy specimen and analysis of CSF samples did not demonstate amebae, but a second biopsy specimen and the postmortem pathologic examination showed Balamuthia trophozoites surrounded by widespread granulomatous inflammation and vasculitis. The patient's neutropenia and antibiotic use may have caused susceptibility to this organism. Amebic meningoencephalitis should be considered in cases of subacute meningoencephalitis with greatly depressed CSF glucose concentrations and multiple nodular lesions on cerebral imaging. Arch Neurol. 2000;57:1210-1212 PMID:10927804

  12. Meningoencephalitis due to Acanthamoeba SP. Pathogenesis and clinico-pathological study.

    PubMed

    Martínez, A J; Sotelo-Avila, C; Garcia-Tamayo, J; Morón, J T; Willaert, E; Stamm, W P

    1977-03-31

    Amebic Meningoencephalitis (AM) and Primary Amebic Meningoencephalitis (PAM) are infectious diseases essentially confined to the Central Nervous System (CNS) and caused by free-living amebas of the genus Acanthamoeba (A.) and Naegleria (N.) respectively. AM due to A. sp. (Acanthamoeba castellanii and Acanthamoeba culbertsoni) have been reported in chronically ill debilitated individuals, some of them under immunosuppressive therapy, or in immunologically impaired patients without a history of recent swimming in contrast to cases due to N. sp. which usually occurs in healthy, young individuals with a recent history of swimming in man-made lakes or heated swimming pools. AM due to A.sp. is characterized by a subacute or chronic granulomatous meningoencephalitis involving mainly the midbrain, basal areas of the temporal and occipital lobes and posterior fossa structures. CNS lesions in AM are perhaps secondary and the portal of entry in humans is probably from the lower respiratory tract, genitourinary system or skin reaching the CNS by hematogenous spread. The predominant host reaction is usually composed of lymphocytes, plasma cells, monocytes and multinucleated foreign body giant cells. Necrosis is moderate and hemorrhage scant or absent. Cysts as well as trophozoites may be seen within the CNS lesions. PAM is due to Naegleria fowleri and is characterized by an hemorrhagic necrotizing meningoencephalities with an acute inflammatory response. Only trophozoites are found in lesions. The portal of entry is through the olfactory neuroepithelium. CNS tissues fixed in formalin may be used for further identification and taxonomical classification of the causative protoza using immunofluorescent antibody techniques (IFAT) and electron microscopic methods. PMID:857580

  13. Naegleria australiensis: experimental meningoencephalitis in mice.

    PubMed

    De Jonckheere, J F; Aerts, M; Martinez, A J

    1983-01-01

    Naegleria australiensis was recently described as a new species of free-living amoeba pathogenic for mice. Infections of human brain by the free-living amoebae N. fowleri and Acanthamoeba spp. are well known. We here describe the clinicopathological features of experimental infection of the central nervous system of mice by N. australiensis. Weanling mice were inoculated intranasally and intracerebrally. The involvement of the nasal mucosa, olfactory neuroepithelium and lobes, cerebrum and cerebellum was detected in haematoxylin-eosin stained paraffin-embedded sections. Amoebic trophozoites sparsely located throughout the central nervous system were shown better by the immunoperoxidase method. Cysts were not detected. The histopathological changes differ from those produced by N. fowleri, especially in the degree of severity. They may be confused with those caused by Acanthamoeba spp. which usually produced subacute and chronic encephalitis with a prolonged clinical course. PMID:6659050

  14. Taking a bite: Amoebic trogocytosis in Entamoeba histolytica and beyond.

    PubMed

    Ralston, Katherine S

    2015-12-01

    Entamoeba histolytica is a diarrheal pathogen with the ability to cause profound host tissue damage. This organism possesses contact-dependent cell killing activity, which is likely to be a major contributor to tissue damage. E. histolytica trophozoites were recently shown to ingest fragments of living human cells. It was demonstrated that this process, termed amoebic trogocytosis, contributes to cell killing. Recent advances in ex vivo and 3-D cell culture approaches have shed light on mechanisms for tissue destruction by E. histolytica, allowing amoebic trogocytosis to be placed in the context of additional host and pathogen mediators of tissue damage. In addition to its relevance to pathogenesis of amoebiasis, an appreciation is emerging that intercellular nibbling occurs in many organisms, from protozoa to mammals.

  15. Amebic meningoencephalitis caused by Balamuthia mandrillaris.

    PubMed

    Griesemer, D A; Barton, L L; Reese, C M; Johnson, P C; Gabrielsen, J A; Talwar, D; Visvesvara, G S

    1994-05-01

    Free-living amebae etiologically associated with central nervous system (CNS) infection in children have included Acanthamoeba, Naegleria, and recently, leptomyxid ameba. Two previously healthy children are reported with CNS infection caused by leptomyxid ameba, recently classified as Balamuthia mandrillaris. One child, a 27-month-old boy, had right hemiparesis and aphasia, and the other, a 13-year-old girl, had headache, right hemiparesis, diplopia, and left facial weakness. Cerebrospinal fluid studies of both children revealed a mononuclear pleocytosis and mildly elevated protein. The younger child developed seizures and progressive cerebrovascular occlusions; both developed hydrocephalus and coma progressing to death 16 days after onset of symptoms. The younger child at autopsy had necrotizing meningoencephalitis, left internal carotid arteritis, and amebic trophozoites and cysts in brain. Perivascular trophozoites were difficult to distinguish morphologically from macrophages in the older child, who had no cyst forms. Indirect immunofluorescence test revealed CNS infection with B. mandrillaris in both. This leptomyxid ameba, formerly considered an innocuous soil organism, should be considered in the differential diagnosis of progressive or atypical childhood stroke. PMID:8060431

  16. Pathological and immunological features of canine necrotising meningoencephalitis and granulomatous meningoencephalitis.

    PubMed

    Uchida, Kazuyuki; Park, Eunsil; Tsuboi, Masaya; Chambers, James K; Nakayama, Hiroyuki

    2016-07-01

    Necrotising meningoencephalitis (NME) and granulomatous meningoencephalitis (GME) are idiopathic inflammatory diseases of the canine central nervous system (CNS). Typical NME occurs predominantly in small breeds of dogs, such as Pug, Maltese and Yorkshire terriers. Although there is no specific breed predisposition to GME, toy and terrier breeds appear to be overrepresented. Recent molecular investigations have identified genetic risk factors for NME in Pug, Maltese and other toy breed dogs; however, details of the pathogenesis of this disease remain to be clarified. NME is characterised pathologically by necrotic lesions with mononuclear cell infiltration in the meninges and perivascular spaces. On the basis of the distribution pattern of major necrotic foci, NME can be divided into cortex dominant and white matter dominant types; the latter is designated necrotising leucoencephalitis (NLE). Lesions in GME are characterised by the accumulation of lymphocytes and macrophages with epithelioid morphology, forming granulomas around blood vessels. Some common genetic factors and/or some additional triggers, such as infection or vaccination, may play a role in the pathogenesis of NME, NLE and GME; however, the host immune responses may define the pathological phenotypes. Different cytokine and chemokine responses are seen in NME, NLE and GME, whilst autoantibodies against astrocytes are detected predominantly in NME. This review focuses on the pathological and immunological characteristics of these canine idiopathic inflammatory CNS disorders. PMID:27240919

  17. Pathological and immunological features of canine necrotising meningoencephalitis and granulomatous meningoencephalitis.

    PubMed

    Uchida, Kazuyuki; Park, Eunsil; Tsuboi, Masaya; Chambers, James K; Nakayama, Hiroyuki

    2016-07-01

    Necrotising meningoencephalitis (NME) and granulomatous meningoencephalitis (GME) are idiopathic inflammatory diseases of the canine central nervous system (CNS). Typical NME occurs predominantly in small breeds of dogs, such as Pug, Maltese and Yorkshire terriers. Although there is no specific breed predisposition to GME, toy and terrier breeds appear to be overrepresented. Recent molecular investigations have identified genetic risk factors for NME in Pug, Maltese and other toy breed dogs; however, details of the pathogenesis of this disease remain to be clarified. NME is characterised pathologically by necrotic lesions with mononuclear cell infiltration in the meninges and perivascular spaces. On the basis of the distribution pattern of major necrotic foci, NME can be divided into cortex dominant and white matter dominant types; the latter is designated necrotising leucoencephalitis (NLE). Lesions in GME are characterised by the accumulation of lymphocytes and macrophages with epithelioid morphology, forming granulomas around blood vessels. Some common genetic factors and/or some additional triggers, such as infection or vaccination, may play a role in the pathogenesis of NME, NLE and GME; however, the host immune responses may define the pathological phenotypes. Different cytokine and chemokine responses are seen in NME, NLE and GME, whilst autoantibodies against astrocytes are detected predominantly in NME. This review focuses on the pathological and immunological characteristics of these canine idiopathic inflammatory CNS disorders.

  18. A rare cause of cerebral venous thrombosis: cryptococcal meningoencephalitis.

    PubMed

    Senadim, Songul; Alpaydin Baslo, Sezin; Tekin Güveli, Betül; Dedei Daryan, Metin; Kantaroglu, Elif; Ozturk, Oya; Atakli, Dilek

    2016-07-01

    Cryptococcal meningoencephalitis (CM) is a serious central nervous system infection caused by Cryptococcus neoformans, seen mostly in immunocompromised hosts and less in immunocompetent patients. The vast majority of cryptococcosis cases are seen as human immunodeficiency virus infections with advanced immunosuppression. Meningitis and meningoencephalitis are the most common clinical manifestations. Nevertheless, immunocompetent patients with CM are rarely reported. Cerebral venous sinus thrombosis is a rare complication of CM. Here, we report an immunocompetent patient with CM from a non-endemic area, who presented with an acute onset and atypical symptoms associated with cerebral venous thrombosis. PMID:27025504

  19. Curative properties of muramyl dipeptide in experimental Naegleria meningoencephalitis.

    PubMed

    Ferrante, A; Lederer, E

    1986-01-01

    Naegleria fowleri is a free-living amoeba which causes a fatal meningoencephalitis in man. Mice injected with the immunostimulant MDP or an attenuated 11RX strain of Salmonella enteritidis showed some resistance to an intranasal challenge with N. fowleri. In addition it was observed that some of the mice infected with N. fowleri and showing symptoms of naegleria meningoencephalitis, given a single injection of MDP were cured of this disease. Our findings suggest that the use of immunostimulants could be a new approach in the quest for therapeutic agents for this disease. PMID:3538525

  20. Pan-Genome Analysis of Brazilian Lineage A Amoebal Mimiviruses

    PubMed Central

    Assis, Felipe L.; Bajrai, Leena; Abrahao, Jonatas S.; Kroon, Erna G.; Dornas, Fabio P.; Andrade, Kétyllen R.; Boratto, Paulo V. M.; Pilotto, Mariana R.; Robert, Catherine; Benamar, Samia; La Scola, Bernard; Colson, Philippe

    2015-01-01

    Since the recent discovery of Samba virus, the first representative of the family Mimiviridae from Brazil, prospecting for mimiviruses has been conducted in different environmental conditions in Brazil. Recently, we isolated using Acanthamoeba sp. three new mimiviruses, all of lineage A of amoebal mimiviruses: Kroon virus from urban lake water; Amazonia virus from the Brazilian Amazon river; and Oyster virus from farmed oysters. The aims of this work were to sequence and analyze the genome of these new Brazilian mimiviruses (mimi-BR) and update the analysis of the Samba virus genome. The genomes of Samba virus, Amazonia virus and Oyster virus were 97%–99% similar, whereas Kroon virus had a low similarity (90%–91%) with other mimi-BR. A total of 3877 proteins encoded by mimi-BR were grouped into 974 orthologous clusters. In addition, we identified three new ORFans in the Kroon virus genome. Additional work is needed to expand our knowledge of the diversity of mimiviruses from Brazil, including if and why among amoebal mimiviruses those of lineage A predominate in the Brazilian environment. PMID:26131958

  1. Acute meningoencephalitis as the sole manifestation of Q fever.

    PubMed

    Guerrero, M; Gutierrez, J; Carnero, C; Gonzalez-Maldonado, R; Maroto, C

    1993-01-01

    The case of a 25-year old man who presented with meningoencephalitis as the sole clinical manifestation of Q fever is described. Serological studies revealed the presence of IgM and IgG antibodies to Coxiella burnetii. The patient responded favourably to a ten-day course of i.v. ceftriaxone and was discharged without any neurological sequelae.

  2. Listeria meningoencephalitis and anti-GQ1b antibody syndrome.

    PubMed

    Vergori, A; Masi, G; Donati, D; Ginanneschi, F; Annunziata, P; Cerase, A; Mencarelli, M; Rossetti, B; De Luca, A; Zanelli, G

    2016-08-01

    We report the first case of Listeria monocytogenes meningoencephalitis associated with anti-GQ1b antibody syndrome in an immunocompetent adult. A prompt diagnosis, made thanks to the multidisciplinary contribution, allowed a combined therapeutic approach leading to final favourable outcome, despite several intercurrent complications. PMID:26825308

  3. MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE.

    PubMed

    Corti, Marcelo; Villafañe, María F; Vittar, Natalia; Banco, María C; Priarone, Maia; Mammana, Lilia; Gilardi, Leonardo

    2015-12-01

    Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease.

  4. MENINGOENCEPHALITIS DUE TO VARICELLA ZOSTER VIRUS IN AIDS PATIENTS. REPORT OF ELEVEN CASES AND REVIEW OF THE LITERATURE

    PubMed Central

    CORTI, Marcelo; VILLAFAÑE, María F.; VITTAR, Natalia; BANCO, María C.; PRIARONE, Maia; MAMMANA, Lilia; GILARDI, Leonardo

    2015-01-01

    Neurological complications of varicella-zoster virus (VZV) are infrequent and include various clinical pictures. The reactivation of VZV in patients with AIDS is generally associated with an acute and severe meningoencephalitis. We report the epidemiological, clinical and virological data from 11 consecutive patients with diagnosis of HIV/AIDS and central nervous system (CNS) involvement due to VZV. All patients were male and seropositive for HIV. The primary risk factor for HIV infection was unprotected sexual contact. The median of CD4 T cell count was 142 cells/µL. All of them presented signs and symptoms of meningoencephalitis. Six patients (54.5%) presented pleocytosis; they all showed high CSF protein concentrations with a median of 2.1 g/dL. Polymerase chain reaction of cerebrospinal fluid specimen was positive for VZV in all of them and they were treated with intravenous acyclovir at doses of 30/mg/kg/day for 21 days. Overall survival was 63% (7 of 11 patients). The four dead patients had low cellular counts in CSF, below the median of this parameter. VZV should be included among the opportunistic pathogens that can involve CNS with a diffuse and severe meningoencephalitis in patients with advanced HIV/AIDS disease. PMID:27049704

  5. Multiple Medium Amoebic Liver Abscesses Successfully Treated with Medication and Comprehensive Percutaneous Catheter Drainage.

    PubMed

    Kasamatsu, Yu; Shirano, Michinori; Iida, Ko; Shimizu, Sadatoshi; Goto, Tetsushi

    2016-01-01

    Solitary small (<5 cm) amoebic liver abscesses in the right lobe are generally treated using medication alone, while large abscesses are typically treated via a combination of medication and drainage. However, the therapeutic indications for multiple medium (5-10 cm) amoebic liver abscesses remain unclear. We herein report the findings of a 53-year-old woman who was receiving lenalidomide for multiple myeloma and subsequently developed multiple amoebic abscesses. Metronidazole alone was unsuccessful, although metronidazole and repeated percutaneous catheter drainage of the right lobe, left lobe, and thorax proved to ultimately be successful. Therefore, the successful use of medication alone may be associated with the total combined abscess volume. PMID:27523014

  6. Ultrasound-guided needle aspiration of amoebic liver abscess.

    PubMed Central

    Ramani, A.; Ramani, R.; Kumar, M. S.; Lakhkar, B. N.; Kundaje, G. N.

    1993-01-01

    This prospective study was carried out on 200 patients with clinically, ultrasonographically and serologically confirmed amoebic liver abscess. The role of ultrasound-guided needle aspiration in addition to medications was evaluated compared to drug treatment alone. Both the groups were monitored clinically and sonographically for up to 6 months after diagnosis. The initial response (after 15 days) was better in the aspirated group (P < 0.05) but resolution of abscess after 6 months were similar. There was a more rapid clinical response in the aspirated group, particularly in those with larger (> 6 cm) abscesses and there were no complications. Percutaneous ultrasound-guided needle aspiration is a safe diagnostic and therapeutic approach which enhances clinical recovery, accelerates resolution, especially in large abscesses, and prevents complications. PMID:8346134

  7. Amoebic liver abscess: ultrasonographic characteristics and results of different therapeutic approaches.

    PubMed

    Widjaya, P; Bilić, A; Babić, Z; Ljubicić, N; Bakula, B; Pilas, V

    1991-01-01

    This prospective study was carried out on 33 patients with clinically, serologically and ultrasonographically confirmed amoebic liver abscess. All patients were randomly treated with metronidazole and chlorochin or a combination of medicamentous therapy and percutaneous drainage. Ultrasonographic characteristics of amoebic liver abscesses were rotound or oval shape, usually hypoechogenic content with specific dorsal sonic enhancement, and in the majority of cases, location near liver capsule. Shorter duration of amoebic liver abscess resolution time in the group of patients treated with the combined therapy was observed particularly in the first four weeks of the treatment. The authors concluded that percutaneous drainage in combination with medicamentous therapy represents a successful therapeutic approach in the treatment of amoebic liver abscesses. PMID:2035339

  8. [A case of Paragonimus Miyazaki with pleuritis and meningoencephalitis].

    PubMed

    Itakura, M; Shinozaki, T; Shingyouji, M

    1997-09-01

    A 35-year-old man was admitted to our hospital with fever and headache. Chest X-ray revealed right pleural effusion. Lab tests revealed increase of eosinophils in his serum and pleural effusion. After admission he complained of doplopia and neck stiffness. Lumber puncture revealed eosinophilia in the cerbrospinal fluid. Brain CT and MRI showed characteristic images of meningoencephalitis. The patient had eaten raw Potamon dehaani and the case was diagnosed as paragonimus miyazaki after administration of intradermal reaction and Ouchterony's double diffusion test. The patient was successfully treated with praziqantel. It revealed that the pleural effusion and brain edema disappeared chest X-ray and brain MRI. This case can be considered as a characteristic example of Paragonimus Miyazaki with pleuritis and meningoencephalitis.

  9. Amebic meningoencephalitis caused by Balamuthia mandrillaris: case report and review.

    PubMed

    Denney, C F; Iragui, V J; Uber-Zak, L D; Karpinski, N C; Ziegler, E J; Visvesvara, G S; Reed, S L

    1997-12-01

    Balamuthia mandrillaris, formerly referred to as a leptomyxid ameba, is a free-living ameba that has recently been identified as a cause of meningoencephalitis. Previously, only two genera, Naegleria and Acanthamoeba, were recognized as causes of central nervous system (CNS) infections in humans. In contrast to Naegleria, Balamuthia causes a subacute-to-chronic infection of the CNS. Distinct from Acanthamoeba, which appears to favor the immunocompromised host, Balamuthia is capable of infecting both healthy and immunosuppressed hosts. Retrospective analyses as well as an accumulation of newly identified cases have demonstrated that this ameba is an increasingly important pathogen to recognize. We report the isolation, histopathologic features, and confirmation by indirect immunofluorescence of B. mandrillaris in a case of fatal amebic meningoencephalitis. PMID:9431377

  10. Periodic lateralized epileptiform discharges as manifestation of pneumococcal meningoencephalitis

    PubMed Central

    2011-01-01

    Periodic Lateralized Epileptiform Discharges (PLEDs) are usually seen in the context of destructive structural lesions of the cortex, more frequently in acute ischemic stroke and less common in tumours and meningoencephalitis, specially herpes simplex virus. Its origin and prognosis are uncertain but it is known that PLEDs are linked to epilectic seizures, including status epilepticus. We report on a 75-year old woman with pneumococcal meningoencephalitis who presented altered level of consciousness, acute focal deficits, convulsive seizures and PLEDs in left hemisphere. The finding of PLEDs on the electroencephalogram is related to focal lesions of heterogeneous origin, which up to date, have not been documented in pneumococcal infections of the central nervous system. Our case highlights the importance of identifying and addressing any modifiable etiologic factors of PLEDs. PMID:21703002

  11. Naegleria fowleri hemorrhagic meningoencephalitis: report of two fatalities in children.

    PubMed

    Okuda, Darin T; Hanna, Hank J; Coons, Stephen W; Bodensteiner, John B

    2004-03-01

    Two cases of hemorrhagic meningoencephalitis secondary to Naegleria fowleri infection confirmed by postmortem analysis are described. The first patient is a 5-year-old boy who presented with a severe headache, neck stiffness, and lethargy. His neurologic examination was significant for somnolence and nuchal rigidity. Cerebrospinal fluid studies and structural neuroimaging were consistent with hemorrhagic meningoencephalitis. Another 5-year-old boy presented to a different institution 2 miles away in the same week with similar complaints. Both patients declined rapidly and expired within 48 hours of admission secondary to transtentorial herniation caused by the mass effect of inflammation, edema, and hemorrhage with displacement of the brain stem. Histopathologic and immunochemistry analysis of brain tissue revealed the presence of Naegleria trophozoites in both cases.

  12. Trypanosoma cruzi meningoencephalitis in a patient with acquired immunodeficiency syndrome.

    PubMed

    Yasukawa, Kosuke; Patel, Shital M; Flash, Charlene A; Stager, Charles E; Goodman, Jerry C; Woc-Colburn, Laila

    2014-07-01

    As a result of global migration, a significant number of people with Trypanosoma cruzi infection now live in the United States, Canada, many countries in Europe, and other non-endemic countries. Trypanosoma cruzi meningoencephalitis is a rare cause of ring-enhancing lesions in patients with acquired immunodeficiency syndrome (AIDS) that can closely mimic central nervous system (CNS) toxoplasmosis. We report a case of CNS Chagas reactivation in an AIDS patient successfully treated with benznidazole and antiretroviral therapy in the United States.

  13. First Human Case of Fatal Halicephalobus gingivalis Meningoencephalitis in Australia

    PubMed Central

    Crawford, April; Moore, Casey V.; Gasser, Robin B.; Nelson, Renjy; Koehler, Anson V.; Bradbury, Richard S.; Speare, Rick; Dhatrak, Deepak; Weldhagen, Gerhard F.

    2015-01-01

    Halicephalobus gingivalis (previously Micronema deletrix) is a free-living nematode known to cause opportunistic infections, mainly in horses. Human infections are very rare, but all cases described to date involved fatal meningoencephalitis. Here we report the first case of H. gingivalis infection in an Australian human patient, confirmed by nematode morphology and sequencing of ribosomal DNA. The implications of this case are discussed, particularly, the need to evaluate real-time PCR as a diagnostic tool. PMID:25694532

  14. Fever of Unknown Origin in a Patient with Confirmed West Nile Virus Meningoencephalitis

    PubMed Central

    Sabre, Alexander; Farricielli, Laurie

    2014-01-01

    West Nile Virus (WNV), an RNA arbovirus and member of the Japanese encephalitis virus antigenic complex, causes a wide range of clinical symptoms, from asymptomatic to encephalitis and meningitis. Nearly all human infections of WNV are due to mosquito bites with birds being the primary amplifying hosts. Advanced age is the most important risk factor for neurological disease leading most often to poor prognosis in those afflicted. We report a case of WNV meningoencephalitis in a 93-year-old Caucasian male who presented with fever of unknown origin (FUO) and nuchal rigidity that rapidly decompensated within 24 h to a persistent altered mental state during inpatient stay. The patient's ELISA antibody titers confirmed pathogenesis of disease by WNV; he given supportive measures and advanced to an excellent recovery. In regard to the approach of FUO, it is important to remain impartial yet insightful to all elements when determining pathogenesis in atypical presentation. PMID:25580318

  15. Cerebral Ventriculitis Associated with Otogenic Meningoencephalitis in a Dog.

    PubMed

    Wu, Chih-Ching; Chang, Ya-Pei

    2015-01-01

    A dog was evaluated for rapidly progressive mentation change, ataxia, and tetraparesis. The dog's neurological status deteriorated drastically. It became comatose with bilateral mydriasis, and the pupillary light reflex was absent. An anti-inflammatory dose of methylprednisolone was administered, and temporary stabilization of neurological status was achieved. MRI findings were suggestive of ventriculitis and meningoencephalitis originating from the left tympanic cavity. A gadolinium leakage phenomenon was noted, likely resulting from severe damage to the blood-cerebrospinal fluid barrier during the inflammatory process. Analysis of the cerebrospinal fluid and materials in the left tympanic cavity further confirmed the diagnosis. Following surgical and antibiotic treatment, the dog recovered well with only a mild residual head tilt. Seven months after surgery, the dog had a recurrent infection of the left tympanic cavity without intracranial involvement. A second surgery led to an uneventful recovery, and the dog was clinically normal except for a mild head tilt 3 yr after the initial presentation. This is the first report describing ventriculitis associated with otogenic meningoencephalitis in dogs and a gadolinium leakage phenomenon displayed on MRI. The long-term outcome of ventriculitis-complicated otogenic meningoencephalitis in dogs could be satisfied with prompt diagnosis and treatment. PMID:26083434

  16. [Cerebral salt wasting syndrome in a patient with viral meningoencephalitis].

    PubMed

    Namba, Tomoko; Harada, Tamaki; Sakai, Kanaki; Takeji, Masanobu; Takahara, Ken; Uzu, Takashi; Yamauchi, Atsushi

    2006-01-01

    A 53-year-old male was admitted to our hospital for a high fever. He suffered a change in personality, memory loss and disorientation as well. The findings of cerebrospinal fluid showed monocytosis, but the titers of glucose, C1 and ADA were all normal. Although there was no bacterium in the CSF, the patient's electroencephalography finding was abnormal. We diagnosed his condition as viral meningoencephalitis and started treatment with antiviral agents. Blood chemistry showed serum sodium of 130 mEq/l and plasma osmolarity was reduced to 272 mOsm/kg, while urine osmolarity was high at 353 mOsm/kg. Two potential causes of hyponatremia in this patient were the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (CSWS). Physical findings revealed a contracted extracellular fluid volume, strongly suggesting the presence of CSWS. The massive urine sodium loss overcoming sodium intake supported this diagnosis. After treatment with vigorous sodium and volume replacement for over 4 weeks, hyponatremia as well as meningoencephalitis were improved without any complication. To the best of our knowledge, this is the first report on CSWS in a patient with viral meningoencephalitis.

  17. Amoebic gill disease: sequential pathology in cultured Atlantic salmon, Salmo salar L.

    PubMed

    Adams, M B; Nowak, B F

    2003-10-01

    Amoebic gill disease (AGD) affects the marine culture phase of Atlantic salmon, Salmo salar L., in Tasmania. Here, we describe histopathological observations of AGD from smolts, sampled weekly, following transfer to estuarine/marine sites. AGD was initially detected histologically at week 13 post-transfer while gross signs were not observed for a further week post-transfer. Significant increases (P < 0.001) in the proportion of affected gill filaments occurred at weeks 18 and 19 post-transfer coinciding with the cessation of a halocline and increased water temperature at the cage sites. The progression of AGD histopathology, during the sampling period, was characterized by three phases. (1) Primary attachment/interaction associated with extremely localized host cellular alterations, juxtaposed to amoebae, including epithelial desquamation and oedema. (2) Innate immune response activation and initial focal hyperplasia of undifferentiated epithelial cells. (3) Finally, lesion expansion, squamation-stratification of epithelia at lesion surfaces and variable recruitment of mucous cells to these regions. A pattern of preferential colonization of amoebae at lesion margins was apparent during stage 3 of disease development. Together, these data suggest that AGD progression was linked to retraction of the estuarine halocline and increases in water temperature. The host response to gill infection with Neoparamoeba sp. is characterized by a focal fortification strategy concurrent with a migration of immunoregulatory cells to lesion-affected regions. PMID:14653318

  18. Cryptococcal 3-Hydroxy Fatty Acids Protect Cells Against Amoebal Phagocytosis.

    PubMed

    Madu, Uju L; Ogundeji, Adepemi O; Mochochoko, Bonang M; Pohl, Carolina H; Albertyn, Jacobus; Swart, Chantel W; Allwood, J William; Southam, Andrew D; Dunn, Warwick B; May, Robin C; Sebolai, Olihile M

    2015-01-01

    We previously reported on a 3-hydroxy fatty acid that is secreted via cryptococcal capsular protuberances - possibly to promote pathogenesis and survival. Thus, we investigated the role of this molecule in mediating the fate of Cryptococcus (C.) neoformans and the related species C. gattii when predated upon by amoebae. We show that this molecule protects cells against the phagocytic effects of amoebae. C. neoformans UOFS Y-1378 (which produces 3-hydroxy fatty acids) was less sensitive toward amoebae compared to C. neoformans LMPE 046 and C. gattii R265 (both do not produce 3-hydroxy fatty acids) and addition of 3-hydroxy fatty acids to C. neoformans LMPE 046 and C. gattii R265 culture media, causes these strains to become more resistant to amoebal predation. Conversely, addition of aspirin (a 3-hydroxy fatty acid inhibitor) to C. neoformans UOFS Y-1378 culture media made cells more susceptible to amoebae. Our data suggest that this molecule is secreted at a high enough concentration to effect intracellular signaling within amoeba, which in turn, promotes fungal survival. PMID:26696972

  19. Ankyrin-repeat proteins from sponge symbionts modulate amoebal phagocytosis.

    PubMed

    Nguyen, Mary T H D; Liu, Michael; Thomas, Torsten

    2014-03-01

    Bacteria-eukaryote symbiosis occurs in all stages of evolution, from simple amoebae to mammals, and from facultative to obligate associations. Sponges are ancient metazoans that form intimate symbiotic interactions with complex communities of bacteria. The basic nutritional requirements of the sponge are in part satisfied by the phagocytosis of bacterial food particles from the surrounding water. How bacterial symbionts, which are permanently associated with the sponge, survive in the presence of phagocytic cells is largely unknown. Here, we present the discovery of a genomic fragment from an uncultured gamma-proteobacterial sponge symbiont that encodes for four proteins, whose closest known relatives are found in a sponge genome. Through recombinant approaches, we show that these four eukaryotic-like, ankyrin-repeat proteins (ARP) when expressed in Eschericha coli can modulate phagocytosis of amoebal cells and lead to accumulation of bacteria in the phagosome. Mechanistically, two ARPs appear to interfere with phagosome development in a similar way to reduced vacuole acidification, by blocking the fusion of the early phagosome with the lysosome and its digestive enzymes. Our results show that ARP from sponge symbionts can function to interfere with phagocytosis, and we postulate that this might be one mechanism by which symbionts can escape digestion in a sponge host.

  20. Cryptococcal 3-Hydroxy Fatty Acids Protect Cells Against Amoebal Phagocytosis

    PubMed Central

    Madu, Uju L.; Ogundeji, Adepemi O.; Mochochoko, Bonang M.; Pohl, Carolina H.; Albertyn, Jacobus; Swart, Chantel W.; Allwood, J. William; Southam, Andrew D.; Dunn, Warwick B.; May, Robin C.; Sebolai, Olihile M.

    2015-01-01

    We previously reported on a 3-hydroxy fatty acid that is secreted via cryptococcal capsular protuberances - possibly to promote pathogenesis and survival. Thus, we investigated the role of this molecule in mediating the fate of Cryptococcus (C.) neoformans and the related species C. gattii when predated upon by amoebae. We show that this molecule protects cells against the phagocytic effects of amoebae. C. neoformans UOFS Y-1378 (which produces 3-hydroxy fatty acids) was less sensitive toward amoebae compared to C. neoformans LMPE 046 and C. gattii R265 (both do not produce 3-hydroxy fatty acids) and addition of 3-hydroxy fatty acids to C. neoformans LMPE 046 and C. gattii R265 culture media, causes these strains to become more resistant to amoebal predation. Conversely, addition of aspirin (a 3-hydroxy fatty acid inhibitor) to C. neoformans UOFS Y-1378 culture media made cells more susceptible to amoebae. Our data suggest that this molecule is secreted at a high enough concentration to effect intracellular signaling within amoeba, which in turn, promotes fungal survival. PMID:26696972

  1. Cryptococcal 3-Hydroxy Fatty Acids Protect Cells Against Amoebal Phagocytosis.

    PubMed

    Madu, Uju L; Ogundeji, Adepemi O; Mochochoko, Bonang M; Pohl, Carolina H; Albertyn, Jacobus; Swart, Chantel W; Allwood, J William; Southam, Andrew D; Dunn, Warwick B; May, Robin C; Sebolai, Olihile M

    2015-01-01

    We previously reported on a 3-hydroxy fatty acid that is secreted via cryptococcal capsular protuberances - possibly to promote pathogenesis and survival. Thus, we investigated the role of this molecule in mediating the fate of Cryptococcus (C.) neoformans and the related species C. gattii when predated upon by amoebae. We show that this molecule protects cells against the phagocytic effects of amoebae. C. neoformans UOFS Y-1378 (which produces 3-hydroxy fatty acids) was less sensitive toward amoebae compared to C. neoformans LMPE 046 and C. gattii R265 (both do not produce 3-hydroxy fatty acids) and addition of 3-hydroxy fatty acids to C. neoformans LMPE 046 and C. gattii R265 culture media, causes these strains to become more resistant to amoebal predation. Conversely, addition of aspirin (a 3-hydroxy fatty acid inhibitor) to C. neoformans UOFS Y-1378 culture media made cells more susceptible to amoebae. Our data suggest that this molecule is secreted at a high enough concentration to effect intracellular signaling within amoeba, which in turn, promotes fungal survival.

  2. Misdiagnosed amoebic colitis leading to severe dysentery and necrotizing colitis--report of a case and review of the literature.

    PubMed

    Mogensen, Trine H; Christiansen, Jens J; Eivindson, Martin V; Larsen, Carsten S; Tøttrup, Anders

    2014-03-01

    We present a case of amoebic colitis, misdiagnosed as inflammatory bowel disease and treated with corticosteroids, leading to severe necrotizing enterocolitis. We review the literature on the epidemiology, pathogenesis, diagnosis, and treatment of amoebic dysentery, with special emphasis on the association between immunosuppressive treatment and the development of severe invasive amoebiasis.

  3. [Prevention of tick-borne meningoencephalitis--summary report].

    PubMed

    Vlcková, J; Rupes, V; Kollárová, H; Horáková, D

    2011-09-01

    Tick-borne meningoencephalitis is a zoonosis that shows an upward trend. The causative agent is an RNA virus of the family Flaviviridae whose vector in Central Europe is the castor bean tick (Ixodes ricinus). The infection is most often transmitted via tick bite or, less commonly, by the alimentary route, through the consumption of unpasteurized milk of infected animals. Preventive measures consist in personal protection from ticks, exceptionally in blanket treatment with contact insecticides, in preventing consumption of unpasteurized milk and dairy products from areas with a high incidence of tick-borne encephalitis, and particularly in vaccination of the susceptible population.

  4. Computed tomography of necrotizing meningoencephalitis in 3 Yorkshire Terriers.

    PubMed

    Ducoté, J M; Johnson, K E; Dewey, C W; Walker, M A; Coates, J R; Berridge, B R

    1999-01-01

    A necrotizing meningoencephalitis of Yorkshire terriers has recently been reported in 6 dogs in Switzerland, 1 dog in Japan and 1 dog in the United States. The purpose of this report is to describe the computed tomographic (CT) findings in 3 dogs with this disease, and to correlate the CT abnormalities with the clinical and pathologic findings in each case. Three Yorkshire Terriers between 2 and 10 years old were evaluated. Physical and neurologic examinations, complete blood count (CBC), serum biochemistry profile, cerebrospinal fluid analysis, and CT scan were performed on all 3 dogs. Brainstem auditory evoked responses (BAER) were evaluated for 2 dogs. Two dogs were euthanized at the owners' request and necropsies were performed. Neurologic examination findings were consistent with a multifocal/diffuse encephalitis involving the cerebrum and brainstem in all 3 dogs. Complete blood count and biochemistry profiles were normal. Elevated protein concentration and a mononuclear pleocytosis were demonstrated in 2 of 3 dogs on cerebrospinal fluid evaluation. Multifocal, extensive areas of decreased opacity throughout the cerebral hemispheres, asymmetric ventriculomegaly, and lack of contrast enhancement were appreciated on CT images of all three dogs. No mass effect was seen. These findings correlated well with pathologic findings at necropsy, which included multiple malacic cavitations within the brain, representing areas of locally extensive necrosis. CT abnormalities in combination with signalment, clinical findings and cerebrospinal fluid analysis should facilitate a presumptive diagnosis of Yorkshire Terrier necrotizing meningoencephalitis.

  5. Nuclease Activity of Legionella pneumophila Cas2 Promotes Intracellular Infection of Amoebal Host Cells

    PubMed Central

    Gunderson, Felizza F.; Mallama, Celeste A.; Fairbairn, Stephanie G.

    2014-01-01

    Legionella pneumophila, the primary agent of Legionnaires' disease, flourishes in both natural and man-made environments by growing in a wide variety of aquatic amoebae. Recently, we determined that the Cas2 protein of L. pneumophila promotes intracellular infection of Acanthamoeba castellanii and Hartmannella vermiformis, the two amoebae most commonly linked to cases of disease. The Cas2 family of proteins is best known for its role in the bacterial and archeal clustered regularly interspaced short palindromic repeat (CRISPR)–CRISPR-associated protein (Cas) system that constitutes a form of adaptive immunity against phage and plasmid. However, the infection event mediated by L. pneumophila Cas2 appeared to be distinct from this function, because cas2 mutants exhibited infectivity defects in the absence of added phage or plasmid and since mutants lacking the CRISPR array or any one of the other cas genes were not impaired in infection ability. We now report that the Cas2 protein of L. pneumophila has both RNase and DNase activities, with the RNase activity being more pronounced. By characterizing a catalytically deficient version of Cas2, we determined that nuclease activity is critical for promoting infection of amoebae. Also, introduction of Cas2, but not its catalytic mutant form, into a strain of L. pneumophila that naturally lacks a CRISPR-Cas locus caused that strain to be 40- to 80-fold more infective for amoebae, unequivocally demonstrating that Cas2 facilitates the infection process independently of any other component encoded within the CRISPR-Cas locus. Finally, a cas2 mutant was impaired for infection of Willaertia magna but not Naegleria lovaniensis, suggesting that Cas2 promotes infection of most but not all amoebal hosts. PMID:25547789

  6. Meningoencephalitis in two stranded California sea lions (Zalophus californianus) caused by aberrant trematode migration.

    PubMed

    Fauquier, Deborah; Gulland, Frances; Haulena, Martin; Dailey, Murray; Rietcheck, Randall L; Lipscomb, Thomas P

    2004-10-01

    Meningoencephalitis caused by aberrant trematode migration is described in two California sea lions (Zalophus californianus) admitted to a rehabilitation hospital between May and August 2001. Both animals displayed seizure activity and were euthanized due to poor response to therapy. Gross abnormal findings included liver flukes (Zalophotrema hepaticum) in the bile ducts and areas of swelling and necrosis in the cerebrum, cerebellum, and brain stem. Histopathology revealed meningoencephalitis with necrosis, hemorrhage, and many trematode eggs within the brain. In one sea lion, an adult trematode was found on the surface of the cerebrum. These are believed to be the first reported cases of meningoencephalitis caused by aberrant trematode migration in pinnipeds. PMID:15650108

  7. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals.

    PubMed Central

    Visvesvara, G S; Martinez, A J; Schuster, F L; Leitch, G J; Wallace, S V; Sawyer, T K; Anderson, M

    1990-01-01

    Amebae belonging to the order Leptomyxida are regarded as innocuous soil organisms incapable of infecting mammals. We report here the isolation of a leptomyxid ameba from the brain of a pregnant baboon (Papio sphinx) that died of meningoencephalitis at the San Diego Zoo Wild Animal Park. By using rabbit anti-leptomyxid serum in the immunofluorescence assay, we have identified the leptomyxid ameba in the brain sections of a number of human encephalitic cases from around the world as well as a few cases of meningoencephalitis in animals in the United States, which suggests that the leptomyxid amebae are potential etiologic agents of fatal meningoencephalitis in humans and animals. Images PMID:2280005

  8. Genome Sequence of Legionella anisa, Isolated from a Respiratory Sample, Using an Amoebal Coculture Procedure

    PubMed Central

    Pagnier, Isabelle; Croce, Olivier; Robert, Catherine; Raoult, Didier

    2014-01-01

    Legionella anisa is a gammaproteobacterium from the class Legionellaceae, which is responsible for nosocomial pneumonia. We sequenced the genome from the L. anisa strain Linanisette, which was recovered from a clinical sample using an amoebal coculture procedure but not with standard culture methods. PMID:24503989

  9. First Draft Genome Sequence of Balamuthia mandrillaris, the Causative Agent of Amoebic Encephalitis

    PubMed Central

    Aebischer, T.; Dabrowski, P. W.; Radonić, A.; Nitsche, A.; Renard, B. Y.

    2015-01-01

    The free-living amoeba Balamuthia mandrillaris is a rare but highly lethal agent of amoebic encephalitis in humans and many other mammalian species. Here, we announce the first draft genome sequence of the original 1990 isolate cultured from the brain of a deceased mandrill baboon. PMID:26404594

  10. Influence of intra-amoebic and other growth conditions on the surface properties of Legionella pneumophila.

    PubMed Central

    Barker, J; Lambert, P A; Brown, M R

    1993-01-01

    The surface properties of Legionella pneumophila were examined by analyzing outer membrane (OM) proteins, lipopolysaccharides (LPS), and cellular fatty acids after growth within Acanthamoeba polyphaga and in vitro under various nutrient-depleted conditions. Intra-amoeba-grown legionellae were found to differ in several respects from cells grown in vitro; most notably, they contained a 15-kDa OM protein and a monounsaturated straight-chain fatty acid (18:1(9)). These compounds were also found in abundant quantities in the host amoeba. Immunoblot analysis of intra-amoeba-grown legionellae with antiacanthamoebic serum revealed that both the bacterial whole cells and Sarkosyl-extracted OMs contained amoebic antigens. The findings suggest that the 15-kDa OM protein is likely to be of amoebic origin and associates with the OM of the bacterium. It is proposed that disruption of amoebic membranes, as a result of intra-amoebic infection, may liberate macromolecules, including a 15-kDa polypeptide, a major constituent of the amoebic membrane, which adhere to the surface of the legionellae. Growth under specific nutrient depletions also had a significant effect on the surface composition of L. pneumophila. Cells grown under phosphate depletion were markedly sensitive to protease K digestion and contained lower levels of LPS, as observed by silver staining of the digests on polyacrylamide gels. Intra-amoeba-grown cells contained more bands than the in vitro-grown organisms, reflecting further differences in the nature of the LPS. The whole-cell fatty acids of the phosphate-depleted cells were appreciably different from those of cells grown under other nutritional conditions. We found no evidence for expression of iron-regulated OM proteins under iron depletion. Images PMID:8335382

  11. Cerebral salt wasting following tuberculous meningoencephalitis in an infant

    PubMed Central

    Zaki, Syed Ahmed; Lad, Vijay; Shanbag, Preeti

    2012-01-01

    In patients with central nervous system disease, life-threatening hyponatremia can result from either the syndrome of inappropriate secretion of antidiuretic hormone or cerebral salt wasting. Clinical manifestations of the two conditions may be similar, but their pathogeneses and management protocols are different. Cerebral salt wasting syndrome is a disorder in which excessive natriuresis and hyponatremia occurs in patients with intracranial diseases. We report a 6-month-old girl with CSWS associated with tuberculous meningoencephalitis. She was diagnosed as having CSWS on the basis of hypovolemia, polyuria, natriuresis, and the relatively high level of fractional excretion of uric acid. Aggressive replacement of urine salt and water losses using 0.9% or 3% sodium chloride was done. Fludrocortisone was started at 0.1 mg twice daily on the seventh day of admission and was continued for 17 days. PMID:22566734

  12. Ibuprofen-induced aseptic meningoencephalitis confirmed by drug challenge.

    PubMed

    Moreno-Ancillo, A; Gil-Adrados, A C; Jurado-Palomo, J

    2011-01-01

    Drug-induced aseptic meningitis (DIAM) is a diagnostic challenge. The major causative agents are nonsteroidal anti-inflammatory drugs (particularly ibuprofen), antibiotics, intravenous immunoglobulin, and OKT3 monoclonal antibodies. DIAM is more frequently observed in patients with autoimmune diseases. A 36-year-old woman was attended in our department 3 months after being diagnosed with aseptic meningoencephalitis. She had had 2 episodes in 9 months. Neurological symptoms were associated with ibuprofen. A challenge with acetylsalicylic acid was negative, whereas a drug challenge with ibuprofen was positive. Thirty minutes after ingesting 50 mg of ibuprofen, she experienced general malaise and progressively developed chills, fever (39.5 degrees C), headache, and nuchal rigidity. Lumbar puncture showed normal glucose and high protein levels. Neutrophilic pleocytosis was observed at the first admission; lymphocytosis was predominant in the second and third episodes. DIAM is a rare and severe hypersensitivity reaction. Drug challenge enabled us to make an accurate diagnosis. PMID:21995183

  13. [Meningoencephalitis due to Morganella morganii: a case report].

    PubMed

    Ndiaye, M; Sène, M S; Sow, A D; Seck, L B; Coulibaly, T; Diagne, N S; Touré, K; Diop, A G; Ndiaye, M M

    2010-10-01

    A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.

  14. Meningoencephalitis caused by Plesiomonas shigelloides in a Chinese neonate: case report and literature review.

    PubMed

    Xia, Fang-Qin; Liu, Pei-Ning; Zhou, Yong-Hai

    2015-01-01

    The most usual presentation of Plesiomonas shigelloides infection is an acute gastroenteritis, and extraintestinal manifestations are extremely rare. We reported the first neonate with P. shigelloides meningoencephalitis in China and reviewed the twelve cases previously reported. Our report adds further awareness on Plesiomonas shigelloides meningoencephalitis in neonate and points out the importance of an early diagnosis and the use of sensitive antibiotics treatment to this fatal infection. PMID:25599746

  15. An outbreak of caprine meningoencephalitis due to Escherichia coli O157:H7.

    PubMed

    Filioussis, George; Petridou, Evanthia; Karavanis, Emmanouel; Giadinis, Nektarios D; Xexaki, Anna; Govaris, Alexandros; Kritas, Spyridon K

    2013-11-01

    Five 1-month-old kid goats from a local herd in Kozani (northwest Greece) developed neurological disorders characterized by decreased appetite, ataxia, and head pressing. The animals received a 3-day course of treatment with intramuscular administration of enrofloxacin and ketoprofen. However, no significant clinical improvement was achieved, and 2 kids died. The remaining 3 animals were euthanized, and a necropsy was performed within 1 hr. Macroscopic lesions were confined to the central nervous system, with congestion and petechiae in the meninges. Microscopic lesions in all 3 animals revealed multifocal acute meningoencephalitis characterized by infiltrations composed of mononuclear inflammatory cells, lesser numbers of lymphocytes, and occasionally neutrophils and eosinophils. Additionally, in the kidney, there was multifocal expansion of the glomerular tufts by eosinophilic amorphous material, multifocal interstitial hemorrhages, and multifocal glomerular hypercellularity. The above noted lesions are consisted with an acute ongoing nephropathy indicative of a septicemic-toxemic procedure at its primary stages. Small, gray bacterial colonies, 3-4 mm in diameter, were obtained in pure culture from the brain of all 3 necropsied animals and were confirmed as Escherichia coli O157:H7 by use of phenotypic and genotypic methods. The isolates were sensitive to cefuroxime, ceftazidime, and gentamicin. In contrast, resistance to enrofloxacin, trimethoprim-sulfamethoxazole, and tetracycline was displayed. Additionally the bacterial isolates were found to carry a plasmid that harbored qnrS, sulII, and tetB genes that contribute to high-level resistance to fluoroquinolones, co-trimoxazole, and tetracycline, respectively. PMID:24153034

  16. Precision-cut hamster liver slices as an ex vivo model to study amoebic liver abscess.

    PubMed

    Carranza-Rosales, Pilar; Santiago-Mauricio, María Guadalupe; Guzmán-Delgado, Nancy Elena; Vargas-Villarreal, Javier; Lozano-Garza, Gerardo; Ventura-Juárez, Javier; Balderas-Rentería, Isaías; Morán-Martínez, Javier; Gandolfi, A Jay

    2010-10-01

    Entamoeba histolytica is the etiological agent of amoebiasis, the second cause of global morbidity and mortality due to parasitic diseases in humans. In approximately 1% of the cases, amoebas penetrate the intestinal mucosa and spread to other organs, producing extra-intestinal lesions, among which amoebic liver abscess (ALA) is the most common. To study ALA, in vivo and in vitro models are used. However, animal models may pose ethical issues, and are time-consuming and costly; and cell cultures represent isolated cellular lineages. The present study reports the infection of precision-cut hamster liver slices with Entamoeba histolytica trophozoites. The infection time-course, including tissue damage, parallels findings previously reported in the animal model. At the same time amoebic virulence factors were detected in the infected slices. This new model to study ALA is simple and reproducible, and employs less than 1/3 of the hamsters required for in vivo analyses.

  17. Precision-cut hamster liver slices as an ex vivo model to study amoebic liver abscess.

    PubMed

    Carranza-Rosales, Pilar; Santiago-Mauricio, María Guadalupe; Guzmán-Delgado, Nancy Elena; Vargas-Villarreal, Javier; Lozano-Garza, Gerardo; Ventura-Juárez, Javier; Balderas-Rentería, Isaías; Morán-Martínez, Javier; Gandolfi, A Jay

    2010-10-01

    Entamoeba histolytica is the etiological agent of amoebiasis, the second cause of global morbidity and mortality due to parasitic diseases in humans. In approximately 1% of the cases, amoebas penetrate the intestinal mucosa and spread to other organs, producing extra-intestinal lesions, among which amoebic liver abscess (ALA) is the most common. To study ALA, in vivo and in vitro models are used. However, animal models may pose ethical issues, and are time-consuming and costly; and cell cultures represent isolated cellular lineages. The present study reports the infection of precision-cut hamster liver slices with Entamoeba histolytica trophozoites. The infection time-course, including tissue damage, parallels findings previously reported in the animal model. At the same time amoebic virulence factors were detected in the infected slices. This new model to study ALA is simple and reproducible, and employs less than 1/3 of the hamsters required for in vivo analyses. PMID:20412797

  18. Inertia of amoebic cell locomotion as an emergent collective property of the cellular dynamics

    NASA Astrophysics Data System (ADS)

    Nishimura, Shin I.; Sasai, Masaki

    2005-01-01

    Amoebic cells are ubiquitous in many species and have been used as model systems to study the eukaryotic cellular locomotion. We construct a model of amoebic cells on two-dimensional grids, which describes sensing, cell status, and locomotion in a unified way. We show that the averaged position of simulated cells is described by a second-order differential equation of motion and that the mechanical pushing at the initial moment boosts the cell movement, which continues after the cell is released from the pushing. These “inertialike” features suggest the possibility of Newtonian-type motions in chemical distributions of the signaling molecule. We show, as an example, the possibility of rotating motion in a “centripetal” distribution. The observed inertial motion is an emergent collective dynamics, which is controlled by diffusive and chemical processes in the cell.

  19. Chew on this: Amoebic trogocytosis and host cell killing by Entamoeba histolytica

    PubMed Central

    Ralston, Katherine S.

    2015-01-01

    Entamoeba histolytica was named “histolytica” (histo-: tissue; lytic-: dissolving) for its ability to destroy host tissues. Direct killing of host cells by the amoebae is likely to be the driving factor that underlies tissue destruction, but the mechanism was unclear. We recently showed that after attaching to host cells, amoebae bite off and ingest distinct host cell fragments, and that this contributes to cell killing. Here we review this process, termed “amoebic trogocytosis” (trogo-: nibble), and how this process interplays with phagocytosis, or whole cell ingestion, in this organism. “Nibbling” processes have been described in other microbes and in multicellular organisms. The discovery of amoebic trogocytosis in E. histolytica may also shed light on an evolutionarily conserved process for intercellular exchange. PMID:26070402

  20. A proposed cascade of vascular events leading to granulomatous amoebic encephalitis.

    PubMed

    Baig, Abdul Mannan; Khan, Naveed Ahmed

    2015-11-01

    Granulomatous amoebic encephalitis due to Acanthamoeba is a chronic disease that almost always results in death. Hematogenous spread is a pre-requisite followed by amoebae invasion of the blood-brain barrier to enter the central nervous system. Given the systemic nature of this infection, a significant latent period of several months before the appearance of clinical manifestations is puzzling. Based on reported cases, here we propose pathogenetic mechanisms that explain the above described latency of the disease.

  1. A proposed cascade of vascular events leading to granulomatous amoebic encephalitis.

    PubMed

    Baig, Abdul Mannan; Khan, Naveed Ahmed

    2015-11-01

    Granulomatous amoebic encephalitis due to Acanthamoeba is a chronic disease that almost always results in death. Hematogenous spread is a pre-requisite followed by amoebae invasion of the blood-brain barrier to enter the central nervous system. Given the systemic nature of this infection, a significant latent period of several months before the appearance of clinical manifestations is puzzling. Based on reported cases, here we propose pathogenetic mechanisms that explain the above described latency of the disease. PMID:26276705

  2. Treatment of Granulomatous Amoebic Encephalitis with Voriconazole and Miltefosine in an Immunocompetent Soldier

    PubMed Central

    Webster, Duncan; Umar, Imram; Kolyvas, George; Bilbao, Juan; Guiot, Marie-Christine; Duplisea, Kevin; Qvarnstrom, Yvonne; Visvesvara, Govinda S.

    2012-01-01

    A 38-year-old male immunocompetent soldier developed generalized seizures. He underwent surgical debulking and a progressive demyelinating pseudotumor was identified. Serology and molecular testing confirmed a diagnosis of granulomatous amoebic encephalitis caused by Acanthamoeba sp. in this immunocompetent male. The patient was treated with oral voriconazole and miltefosine with Acanthamoeba titers returning to control levels and serial imaging demonstrating resolution of the residual lesion. PMID:22869634

  3. Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

    PubMed Central

    Graeff-Teixeira, Carlos; da Silva, Ana Cristina Arámburu; Yoshimura, Kentaro

    2009-01-01

    Summary: Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections. PMID:19366917

  4. Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS.

    PubMed

    Park, K H; Bang, J H; Park, W B; Kim, H B; Kim, N J; Ahn, J K; Chang, K H; Oh, M D; Choe, K W

    2008-10-01

    We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient. PMID:18574556

  5. Retrobulbar optic neuritis and meningoencephalitis following progressive outer retinal necrosis due to CMV in a patient with AIDS.

    PubMed

    Park, K H; Bang, J H; Park, W B; Kim, H B; Kim, N J; Ahn, J K; Chang, K H; Oh, M D; Choe, K W

    2008-10-01

    We report on a 34-year-old male patient with AIDS who developed retrobulbar optic neuritis and meningoencephalitis following bilateral progressive outer retinal necrosis (PORN) caused by cytomegalovirus (CMV). This case documents the presumed association of PORN with retrobulbar optic neuritis, and CMV meningoencephalitis in an AIDS patient.

  6. Protozoal Meningoencephalitis in Sea Otters (Enhydra lutris): a Histopathological and Immunohistochemical Study of Naturally Occuring Cases

    USGS Publications Warehouse

    Thomas, N.J.; Dubey, J.P.; Lindsay, D.S.; Cole, R.A.; Meteyer, C.U.

    2007-01-01

    Protozoal meningoencephalitis is considered to be an important cause of mortality in the California sea otter (Enhydra lutris). Thirty nine of 344 (11.3%) California (CA) and Washington state (WA) sea otters examined from 1985 to 2004 had histopathological evidence of significant protozoal meningoencephalitis. The aetiological agents and histopathological changes associated with these protozoal infections are described. The morphology of the actively multiplicative life stages of the organisms (tachyzoites for Toxoplasma gondii and merozoites for Sarcocystis neurona) and immunohistochemical labelling were used to identify infection with S. neurona (n=22, 56.4%), T. gondii (n=5, 12.8%) or dual infection with both organisms (n=12, 30.8%). Active S. neurona was present in all dual infections, while most had only the latent form of T. gondii. In S. neurona meningoencephalitis, multifocal to diffuse gliosis was widespread in grey matter and consistently present in the molecular layer of the cerebellum. In T. gondii meningoencephalitis, discrete foci of gliosis and malacia were more widely separated, sometimes incorporated pigment-laden macrophages and mineral, and were found predominantly in the cerebral cortex. Quiescent tissue cysts of T. gondii were considered to be incidental and not a cause of clinical disease and mortality. Protozoal meningoencephalitis was diagnosed more frequently in the expanding population of WA sea otters (10 of 31, 32.3%) than in the declining CA population (29 of 313, 9.3%). Among sea otters with protozoal meningoencephalitis, those that had displayed neurological signs prior to death had active S. neurona encephalitis, supporting the conclusion that S. neurona is the most significant protozoal pathogen in the central nervous system of sea otters.

  7. Meningoencephalitis due to Listeria monocytogenes in a pregnant rhesus macaque (Macaca mulatta).

    PubMed

    Lemoy, Marie-Josee M F; Lopes, Danielle A; Reader, J Rachel; Westworth, Diccon R; Tarara, Ross P

    2012-10-01

    We here report a spontaneous case of meningoencephalitis due to Listeria monocytogenes in an adult primiparous rhesus macaque (Macaca mulatta) during an outbreak of listeriosis in an outdoor enclosure. Clinical signs included tremors, abnormal posture, and altered mental status. Hematology and analyses of cerebrospinal fluid were consistent with bacterial infection. Pure cultures of L. monocytogenes were recovered from the placenta-abortus, cerebrospinal fluid, and brain tissue. The macaque did not respond to treatment and was euthanized. Histopathologic examination of the brain revealed acute meningoencephalitis. This case represents an unusual clinical and pathologic presentation of listeriosis in a nonhuman primate in which the dam and fetus both were affected.

  8. Meningoencephalitis and brain abscess due to a free-living amoeba.

    PubMed

    Duma, R J; Helwig, W B; Martinez, A J

    1978-04-01

    A 47-year-old diabetic woman developed fatal meningoencephalitis due to a free-living amoeba. The responsible organism appeared to be neither Naegleria nor Acanthamoeba-Hartmannella. Both acute and chronic (granulomatous) inflammatory reactions of the brain were present, and both cysts and trophozoite forms were readily visualized. The latest classification and methods of identification of such amoebae are reviewed and their threat to public health underscored. It should be realized that a variety of free-living amoebae exist in nature, which potentially can produce meningoencephalitis in humans, and that none of these organisms should be labeled or considered as "avirulent" or "nonpathogenic" until proved otherwise. PMID:637425

  9. Anti-amoebic properties of a Malaysian marine sponge Aaptos sp. on Acanthamoeba castellanii.

    PubMed

    Nakisah, M A; Ida Muryany, M Y; Fatimah, H; Nor Fadilah, R; Zalilawati, M R; Khamsah, S; Habsah, M

    2012-03-01

    Crude methanol extracts of a marine sponge, Aaptos aaptos, collected from three different localities namely Kapas, Perhentian and Redang Islands, Terengganu, Malaysia, were tested in vitro on a pathogenic Acanthamoeba castellanii (IMR isolate) to examine their anti-amoebic potential. The examination of anti-Acanthamoebic activity of the extracts was conducted in 24 well plates for 72 h at 30 °C. All extracts possessed anti-amoebic activity with their IC(50) values ranging from 0.615 to 0.876 mg/mL. The effect of the methanol extracts on the surface morphology of A. castellanii was analysed under scanning electron microscopy. The ability of the extracts to disrupt the amoeba cell membrane was indicated by extensive cell's blebbing, changes in the surface morphology, reduced in cell size and with cystic appearance of extract-treated Acanthamoeba. Number of acanthapodia and food cup was also reduced in this Acanthamoeba. Morphological criteria of apoptosis in Acanthamoeba following treatment with the sponge's extracts was determined by acridine orange-propidium iodide staining and observed by fluorescence microscopy. By this technique, apoptotic and necrotic cells can be visualized and quantified. The genotoxic potential of the methanol extracts was performed by the alkaline comet assay. All methanol extracts used were significantly induced DNA damage compared to untreated Acanthamoeba by having high percentage of scores 1, 2, and 3 of the DNA damage. Results from cytotoxicity and genotoxicity studies carried out in the present study suggest that all methanol extracts of A. aaptos have anti-amoebic properties against A. castellanii. PMID:22805843

  10. Stenotrophomonas maltophilia and Vermamoeba vermiformis relationships: bacterial multiplication and protection in amoebal-derived structures.

    PubMed

    Cateau, Estelle; Maisonneuve, Elodie; Peguilhan, Samuel; Quellard, Nathalie; Hechard, Yann; Rodier, Marie-Helene

    2014-12-01

    Stenotrophomonas maltophilia, a bacteria involved in healthcare-associated infections, can be found in hospital water systems. Other microorganisms, such as Free Living amoebae (FLA), are also at times recovered in the same environment. Amongst these protozoa, many authors have reported the presence of Vermamoeba vermiformis. We show here that this amoeba enhances S. maltophilia growth and harbors the bacteria in amoebal-derived structures after 28 days in harsh conditions. These results highlight the fact that particular attention should be paid to the presence of FLA in hospital water systems, because of their potential implication in survival and growth of pathogenic bacterial species.

  11. Stenotrophomonas maltophilia and Vermamoeba vermiformis relationships: bacterial multiplication and protection in amoebal-derived structures.

    PubMed

    Cateau, Estelle; Maisonneuve, Elodie; Peguilhan, Samuel; Quellard, Nathalie; Hechard, Yann; Rodier, Marie-Helene

    2014-12-01

    Stenotrophomonas maltophilia, a bacteria involved in healthcare-associated infections, can be found in hospital water systems. Other microorganisms, such as Free Living amoebae (FLA), are also at times recovered in the same environment. Amongst these protozoa, many authors have reported the presence of Vermamoeba vermiformis. We show here that this amoeba enhances S. maltophilia growth and harbors the bacteria in amoebal-derived structures after 28 days in harsh conditions. These results highlight the fact that particular attention should be paid to the presence of FLA in hospital water systems, because of their potential implication in survival and growth of pathogenic bacterial species. PMID:25463386

  12. Modulation of endogenous Cysteine Protease Inhibitor (ICP) 1 expression in Entamoeba histolytica affects amoebic adhesion to Extracellular Matrix proteins.

    PubMed

    Lee, Young Ah; Saito-Nakano, Yumiko; Kim, Kyeong Ah; Min, Arim; Nozaki, Tomoyoshi; Shin, Myeong Heon

    2015-02-01

    Entamoeba histolytica is an enteric tissue-invading protozoan parasite that causes amoebic colitis and occasionally liver abscess in humans. During tissue invasion, amoebic adhesion to host components is an important event for host cell death leading to successful invasion and infection. Among amoebic virulence factors, Gal/GalNAc lectin is known to be major adhesion factor to host cells. In this study, we investigated the role of amoebic secreted CP (Cysteine Proteases) in amoebic adhesion to extracellular matrix (ECM) protein using CP inhibitor and E. histolytica strains in which the endogenous inhibitor of cysteine protease (ICP) 1 gene was overexpressed (ICP1(+)) or repressed by antisense small RNA-mediated gene silencing (ICP1(-)). We found that pretreatment of wild-type amoebae with CP inhibitor E64, or thiol-group modifiers such as diamide and N-Ethylmaleimide resulted in a significant decrease in adhesion to laminin and collagen ECM proteins. Furthermore, ICP1(+) strain, with a reduction of secreted CP activity, exhibited reduced ability by 40% to adhere to laminin. In contrast, ICP1(-) strain, with a 1.9-fold increase of secreted CP activity, showed a two-fold increase in amoebic adherence to laminin compared to the control strain. In addition, total amount of secreted CP5 was decreased in ICP1(+) amoeba. Conversely, total amount of secreted CP1 and mature-form CP5 were increased in ICP1(-) amoeba. We also found that ICP1 was secreted into extracellular milieu. These results suggest that secreted CP activity by E. histolytica may be an important factor affecting adhesion to host proteins, and regulation of CP secretion by ICP plays a major role in pathogenesis. This study provides insight into the CP-mediated tissue pathogenesis in amoeba-invaded lesions during human amoebiasis.

  13. Modulation of endogenous Cysteine Protease Inhibitor (ICP) 1 expression in Entamoeba histolytica affects amoebic adhesion to Extracellular Matrix proteins.

    PubMed

    Lee, Young Ah; Saito-Nakano, Yumiko; Kim, Kyeong Ah; Min, Arim; Nozaki, Tomoyoshi; Shin, Myeong Heon

    2015-02-01

    Entamoeba histolytica is an enteric tissue-invading protozoan parasite that causes amoebic colitis and occasionally liver abscess in humans. During tissue invasion, amoebic adhesion to host components is an important event for host cell death leading to successful invasion and infection. Among amoebic virulence factors, Gal/GalNAc lectin is known to be major adhesion factor to host cells. In this study, we investigated the role of amoebic secreted CP (Cysteine Proteases) in amoebic adhesion to extracellular matrix (ECM) protein using CP inhibitor and E. histolytica strains in which the endogenous inhibitor of cysteine protease (ICP) 1 gene was overexpressed (ICP1(+)) or repressed by antisense small RNA-mediated gene silencing (ICP1(-)). We found that pretreatment of wild-type amoebae with CP inhibitor E64, or thiol-group modifiers such as diamide and N-Ethylmaleimide resulted in a significant decrease in adhesion to laminin and collagen ECM proteins. Furthermore, ICP1(+) strain, with a reduction of secreted CP activity, exhibited reduced ability by 40% to adhere to laminin. In contrast, ICP1(-) strain, with a 1.9-fold increase of secreted CP activity, showed a two-fold increase in amoebic adherence to laminin compared to the control strain. In addition, total amount of secreted CP5 was decreased in ICP1(+) amoeba. Conversely, total amount of secreted CP1 and mature-form CP5 were increased in ICP1(-) amoeba. We also found that ICP1 was secreted into extracellular milieu. These results suggest that secreted CP activity by E. histolytica may be an important factor affecting adhesion to host proteins, and regulation of CP secretion by ICP plays a major role in pathogenesis. This study provides insight into the CP-mediated tissue pathogenesis in amoeba-invaded lesions during human amoebiasis. PMID:25500214

  14. Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis.

    PubMed

    Loo, K L; Ramachandran, R; Abdullah, B J; Chow, S K; Goh, E M L; Yeap, S S

    2003-09-01

    A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.

  15. Cerebrospinal fluid soluble L-selectin (sCD62L) in meningoencephalitis.

    PubMed Central

    Bührer, C; Herold, R; Stibenz, D; Henze, G; Obladen, M

    1996-01-01

    The leucocyte adhesion molecule L-selectin (CD62L) is rapidly cleaved off proteolytically after cell activation, generating soluble L-selectin (sCD62L) molecules. sCD62L concentrations were determined in 185 cerebrospinal fluid (CSF) samples obtained from children aged 1 month to 17 years. In 36 CSF samples of children with meningoencephalitis, sCD62L was significantly higher (median 209 fmol/ml) than in samples of children with other febrile diseases (n = 67, median 50 fmol/ml) or non-febrile disorders (n = 82, median 44 fmol/ml). There was a positive correlation between CSF protein and CSF sCD62L (rS = 0.68), suggesting that a disturbed blood-brain barrier contributes to raised sCD62L concentrations in the CSF. However, the CSF sCD62L/protein ratio of children with meningoencephalitis was significantly higher than in children with other febrile diseases or non-febrile disorders, indicating that sCD62L concentrations in children with meningoencephalitis were higher than expected from plasma leakage alone. It is concluded that both an impaired blood-brain barrier and the generation of sCD62L by infiltrating leucocytes contribute to raised CSF sCD62L concentrations in children with meningoencephalitis. PMID:8669926

  16. Baylisascaris procyonis-Associated Meningoencephalitis in a Previously Healthy Adult, California, USA.

    PubMed

    Langelier, Charles; Reid, Michael J; Halabi, Cathra; Wietek, Natalie; LaRiviere, Alejandro; Shah, Maulik; Wilson, Michael R; Chin-Hong, Peter; Douglas, Vanja; Kazacos, Kevin R; Babik, Jennifer M

    2016-08-01

    After severe neurocognitive decline developed in an otherwise healthy 63-year-old man, brain magnetic resonance imaging showed eosinophilic meningoencephalitis and enhancing lesions. The patient tested positive for antibodies to Baylisascaris spp. roundworms, was treated with albendazole and dexamethasone, and showed improvement after 3 months. Baylisascariasis should be considered for all patients with eosinophilic meningitis. PMID:27434260

  17. Baylisascaris procyonis–Associated Meningoencephalitis in a Previously Healthy Adult, California, USA

    PubMed Central

    Reid, Michael J.; Halabi, Cathra; Wietek, Natalie; LaRiviere, Alejandro; Shah, Maulik; Wilson, Michael R.; Chin-Hong, Peter; Douglas, Vanja; Kazacos, Kevin R.; Babik, Jennifer M.

    2016-01-01

    After severe neurocognitive decline developed in an otherwise healthy 63-year-old man, brain magnetic resonance imaging showed eosinophilic meningoencephalitis and enhancing lesions. The patient tested positive for antibodies to Baylisascaris spp. roundworms, was treated with albendazole and dexamethasone, and showed improvement after 3 months. Baylisascariasis should be considered for all patients with eosinophilic meningitis. PMID:27434260

  18. Naegleria fowleri-associated encephalitis in a cow from Costa Rica.

    PubMed

    Morales, Juan A; Chaves, Aida J; Visvesvara, G S; Dubey, J P

    2006-06-30

    Species of Naegleria, Acanthamoeba, and Balamuthia are soil amoebae that can cause encephalitis in animals and humans. Of these, Naegleria fowleri is the cause of often fatal primary meningoencephalitis in humans. N. fowleri-associated encephalitis was diagnosed in a cow that was suspected to have rabies. Only formalin-fixed brain was available for diagnosis. There was severe meningoencephalitis involving all parts of the brain and numerous amoebic trophozoites were present in lesions. The amoebae reacted with N. fowleri-specific polyclonal antibodies in an indirect immunofluorescent antibody test. This is the first report of amoebic encephalitis in any host from Costa Rica.

  19. Interactions of Bacterial and Amoebal Populations in Soil Microcosms with Fluctuating Moisture Content

    PubMed Central

    Bryant, R. J.; Woods, L. E.; Coleman, D. C.; Fairbanks, B. C.; McClellan, J. F.; Cole, C. V.

    1982-01-01

    Sterilized soil samples (20 g of soil per 50-ml flask), amended with 600 μg of glucose-carbon and 60 μg of NH4-N · g of dry soil−1, were inoculated with bacteria (Pseudomonas paucimobilis) alone or with bacteria and amoebae (Acanthamoeba polyphaga). We used wet-dry treatments, which involved air drying the samples to a moisture content of approximately 2% and remoistening the samples three times during the 83-day experiment. Control treatments were kept moist. In the absence of amoebae, bacterial populations were reduced by the first drying to about 60% of the moist control populations, but the third drying had no such effect. With amoebae present, bacterial numbers were not significantly affected by the dryings. Amoebal grazing reduced bacterial populations to 20 to 25% of the ungrazed bacterial populations in both moisture treatments. Encystment was an efficient survival mechanism for amoebae subjected to wet-dry cycles. The amoebal population was entirely encysted in dry soil, but the total number of amoebae was not affected by the three dryings. Growth efficiencies for amoebae feeding on bacteria were 0.33 and 0.39 for wet-dry and constantly moist treatments, respectively, results that compared well with those previously reported for Acanthamoeba spp. PMID:16345984

  20. Bacterial-type oxygen detoxification and iron-sulfur cluster assembly in amoebal relict mitochondria.

    PubMed

    Maralikova, Barbora; Ali, Vahab; Nakada-Tsukui, Kumiko; Nozaki, Tomoyoshi; van der Giezen, Mark; Henze, Katrin; Tovar, Jorge

    2010-03-01

    The assembly of vital reactive iron-sulfur (Fe-S) cofactors in eukaryotes is mediated by proteins inherited from the original mitochondrial endosymbiont. Uniquely among eukaryotes, however, Entamoeba and Mastigamoeba lack such mitochondrial-type Fe-S cluster assembly proteins and possess instead an analogous bacterial-type system acquired by lateral gene transfer. Here we demonstrate, using immunomicroscopy and biochemical methods, that beyond their predicted cytosolic distribution the bacterial-type Fe-S cluster assembly proteins NifS and NifU have been recruited to function within the relict mitochondrial organelles (mitosomes) of Entamoeba histolytica. Both Nif proteins are 10-fold more concentrated within mitosomes compared with their cytosolic distribution suggesting that active Fe-S protein maturation occurs in these organelles. Quantitative immunoelectron microscopy showed that amoebal mitosomes are minute but highly abundant cellular structures that occupy up to 2% of the total cell volume. In addition, protein colocalization studies allowed identification of the amoebal hydroperoxide detoxification enzyme rubrerythrin as a mitosomal protein. This protein contains functional Fe-S centres and exhibits peroxidase activity in vitro. Our findings demonstrate the role of analogous protein replacement in mitochondrial organelle evolution and suggest that the relict mitochondrial organelles of Entamoeba are important sites of metabolic activity that function in Fe-S protein-mediated oxygen detoxification. PMID:19888992

  1. Severe Amoebic Placentitis in a Horse Caused by an Acanthamoeba hatchetti Isolate Identified Using Next-Generation Sequencing

    PubMed Central

    Begg, Angela P.; Todhunter, Kristen; Donahoe, Shannon L.; Krockenberger, Mark

    2014-01-01

    A case of amoebic placentitis in a mare from eastern Australia was diagnosed postpartum by histopathological examination of the placenta. The identity of the etiological agent was confirmed as Acanthamoeba hatchetti by use of diversity profiling based on a next-generation sequencing approach. PMID:24829227

  2. A severe manifestation of primary HIV-1 infection in an adolescent

    PubMed Central

    Morgado, Joana; Póvoas, Marta Isabel; Cruz, Carla; Teixeira, Andrea

    2014-01-01

    Primary HIV infection (PHI) is symptomatic in 50–90% of patients with symptoms resembling infectious mononucleosis. The diagnosis, however, is seldom made at first presentation. Clinically severe presentations during primary HIV type 1 infection are considered to occur infrequently. We report a case of a severe manifestation of PHI with meningoencephalitis in the setting of HIV seroconversion in an adolescent girl. PMID:25281249

  3. Sarcocystis sp.-associated meningoencephalitis in a bald eagle (Haliaeetus leucocephalus).

    PubMed

    Olson, Erik J; Wünschmann, Arno; Dubey, J P

    2007-09-01

    Protozoal meningoencephalitis is uncommon in raptors. An adult female bald eagle (Haliaeetus leucocephalus) was euthanized after several months of treatment for progressive neurologic signs. The predominant histologic lesion was lymphoplasmacytic and histiocytic meningoencephalitis involving the cerebrum and cerebellum. There was a marked segmental loss of granular cells and Purkinje cells, as well as segmental atrophy of the molecular layer in the cerebellum. Protozoal merozoites and schizonts were observed in the gray matter of the cerebellum. Ultrastructurally, the merozoites were classified as a species of Sarcocystis due to the lack of rhoptries. Immunohistochemistry of the agent revealed a positive reaction for Sarcocystis neurona, while sections were negative for Toxoplasma gondii and Neospora caninum. Sarcocystis sp. infection should be considered as a differential diagnosis in bald eagles with chronic neurologic disease.

  4. Genotyping of Toxoplasma gondii isolates in meningo-encephalitis affected striped dolphins (Stenella coeruleoalba) from Italy.

    PubMed

    Di Guardo, Giovanni; Di Cesare, Angela; Otranto, Domenico; Casalone, Cristina; Iulini, Barbara; Mignone, Walter; Tittarelli, Cristiana; Meloni, Silvana; Castagna, Giuseppe; Forster, Fiona; Kennedy, Seamus; Traversa, Donato

    2011-12-29

    This study reports the occurrence of Toxoplasma gondii in the brain of three striped dolphins (Stenella ceoruleoalba) found stranded on the Ligurian Sea coast of Italy between 2007 and 2008. These animals showed a severe, subacute to chronic, non-purulent, multifocal meningo-encephalitis, with the cerebral parenchyma of two dolphins harbouring protozoan cysts and zoites immunohistochemically linked to T. gondii. Molecular, phylogenetic and mutation scanning analyses showed the occurrence of Type II and of an atypical Type II T. gondii isolates in one and two dolphins, respectively. In spite of the different molecular patterns characterizing the above T. gondii genotypes, the brain lesions observed in the three animals showed common microscopic features, with no remarkable differences among them. The role of T. gondii in causing the meningo-encephalitis is herein discussed. PMID:21802209

  5. Sarcocystis sp.-associated meningoencephalitis in a bald eagle (Haliaeetus leucocephalus).

    PubMed

    Olson, Erik J; Wünschmann, Arno; Dubey, J P

    2007-09-01

    Protozoal meningoencephalitis is uncommon in raptors. An adult female bald eagle (Haliaeetus leucocephalus) was euthanized after several months of treatment for progressive neurologic signs. The predominant histologic lesion was lymphoplasmacytic and histiocytic meningoencephalitis involving the cerebrum and cerebellum. There was a marked segmental loss of granular cells and Purkinje cells, as well as segmental atrophy of the molecular layer in the cerebellum. Protozoal merozoites and schizonts were observed in the gray matter of the cerebellum. Ultrastructurally, the merozoites were classified as a species of Sarcocystis due to the lack of rhoptries. Immunohistochemistry of the agent revealed a positive reaction for Sarcocystis neurona, while sections were negative for Toxoplasma gondii and Neospora caninum. Sarcocystis sp. infection should be considered as a differential diagnosis in bald eagles with chronic neurologic disease. PMID:17823405

  6. Amebic meningoencephalitis in a patient with AIDS caused by a newly recognized opportunistic pathogen. Leptomyxid ameba.

    PubMed

    Anzil, A P; Rao, C; Wrzolek, M A; Visvesvara, G S; Sher, J H; Kozlowski, P B

    1991-01-01

    A fatal case of meningoencephalitis due to a leptomyxid ameba in a patient with the acquired immunodeficiency syndrome is presented. This opportunistic organism has not been previously recognized as a human pathogen. A 36-year-old male intravenous drug abuser died after an 18-day hospital course heralded by fever and headache and followed by nuchal rigidity and hemiparesis. Computed tomography of the head showed multiple hypodense lesions. Neuropathologic examination showed that in addition to human immunodeficiency virus encephalomyelitis, there was multifocal meningoencephalitis with trophozoites and cysts morphologically indistinguishable from those of Acanthamoeba. These organisms were also found in the kidneys and adrenal glands. By immunofluorescence, the parasites showed antigenic identity with a free-living leptomyxid ameba and failed to react with any of a spectrum of antiacanthamoeba antisera. This emphasizes the importance of immunofluorescence identification of morphologically indistinguishable ameba species. PMID:1987909

  7. Detection of Listeria monocytogenes in CSF from Three Patients with Meningoencephalitis by Next-Generation Sequencing

    PubMed Central

    Yao, Ming; Zhou, Jiali; Zhu, Yicheng; Zhang, Yinxin; Lv, Xia; Sun, Ruixue; Shen, Ao; Ren, Haitao; Cui, Liying

    2016-01-01

    Background and Purpose Encephalitis caused by Listeria monocytogenes (L. monocytogenes) is rare but sometimes fatal. Early diagnosis is difficult using routine cerebrospinal fluid (CSF) tests, while next-generation sequencing (NGS) is increasingly being used for the detection and characterization of pathogens. Methods This study set up and applied unbiased NGS to detect L. monocytogenes in CSF collected from three cases of clinically suspected listeria meningoencephalitis. Results Three cases of patients with acute/subacute meningoencephalitis are reported. Magnetic resonance imaging and blood cultures led to a suspected diagnosis of L. monocytogenes, while the CSF cultures were negative. Unbiased NGS of CSF identified and sequenced reads corresponding to L. monocytogenes in all three cases. Conclusions This is the first report highlighting the feasibility of applying NGS of CSF as a diagnostic method for central nervous system (CNS) L. monocytogenes infection. Routine application of this technology in clinical microbiology will significantly improve diagnostic methods for CNS infectious diseases.

  8. Mutations in Novel Lipopolysaccharide Biogenesis Genes Confer Resistance to Amoebal Grazing in Synechococcus elongatus.

    PubMed

    Simkovsky, Ryan; Effner, Emily E; Iglesias-Sánchez, Maria José; Golden, Susan S

    2016-05-01

    In natural and artificial aquatic environments, population structures and dynamics of photosynthetic microbes are heavily influenced by the grazing activity of protistan predators. Understanding the molecular factors that affect predation is critical for controlling toxic cyanobacterial blooms and maintaining cyanobacterial biomass production ponds for generating biofuels and other bioproducts. We previously demonstrated that impairment of the synthesis or transport of the O-antigen component of lipopolysaccharide (LPS) enables resistance to amoebal grazing in the model predator-prey system consisting of the heterolobosean amoeba HGG1 and the cyanobacterium Synechococcus elongates PCC 7942 (R. S. Simkovsky et al., Proc Natl Acad Sci U S A 109:16678-16683, 2012,http://dx.doi.org/10.1073/pnas.1214904109). In this study, we used this model system to identify additional gene products involved in the synthesis of O antigen, the ligation of O antigen to the lipid A-core conjugated molecule (including a novel ligase gene), the generation of GDP-fucose, and the incorporation of sugars into the lipid A core oligosaccharide ofS. elongatus Knockout of any of these genes enables resistance to HGG1, and of these, only disruption of the genes involved in synthesis or incorporation of GDP-fucose into the lipid A-core molecule impairs growth. Because these LPS synthesis genes are well conserved across the diverse range of cyanobacteria, they enable a broader understanding of the structure and synthesis of cyanobacterial LPS and represent mutational targets for generating resistance to amoebal grazers in novel biomass production strains. PMID:26921432

  9. Mutations in Novel Lipopolysaccharide Biogenesis Genes Confer Resistance to Amoebal Grazing in Synechococcus elongatus

    PubMed Central

    Effner, Emily E.; Iglesias-Sánchez, Maria José; Golden, Susan S.

    2016-01-01

    In natural and artificial aquatic environments, population structures and dynamics of photosynthetic microbes are heavily influenced by the grazing activity of protistan predators. Understanding the molecular factors that affect predation is critical for controlling toxic cyanobacterial blooms and maintaining cyanobacterial biomass production ponds for generating biofuels and other bioproducts. We previously demonstrated that impairment of the synthesis or transport of the O-antigen component of lipopolysaccharide (LPS) enables resistance to amoebal grazing in the model predator-prey system consisting of the heterolobosean amoeba HGG1 and the cyanobacterium Synechococcus elongatus PCC 7942 (R. S. Simkovsky et al., Proc Natl Acad Sci U S A 109:16678–16683, 2012, http://dx.doi.org/10.1073/pnas.1214904109). In this study, we used this model system to identify additional gene products involved in the synthesis of O antigen, the ligation of O antigen to the lipid A-core conjugated molecule (including a novel ligase gene), the generation of GDP-fucose, and the incorporation of sugars into the lipid A core oligosaccharide of S. elongatus. Knockout of any of these genes enables resistance to HGG1, and of these, only disruption of the genes involved in synthesis or incorporation of GDP-fucose into the lipid A-core molecule impairs growth. Because these LPS synthesis genes are well conserved across the diverse range of cyanobacteria, they enable a broader understanding of the structure and synthesis of cyanobacterial LPS and represent mutational targets for generating resistance to amoebal grazers in novel biomass production strains. PMID:26921432

  10. Acute meningoencephalitis associated with echovirus 9 infection in Sri Lanka, 2009.

    PubMed

    Danthanarayana, Nayomi; Williams, David T; Williams, Simon Hedley; Thevanesam, Vasanthi; Speers, David J; Fernando, M S S

    2015-12-01

    The aetiology of acute meningoencephalitis in Sri Lankan children and adults is poorly understood. This study was carried out to determine pathogens responsible for meningoencephalitis in Sri Lanka. A hospital-based cross-sectional study was performed using cerebrospinal fluid samples (22 adult and 17 pediatric) collected from August to December 2009 from patients clinically diagnosed with acute meningoencephalitis at two tertiary care hospitals in Sri Lanka. Routine microbiology for bacterial pathogens together with in-house RT-PCR and PCR assays for the detection of dengue viruses, Japanese encephalitis virus, West Nile virus, chikungunya virus, enteroviruses, mumps virus, measles virus, herpes simplex viruses types 1 and 2, and varicella zoster virus were performed. Bacterial pathogens were not isolated from any patient specimens. However, from nine of the paediatric patients aged 1 month to 10 years (mean age 5.2 years) echovirus 9 (E-9; family Picornaviridae, genus Enterovirus,species Enterovirus B ) was detected by RT-PCR. All nine patients presented with fever, six had headache, and seven had vomiting. Neck stiffness indicating meningitis was present in six of the patients. Phylogenetic analysis of partial VP1 and VP4-VP2 genes showed these E-9 strains to be most closely related to E-9 strains detected in CSF from Korea and France in 2005 and 2006. The remaining patients were negative for all other viruses tested. E-9 was the most common cause of acute meningoencephalitis in the tested paediatric population from Sri Lanka in 2009, which likely reflects circulation of this E-9 strain between Europe and Asia over several years.

  11. Meningoencephalitis and Listeria monocytogenes, Toxoplasma gondii and Brucella spp. coinfection in a dolphin in Italy.

    PubMed

    Grattarola, Carla; Giorda, Federica; Iulini, Barbara; Pintore, Maria Domenica; Pautasso, Alessandra; Zoppi, Simona; Goria, Maria; Romano, Angelo; Peletto, Simone; Varello, Katia; Garibaldi, Fulvio; Garofolo, Giuliano; Di Francesco, Cristina Esmeralda; Marsili, Letizia; Bozzetta, Elena; Di Guardo, Giovanni; Dondo, Alessandro; Mignone, Walter; Casalone, Cristina

    2016-02-25

    Listeria monocytogenes, Toxoplasma gondii and Brucella spp. can infect a wide range of species, including humans. In cetaceans, meningoencephalitis has been associated with T. gondii and Brucella spp. infection, whereas to our knowledge, L. monocytogenes infection has not previously been reported. Meningoencephalitis and L. monocytogenes, T. gondii and Brucella spp. were identified by means of both direct and indirect laboratory techniques in an adult female striped dolphin Stenella coeruleoalba found stranded in January 2015 on the Ligurian Sea coast, northwestern Italy. The animal was emaciated, and histopathology disclosed severe meningoencephalitis. The nature of the inflammatory response and intra-lesional protozoa were consistent with a mixed infection by L. monocytogenes, T. gondii and Brucella spp. We believe this is an unprecedented case of infection by 3 zoonotic pathogens and also the first bacteriologically confirmed case report of neurolisteriosis in cetaceans. Cerebral toxoplasmosis and neurobrucellosis may have led to the animal's disorientation and stranding, with L. monocytogenes having likely exacerbated the coinfection leading to the demise of this dolphin.

  12. [Case of Streptococcus salivarius bacteremia/meningoencephalitis leading to discovery of early gastric cancer].

    PubMed

    Ijyuuin, Toshiro; Umehara, Fujio

    2012-01-01

    A 73-year old man was brought to our hospital because of acute onset of fever and consciousness disturbance. He had been hemodialyzed three times a week because of chronic renal failure since 13 years ago. Neurological examination revealed deteriorated consciousness and neck stiffness. A lumbar puncture yielded clouded fluid with a WBC 7,912/mm³ (polymorphonuclear cells 88%, mononuclear cells 12%), 786 mg/dl of protein and 4 mg/dl of glucose (blood glucose 118 mg/dl). Brain CT and MRI were unremarkable. He was treated with ceftriaxone and ampicillin. Streptococcus salivarius was isolated from the blood sample, but not from cerebrospinal fluid. The patient responded promptly to antibiotics therapy (ampicillin 3g/day, ceftriaxone 1g/day), and within several days he became lucid and afebrile. Isolated S. salivarius was sensitive for ampicillin and ceftriaxone. We diagnosed this case as S. salivarius bacteremia/meningoencephalitis. A gastrointestinal diagnostic workup revealed an asymptomatic gastric adenocarcinoma. S. salivarius is a common inhabitant of the oral mucosa that has been associated with infection in different sites. Meningeal infection by S. salivarius generally related to neoplasia of colon or iatrogenia, has been described on few occasions. This is the first report of S. salivarius bacteremia/meningoencephalitis associated with gastric neoplasm. Neurologist should be aware of the association of S. salivarius bacteremia/meningoencephalitis and gastrointestinal disease. PMID:22688117

  13. Meningoencephalitis and Listeria monocytogenes, Toxoplasma gondii and Brucella spp. coinfection in a dolphin in Italy.

    PubMed

    Grattarola, Carla; Giorda, Federica; Iulini, Barbara; Pintore, Maria Domenica; Pautasso, Alessandra; Zoppi, Simona; Goria, Maria; Romano, Angelo; Peletto, Simone; Varello, Katia; Garibaldi, Fulvio; Garofolo, Giuliano; Di Francesco, Cristina Esmeralda; Marsili, Letizia; Bozzetta, Elena; Di Guardo, Giovanni; Dondo, Alessandro; Mignone, Walter; Casalone, Cristina

    2016-02-25

    Listeria monocytogenes, Toxoplasma gondii and Brucella spp. can infect a wide range of species, including humans. In cetaceans, meningoencephalitis has been associated with T. gondii and Brucella spp. infection, whereas to our knowledge, L. monocytogenes infection has not previously been reported. Meningoencephalitis and L. monocytogenes, T. gondii and Brucella spp. were identified by means of both direct and indirect laboratory techniques in an adult female striped dolphin Stenella coeruleoalba found stranded in January 2015 on the Ligurian Sea coast, northwestern Italy. The animal was emaciated, and histopathology disclosed severe meningoencephalitis. The nature of the inflammatory response and intra-lesional protozoa were consistent with a mixed infection by L. monocytogenes, T. gondii and Brucella spp. We believe this is an unprecedented case of infection by 3 zoonotic pathogens and also the first bacteriologically confirmed case report of neurolisteriosis in cetaceans. Cerebral toxoplasmosis and neurobrucellosis may have led to the animal's disorientation and stranding, with L. monocytogenes having likely exacerbated the coinfection leading to the demise of this dolphin. PMID:26912047

  14. Investigation of Legionella Contamination in Bath Water Samples by Culture, Amoebic Co-Culture, and Real-Time Quantitative PCR Methods.

    PubMed

    Edagawa, Akiko; Kimura, Akio; Kawabuchi-Kurata, Takako; Adachi, Shinichi; Furuhata, Katsunori; Miyamoto, Hiroshi

    2015-10-01

    We investigated Legionella contamination in bath water samples, collected from 68 bathing facilities in Japan, by culture, culture with amoebic co-culture, real-time quantitative PCR (qPCR), and real-time qPCR with amoebic co-culture. Using the conventional culture method, Legionella pneumophila was detected in 11 samples (11/68, 16.2%). Contrary to our expectation, the culture method with the amoebic co-culture technique did not increase the detection rate of Legionella (4/68, 5.9%). In contrast, a combination of the amoebic co-culture technique followed by qPCR successfully increased the detection rate (57/68, 83.8%) compared with real-time qPCR alone (46/68, 67.6%). Using real-time qPCR after culture with amoebic co-culture, more than 10-fold higher bacterial numbers were observed in 30 samples (30/68, 44.1%) compared with the same samples without co-culture. On the other hand, higher bacterial numbers were not observed after propagation by amoebae in 32 samples (32/68, 47.1%). Legionella was not detected in the remaining six samples (6/68, 8.8%), irrespective of the method. These results suggest that application of the amoebic co-culture technique prior to real-time qPCR may be useful for the sensitive detection of Legionella from bath water samples. Furthermore, a combination of amoebic co-culture and real-time qPCR might be useful to detect viable and virulent Legionella because their ability to invade and multiply within free-living amoebae is considered to correlate with their pathogenicity for humans. This is the first report evaluating the efficacy of the amoebic co-culture technique for detecting Legionella in bath water samples. PMID:26492259

  15. Investigation of Legionella Contamination in Bath Water Samples by Culture, Amoebic Co-Culture, and Real-Time Quantitative PCR Methods.

    PubMed

    Edagawa, Akiko; Kimura, Akio; Kawabuchi-Kurata, Takako; Adachi, Shinichi; Furuhata, Katsunori; Miyamoto, Hiroshi

    2015-10-19

    We investigated Legionella contamination in bath water samples, collected from 68 bathing facilities in Japan, by culture, culture with amoebic co-culture, real-time quantitative PCR (qPCR), and real-time qPCR with amoebic co-culture. Using the conventional culture method, Legionella pneumophila was detected in 11 samples (11/68, 16.2%). Contrary to our expectation, the culture method with the amoebic co-culture technique did not increase the detection rate of Legionella (4/68, 5.9%). In contrast, a combination of the amoebic co-culture technique followed by qPCR successfully increased the detection rate (57/68, 83.8%) compared with real-time qPCR alone (46/68, 67.6%). Using real-time qPCR after culture with amoebic co-culture, more than 10-fold higher bacterial numbers were observed in 30 samples (30/68, 44.1%) compared with the same samples without co-culture. On the other hand, higher bacterial numbers were not observed after propagation by amoebae in 32 samples (32/68, 47.1%). Legionella was not detected in the remaining six samples (6/68, 8.8%), irrespective of the method. These results suggest that application of the amoebic co-culture technique prior to real-time qPCR may be useful for the sensitive detection of Legionella from bath water samples. Furthermore, a combination of amoebic co-culture and real-time qPCR might be useful to detect viable and virulent Legionella because their ability to invade and multiply within free-living amoebae is considered to correlate with their pathogenicity for humans. This is the first report evaluating the efficacy of the amoebic co-culture technique for detecting Legionella in bath water samples.

  16. Investigation of Legionella Contamination in Bath Water Samples by Culture, Amoebic Co-Culture, and Real-Time Quantitative PCR Methods

    PubMed Central

    Edagawa, Akiko; Kimura, Akio; Kawabuchi-Kurata, Takako; Adachi, Shinichi; Furuhata, Katsunori; Miyamoto, Hiroshi

    2015-01-01

    We investigated Legionella contamination in bath water samples, collected from 68 bathing facilities in Japan, by culture, culture with amoebic co-culture, real-time quantitative PCR (qPCR), and real-time qPCR with amoebic co-culture. Using the conventional culture method, Legionella pneumophila was detected in 11 samples (11/68, 16.2%). Contrary to our expectation, the culture method with the amoebic co-culture technique did not increase the detection rate of Legionella (4/68, 5.9%). In contrast, a combination of the amoebic co-culture technique followed by qPCR successfully increased the detection rate (57/68, 83.8%) compared with real-time qPCR alone (46/68, 67.6%). Using real-time qPCR after culture with amoebic co-culture, more than 10-fold higher bacterial numbers were observed in 30 samples (30/68, 44.1%) compared with the same samples without co-culture. On the other hand, higher bacterial numbers were not observed after propagation by amoebae in 32 samples (32/68, 47.1%). Legionella was not detected in the remaining six samples (6/68, 8.8%), irrespective of the method. These results suggest that application of the amoebic co-culture technique prior to real-time qPCR may be useful for the sensitive detection of Legionella from bath water samples. Furthermore, a combination of amoebic co-culture and real-time qPCR might be useful to detect viable and virulent Legionella because their ability to invade and multiply within free-living amoebae is considered to correlate with their pathogenicity for humans. This is the first report evaluating the efficacy of the amoebic co-culture technique for detecting Legionella in bath water samples. PMID:26492259

  17. Acanthamoeba genotypes T3 and T4 as causative agents of amoebic keratitis in Mexico.

    PubMed

    Omaña-Molina, Maritza; Vanzzini-Zago, Virginia; Hernandez-Martinez, Dolores; Gonzalez-Robles, Arturo; Salazar-Villatoro, Lizbeth; Ramirez-Flores, Elizabeth; Oregon-Miranda, Eric; Lorenzo-Morales, Jacob; Martinez-Palomo, Adolfo

    2016-02-01

    Free-living amoebae (FLA) are widely distributed worldwide. Some genera included in this group act as opportunistic pathogens causing fatal encephalitis and Acanthamoeba keratitis (AK), a sight-threatening infection of the cornea associated with the use of soft contact lenses that could even end in blindness if an early diagnosis and treatment are not achieved. Furthermore, the numbers of AK cases keep rising worldwide mainly due to an increase of contact lens wearers and lack of hygiene in the maintenance of lenses and their cases. In Mexico, no cases of AK have been described so far although the isolation of other pathogenic FLA such as Naegleria fowleri and Balamuthia mandrillaris from both clinical and environmental sources has been reported. The present study reports two cases of Acanthamoeba keratitis diagnosed in two patients admitted to the Hospital "Luis Sánchez Bulnes" for Blindness Prevention in Mexico City, Mexico. Corneal scrapes and contact lenses were checked for the presence of Acanthamoeba strains in both patients. Strains were axenized after initial isolation to classify at the genotype level. After sequencing the diagnostic fragment 3 (DF3) region located on the 18S ribosomal DNA (rDNA) gene of Acanthamoeba, genotype T3 and genotype T4 were identified in clinical case 1 and 2, respectively. To our knowledge, these are the first reported cases of AK in Mexico in the literature and the first description of Acanthamoeba genotypes T3 and T4 as causative agents of amoebic infection. PMID:26581373

  18. Oral lactoferrin treatment resolves amoebic intracecal infection in C3H/HeJ mice.

    PubMed

    León-Sicairos, Nidia; Martínez-Pardo, Leonardo; Sánchez-Hernández, Beatriz; de la Garza, Mireya; Carrero, Julio César

    2012-06-01

    Entamoeba histolytica is a protozoan parasite that causes amoebiasis, an illness that affects many people around the world. We have previously reported that lactoferrin is able to kill E. histolytica in in vitro cultures. The aim of the present study was to evaluate the therapeutic effect of orally administered bovine lactoferrin in the control of intestinal amoebiasis of susceptible C3H/HeJ mice. The results showed that 20 mg lactoferrin/kg orally administered each day for 1 week was able to eliminate the infection in 63% of the mice, since neither trophozoites nor evidence of epithelial damage and (or) swelling were found in tissue sections of the cecum. The rest of the treated animals (37%) showed a decrease in trophozoite numbers and mucus secreted to the lumen, as compared with untreated and infected mice (p < 0.05). By immunohistochemistry, the profile of secreted cytokines in the cecum revealed that infected but untreated animals showed a mixed Th1/regulatory cytokines profile, whereas the cecum of mice treated (cured) showed a Th2 cytokine profile (IL-4) and expression of the multifunctional IL-6. In addition, cytokines and increasing cecal production of total IgA antibodies were found associated with little inflammation and disease control observed in the cecum of lactoferrin-treated animals. These results suggest that oral administration of lactoferrin can control intestinal amoebic infection probably by killing amoebas or favoring their removal and reestablish the antiinflammatory intestinal environment.

  19. Morphological Findings in Trophozoites during Amoebic Abscess Development in Misoprostol-Treated BALB/c Mice

    PubMed Central

    Aceves-Cano, Andrés; Gaytán-Ochoa, Rocío; Ramos-Martínez, Ernesto; Erosa de la Vega, Gilberto; González-Horta, Carmen; Talamás-Rohana, Patricia; Sánchez-Ramírez, Blanca

    2015-01-01

    During amoebic liver abscess (ALA) formation in susceptible animals, immune response is regulated by prostaglandin E2 (PGE2) dependent mechanisms. The aim of this study was to analyze the effect of misoprostol (MPL), a PGE1 analogue, on ALA formation in BALB/c mice. Male mice from BALB/c strain were intrahepatically infected with 7.5 × 105 trophozoites of E. histolytica strain HM1:IMSS and treated with 10−4 M of MPL daily until sacrifice at 2, 4, and 7 days postinfection (p.i.). ALA formation was evaluated at 2, 4, and 7 days postinfection; trophozoite morphology was analyzed using immunohistochemistry and image analysis. Results showed an increase in frequency of ALA formation in infected and MPL-treated mice only at 2 days p.i. (P = 0.03). A significant diminution in the size of trophozoites was detected in abscesses from mice independently of MPL treatment (from 5.8 ± 1.1 µm at 2 days p.i. to 2.7 ± 1.9 µm at 7 days p.i.) compared with trophozoites dimensions observed in susceptible hamsters (9.6 ± 2.7 µm) (P < 0.01). These results suggest that MPL treatment may modify the adequate control of inflammatory process to allow the persistence of trophozoites in the liver; however, natural resistance mechanisms cannot be discarded. PMID:26090455

  20. Colon perforation with peritonitis in an acquired immunodeficiency syndrome patient due to cytomegalovirus and amoebic colitis.

    PubMed

    Tsai, Hung-Chin; Lee, Susan Shin-Jung; Wann, Shue-Ren; Chen, Yao-Shen; Chen, Eng-Rin; Yen, Chuan-Min; Liu, Yung-Ching

    2005-11-01

    Invasive amoebiasis is rarely seen in human immunodeficiency virus (HIV)-infected individuals, even in endemic areas. By contrast, cytomegalovirus (CMV) disease is recognized as a major clinical problem in acquired immunodeficiency syndrome patients. A 34-year-old HIV-infected man with amoeba colitis, disseminated Mycobacterium avian complex and CMV infection with cecum perforation, presented with the initial symptoms of fever, shortness of breath and painful sensation when swallowing. He was treated with fluconazole, trimethoprim-sulfamethoxazole and hydrocortisone under the impression of esophageal candidiasis and Pneumocystis jiroveci pneumonia. However, diarrhea and abdominal pain developed on day 6 of hospitalization. Invasive amoebiasis and CMV colitis was diagnosed after examination of colon pathological specimens. Emergent laparotomy was performed. Right hemicolectomy with double barrel ileostomy and colostomy was done due to perforation of the cecum. Iodoquinol was given, followed by metronidazole 14 days afterwards. He underwent closure of double barrel ileostomy and colostomy 5 months later. This case illustrates the diagnostic challenge of caring for acquired immunodeficiency syndrome persons with multiple illnesses and medication use. CMV infection, amoebic colitis and possibly corticosteroid may have played a role in colon perforation in our patient.

  1. Lipid composition of multilamellar bodies secreted by Dictyostelium discoideum reveals their amoebal origin.

    PubMed

    Paquet, Valérie E; Lessire, René; Domergue, Frédéric; Fouillen, Laetitia; Filion, Geneviève; Sedighi, Ahmadreza; Charette, Steve J

    2013-10-01

    When they are fed with bacteria, Dictyostelium discoideum amoebae produce and secrete multilamellar bodies (MLBs), which are composed of membranous material. It has been proposed that MLBs are a waste disposal system that allows D. discoideum to eliminate undigested bacterial remains. However, the real function of MLBs remains unknown. Determination of the biochemical composition of MLBs, especially lipids, represents a way to gain information about the role of these structures. To allow these analyses, a protocol involving various centrifugation procedures has been developed to purify secreted MLBs from amoeba-bacterium cocultures. The purity of the MLB preparation was confirmed by transmission electron microscopy and by immunofluorescence using H36, an antibody that binds to MLBs. The lipid and fatty acid compositions of pure MLBs were then analyzed by high-performance thin-layer chromatography (HPTLC) and gas chromatography (GC), respectively, and compared to those of amoebae as well as bacteria used as a food source. While the bacteria were devoid of phosphatidylcholine (PC) and phosphatidylinositol (PI), these two polar lipid species were major classes of lipids in MLBs and amoebae. Similarly, the fatty acid composition of MLBs and amoebae was characterized by the presence of polyunsaturated fatty acids, while cyclic fatty acids were found only in bacteria. These results strongly suggest that the lipids constituting the MLBs originate from the amoebal metabolism rather than from undigested bacterial membranes. This opens the possibility that MLBs, instead of being a waste disposal system, have unsuspected roles in D. discoideum physiology.

  2. Lipid Composition of Multilamellar Bodies Secreted by Dictyostelium discoideum Reveals Their Amoebal Origin

    PubMed Central

    Paquet, Valérie E.; Lessire, René; Domergue, Frédéric; Fouillen, Laetitia; Filion, Geneviève; Sedighi, Ahmadreza

    2013-01-01

    When they are fed with bacteria, Dictyostelium discoideum amoebae produce and secrete multilamellar bodies (MLBs), which are composed of membranous material. It has been proposed that MLBs are a waste disposal system that allows D. discoideum to eliminate undigested bacterial remains. However, the real function of MLBs remains unknown. Determination of the biochemical composition of MLBs, especially lipids, represents a way to gain information about the role of these structures. To allow these analyses, a protocol involving various centrifugation procedures has been developed to purify secreted MLBs from amoeba-bacterium cocultures. The purity of the MLB preparation was confirmed by transmission electron microscopy and by immunofluorescence using H36, an antibody that binds to MLBs. The lipid and fatty acid compositions of pure MLBs were then analyzed by high-performance thin-layer chromatography (HPTLC) and gas chromatography (GC), respectively, and compared to those of amoebae as well as bacteria used as a food source. While the bacteria were devoid of phosphatidylcholine (PC) and phosphatidylinositol (PI), these two polar lipid species were major classes of lipids in MLBs and amoebae. Similarly, the fatty acid composition of MLBs and amoebae was characterized by the presence of polyunsaturated fatty acids, while cyclic fatty acids were found only in bacteria. These results strongly suggest that the lipids constituting the MLBs originate from the amoebal metabolism rather than from undigested bacterial membranes. This opens the possibility that MLBs, instead of being a waste disposal system, have unsuspected roles in D. discoideum physiology. PMID:23748431

  3. Recombinant Canine Distemper Virus Strain Snyder Hill Expressing Green or Red Fluorescent Proteins Causes Meningoencephalitis in the Ferret

    PubMed Central

    Ludlow, M.; Nguyen, D. T.; Silin, D.; Lyubomska, O.; de Vries, R. D.; von Messling, V.; McQuaid, S.; De Swart, R. L.

    2012-01-01

    The propensity of canine distemper virus (CDV) to spread to the central nervous system is one of the primary features of distemper. Therefore, we developed a reverse genetics system based on the neurovirulent Snyder Hill (SH) strain of CDV (CDVSH) and show that this virus rapidly circumvents the blood-brain and blood-cerebrospinal fluid (CSF) barriers to spread into the subarachnoid space to induce dramatic viral meningoencephalitis. The use of recombinant CDVSH (rCDVSH) expressing enhanced green fluorescent protein (EGFP) or red fluorescent protein (dTomato) facilitated the sensitive pathological assessment of routes of virus spread in vivo. Infection of ferrets with these viruses led to the full spectrum of clinical signs typically associated with distemper in dogs during a rapid, fatal disease course of approximately 2 weeks. Comparison with the ferret-adapted CDV5804P and the prototypic wild-type CDVR252 showed that hematogenous infection of the choroid plexus is not a significant route of virus spread into the CSF. Instead, viral spread into the subarachnoid space in rCDVSH-infected animals was triggered by infection of vascular endothelial cells and the hematogenous spread of virus-infected leukocytes from meningeal blood vessels into the subarachnoid space. This resulted in widespread infection of cells of the pia and arachnoid mater of the leptomeninges over large areas of the cerebral hemispheres. The ability to sensitively assess the in vivo spread of a neurovirulent strain of CDV provides a novel model system to study the mechanisms of virus spread into the CSF and the pathogenesis of acute viral meningitis. PMID:22553334

  4. Mannheimia haemolytica A1-induced fibrinosuppurative meningoencephalitis in a naturally-infected Holstein-Friesian calf.

    PubMed

    Aschenbroich, S; Nemeth, N; Rech, R; Briggs, R; Sanchez, S; Brown, C

    2013-01-01

    Mannheimia haemolytica is an opportunistic bacterium that is widely recognized among the bovine respiratory disease complex as the predominant pathogen causing broncho- and pleuropneumonia in cattle. Among the characterized M. haemolytica serotypes, A1 is the major cause of severe pulmonary lesions in cattle. This report describes post-mortem findings in a Holstein-Friesian calf with fibrinosuppurative meningoencephalitis and fibrinonecrotizing, haemorrhagic broncho- and pleuropneumonia, from which M. haemolytica and bovine viral diarrhoea virus (BVDV) were isolated. Microscopical evaluation showed expansion of the brainstem and cerebellar leptomeninges by neutrophils and fibrin, associated with gram-negative coccobacilli. Occasional blood vessels within the midbrain and cerebellum contained fibrin thrombi. Bacterial culture of cerebellum and lung yielded M. haemolytica with unusually high haemolytic activity. The isolates were confirmed as serotype A1 by rapid plate agglutination. Lung tissue was positive for BVDV by polymerase chain reaction. The broncho- and pleuropneumonia in this calf were consistent with typical mannheimiosis due to serotype A1; however, extrapulmonary infections due to M. haemolytica, as seen in this case, are rarely reported. To our knowledge, this is the first documentation of a natural BVDV and M. haemolytica co-infection associated with fibrinosuppurative meningoencephalitis in a calf.

  5. Importance of Follow-Up Cerebrospinal Fluid Analysis in Cryptococcal Meningoencephalitis

    PubMed Central

    Schwenkenbecher, Philipp; Stoll, Matthias; Conzen, Josef; Bolat, Seza; Vonberg, Ralf-Peter; Wurster, Ulrich; Trebst, Corinna

    2014-01-01

    Cryptococcal meningoencephalitis represents a serious infection of the central nervous system, where reliable prognostic factors during the disease course are needed. Twenty-one patients diagnosed with cryptococcal meningoencephalitis in a German university hospital from 1999 to 2013 were analysed retrospectively. CSF parameters were analysed prior to therapy and during antifungal treatment and were compared between patients who survived or deceased. Fifteen patients clinically improved after antifungal therapy, while six patients died. No differences were observed between the outcome groups for the CSF parameters cell count, lactate, total protein, and CSF-serum albumin quotients (QAlb). Follow-up examinations of serum cryptococcal antigen titer and CSF cell count have shown that these parameters cannot be used to monitor the efficacy of antifungal therapy as well. In contrast, the course of QAlb during therapy was indicative for the outcome as a possible prognostic marker. In patients with clinical improvement QAlb values were falling under therapy, while rising QAlb values were found in patients with fatal outcome indicating a continuing dysfunction of the blood-CSF barrier. In conclusion, our results indicate that, among the various CSF parameters, the course of QAlb presents a promising marker that might be used to monitor the efficacy of antifungal therapy. PMID:25374433

  6. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

    PubMed Central

    2005-01-01

    Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. Case report We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. Conclusion This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis. PMID:16164756

  7. Long-term survival and virulence of Mycobacterium leprae in amoebal cysts.

    PubMed

    Wheat, William H; Casali, Amy L; Thomas, Vincent; Spencer, John S; Lahiri, Ramanuj; Williams, Diana L; McDonnell, Gerald E; Gonzalez-Juarrero, Mercedes; Brennan, Patrick J; Jackson, Mary

    2014-12-01

    Leprosy is a curable neglected disease of humans caused by Mycobacterium leprae that affects the skin and peripheral nerves and manifests clinically in various forms ranging from self-resolving, tuberculoid leprosy to lepromatous leprosy having significant pathology with ensuing disfiguration disability and social stigma. Despite the global success of multi-drug therapy (MDT), incidences of clinical leprosy have been observed in individuals with no apparent exposure to other cases, suggestive of possible non-human sources of the bacteria. In this study we show that common free-living amoebae (FLA) can phagocytose M. leprae, and allow the bacillus to remain viable for up to 8 months within amoebic cysts. Viable bacilli were extracted from separate encysted cocultures comprising three common Acanthamoeba spp.: A. lenticulata, A. castellanii, and A. polyphaga and two strains of Hartmannella vermiformis. Trophozoites of these common FLA take up M. leprae by phagocytosis. M. leprae from infected trophozoites induced to encyst for long-term storage of the bacilli emerged viable by assessment of membrane integrity. The majority (80%) of mice that were injected with bacilli extracted from 35 day cocultures of encysted/excysted A. castellanii and A. polyphaga showed lesion development that was similar to mice challenged with fresh M. leprae from passage mice albeit at a slower initial rate. Mice challenged with coculture-extracted bacilli showed evidence of acid-fast bacteria and positive PCR signal for M. leprae. These data support the conclusion that M. leprae can remain viable long-term in environmentally ubiquitous FLA and retain virulence as assessed in the nu/nu mouse model. Additionally, this work supports the idea that M. leprae might be sustained in the environment between hosts in FLA and such residence in FLA may provide a macrophage-like niche contributing to the higher-than-expected rate of leprosy transmission despite a significant decrease in human reservoirs

  8. Entamoeba histolytica calreticulin: an endoplasmic reticulum protein expressed by trophozoites into experimentally induced amoebic liver abscesses.

    PubMed

    González, Enrique; de Leon, Maria del Carmen García; Meza, Isaura; Ocadiz-Delgado, Rodolfo; Gariglio, Patricio; Silva-Olivares, Angelica; Galindo-Gómez, Silvia; Shibayama, Mineko; Morán, Patricia; Valadez, Alicia; Limón, Angelica; Rojas, Liliana; Hernández, Eric G; Cerritos, René; Ximenez, Cecilia

    2011-02-01

    Entamoeba histolytica calreticulin (EhCRT) is remarkably immunogenic in humans (90-100% of invasive amoebiasis patients). Nevertheless, the study of calreticulin in this protozoan is still in its early stages. The exact location, biological functions, and its role in pathogenesis are yet to be fully understood. The aim of the present work is to determine the location of EhCRT in virulent trophozoites in vivo and the expression of the Ehcrt gene during the development of experimentally induced amoebic liver abscesses (ALA) in hamsters. Antibodies against recombinant EhCRT were used for the immunolocalization of EhCRT in trophozoites through confocal microscopy; immunohistochemical assays were also performed on tissue sections of ALAs at different times after intrahepatic inoculation. The expression of the Ehcrt gene during the development of ALA was estimated through both in situ RT-PCR and real-time RT-PCR. Confocal assays of virulent trophozoites showed a distribution of EhCRT in the cytoplasmic vesicles of different sizes. Apparently, EhCRT is not exported into the hepatic tissue. Real-time RT-PCR demonstrated an over-expression of the Ehcrt gene at 30 min after trophozoite inoculation, reaching a peak at 1-2 h; thereafter, the expression fell sharply to its original levels. These results demonstrate for the first time in an in vivo model of ALA, the expression of Ehcrt gene in E. histolytica trophozoites and add evidence that support CRT as a resident protein of the ER in E. histolytica species. The in vivo experiments suggest that CRT may play an important role during the early stages of the host-parasite relationship, when the parasite is adapting to a new environment, although the protein seems to be constitutively synthesized. Moreover, trophozoites apparently do not export EhCRT into the hepatic tissue in ALA.

  9. Long-term Survival and Virulence of Mycobacterium leprae in Amoebal Cysts

    PubMed Central

    Wheat, William H.; Casali, Amy L.; Thomas, Vincent; Spencer, John S.; Lahiri, Ramanuj; Williams, Diana L.; McDonnell, Gerald E.; Gonzalez-Juarrero, Mercedes; Brennan, Patrick J.; Jackson, Mary

    2014-01-01

    Leprosy is a curable neglected disease of humans caused by Mycobacterium leprae that affects the skin and peripheral nerves and manifests clinically in various forms ranging from self-resolving, tuberculoid leprosy to lepromatous leprosy having significant pathology with ensuing disfiguration disability and social stigma. Despite the global success of multi-drug therapy (MDT), incidences of clinical leprosy have been observed in individuals with no apparent exposure to other cases, suggestive of possible non-human sources of the bacteria. In this study we show that common free-living amoebae (FLA) can phagocytose M. leprae, and allow the bacillus to remain viable for up to 8 months within amoebic cysts. Viable bacilli were extracted from separate encysted cocultures comprising three common Acanthamoeba spp.: A. lenticulata, A. castellanii, and A. polyphaga and two strains of Hartmannella vermiformis. Trophozoites of these common FLA take up M. leprae by phagocytosis. M. leprae from infected trophozoites induced to encyst for long-term storage of the bacilli emerged viable by assessment of membrane integrity. The majority (80%) of mice that were injected with bacilli extracted from 35 day cocultures of encysted/excysted A. castellanii and A. polyphaga showed lesion development that was similar to mice challenged with fresh M. leprae from passage mice albeit at a slower initial rate. Mice challenged with coculture-extracted bacilli showed evidence of acid-fast bacteria and positive PCR signal for M. leprae. These data support the conclusion that M. leprae can remain viable long-term in environmentally ubiquitous FLA and retain virulence as assessed in the nu/nu mouse model. Additionally, this work supports the idea that M. leprae might be sustained in the environment between hosts in FLA and such residence in FLA may provide a macrophage-like niche contributing to the higher-than-expected rate of leprosy transmission despite a significant decrease in human reservoirs

  10. Experimental amoebic liver abscess in hamsters caused by trophozoites of a Brazilian strain of Entamoeba dispar.

    PubMed

    Guzmán-Silva, Maria Angélica; Santos, Helena Lúcia Carneiro; Peralta, Regina Saramago; Peralta, José Mauro; de Macedo, Heloisa Werneck

    2013-05-01

    It has been claimed that amoebic molecules such as amoebapore, galactose/N-acetyl galactosamine inhibitable lectin, and cysteine proteases are responsible for host tissue destruction and are present in both pathogenic Entamoeba histolytica and non-pathogenic Entamoeba dispar. Some reports have provided evidence that after infection with E. dispar, pathological changes may occur in some humans. The aim of this study was to evaluate E. dispar pathogenicity by comparing it to the pathogenicity of E. histolytica through liver abscesses induced in hamsters. Syrian golden hamsters were challenged by intrahepatic inoculation with the 03C E. dispar strain or with two strains of E. histolytica (HM1:IMSS and EGG) to compare their virulence grades. As control groups, we used bacterial flora and Pavlova's modified medium. Lesions were verified at 1, 3 and 6 days after inoculation. Multiplex Polymerase Chain Reaction was performed to characterize each strain using EdP1/EdP2 and EhP1/EhP2 primers. The EGG and HM1:IMSS E. histolytica strains and 03C E. dispar were able to cause liver lesions. The EGG strain caused extensive hepatic abscesses, and trophozoites were found in the lesions throughout the three periods of study. The HM1:IMSS strain caused smaller abscesses when compared to EGG lesions; however, trophozoites were observed at 1 and 3 days after inoculation. The 03C E. dispar strain caused intermediate abscesses when compared to the others; trophozoites were observed in all periods analyzed. The EGG strain caused progressive evolution of the injury, which differed from the HM1:IMSS and 03C strains. These results strongly suggest that the 03C E. dispar strain is pathogenic in the experimental hamster model. Additional studies are necessary to identify potential factors that regulate the manifestation of virulence of this strain and others.

  11. Reevaluation of an Acanthamoeba Molecular Diagnostic Algorithm following an Atypical Case of Amoebic Keratitis

    PubMed Central

    Lau, Rachel; Cunanan, Marlou; Jackson, Jonathan; Ali, Ibne Karim M.; Chong-Kit, Ann; Gasgas, Jason; Tian, Jinfang; Ralevski, Filip

    2015-01-01

    Amoebic keratitis (AK) is a potentially blinding infection, the prompt diagnosis of which is essential for limiting ocular morbidity. We undertook a quality improvement initiative with respect to the molecular detection of acanthamoebae in our laboratory because of an unusual case of discordance. Nine ATCC strains of Acanthamoeba and 40 delinked, biobanked, surplus corneal scraping specimens were analyzed for the presence of acanthamoebae with four separate real-time PCR assays. The assay used by the Free-Living and Intestinal Amebas Laboratory of the CDC was considered the reference standard, and the performance characteristics of each individual assay and pairs of assays were calculated. Outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Of 49 included specimens, 14 (28.6%) were positive by the gold standard assay, and 35 (71.4%) were negative. The sensitivities of the individual assays ranged from 64.3% to 92.9%, compared to the gold standard, while the specificities ranged from 88.6% to 91.4%. The PPVs and NPVs ranged from 69.2% to 78.6% and from 86.1% to 96.9%, respectively. Combinations of assay pairs led to improved performance, with sensitivities ranging from 92.9% to 100% and specificities ranging from 97.1% to 100%. ATCC and clinical strains of Acanthamoeba that failed to be detected by certain individual assays included Acanthamoeba castellanii, Acanthamoeba culbertsoni, and Acanthamoeba lenticulata. For three clinical specimens, false negativity of the gold standard assay could not be excluded. Molecular diagnostic approaches, especially combinations of highly sensitive and specific assays, offer a reasonably performing, operator-independent, rapid strategy for the detection of acanthamoebae in clinical specimens and are likely to be more practical than either culture or direct microscopic detection. PMID:26202123

  12. Reevaluation of an Acanthamoeba Molecular Diagnostic Algorithm following an Atypical Case of Amoebic Keratitis.

    PubMed

    Lau, Rachel; Cunanan, Marlou; Jackson, Jonathan; Ali, Ibne Karim M; Chong-Kit, Ann; Gasgas, Jason; Tian, Jinfang; Ralevski, Filip; Boggild, Andrea K

    2015-10-01

    Amoebic keratitis (AK) is a potentially blinding infection, the prompt diagnosis of which is essential for limiting ocular morbidity. We undertook a quality improvement initiative with respect to the molecular detection of acanthamoebae in our laboratory because of an unusual case of discordance. Nine ATCC strains of Acanthamoeba and 40 delinked, biobanked, surplus corneal scraping specimens were analyzed for the presence of acanthamoebae with four separate real-time PCR assays. The assay used by the Free-Living and Intestinal Amebas Laboratory of the CDC was considered the reference standard, and the performance characteristics of each individual assay and pairs of assays were calculated. Outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Of 49 included specimens, 14 (28.6%) were positive by the gold standard assay, and 35 (71.4%) were negative. The sensitivities of the individual assays ranged from 64.3% to 92.9%, compared to the gold standard, while the specificities ranged from 88.6% to 91.4%. The PPVs and NPVs ranged from 69.2% to 78.6% and from 86.1% to 96.9%, respectively. Combinations of assay pairs led to improved performance, with sensitivities ranging from 92.9% to 100% and specificities ranging from 97.1% to 100%. ATCC and clinical strains of Acanthamoeba that failed to be detected by certain individual assays included Acanthamoeba castellanii, Acanthamoeba culbertsoni, and Acanthamoeba lenticulata. For three clinical specimens, false negativity of the gold standard assay could not be excluded. Molecular diagnostic approaches, especially combinations of highly sensitive and specific assays, offer a reasonably performing, operator-independent, rapid strategy for the detection of acanthamoebae in clinical specimens and are likely to be more practical than either culture or direct microscopic detection.

  13. Detection of free-living amoebae using amoebal enrichment in a wastewater treatment plant of Gauteng Province, South Africa.

    PubMed

    Muchesa, P; Mwamba, O; Barnard, T G; Bartie, C

    2014-01-01

    Free-living amoebae pose a potential health risk in water systems as they may be pathogenic and harbor potential pathogenic bacteria known as amoebae resistant bacteria. Free-living amoebae were observed in 150 (87.2%) of the environmental water samples. In particular, Acanthamoeba sp. was identified in 22 (12.8%) using amoebal enrichment and confirmed by molecular analysis. FLA were isolated in all 8 stages of the wastewater treatment plant using the amoebal enrichment technique. A total of 16 (9.3%) samples were positive for FLA from influent, 20 (11.6%) from bioreactor feed, 16 (9.3%) from anaerobic zone, 16 (9.3%) from anoxic zone, 32 (18.6%) from aerators, 16 (9.3%) from bioreactor effluent, 11 (6.4%) from bioreactor final effluent, and 45 (26.2%) from maturation pond. This study provides baseline information on the occurrence of amoebae in wastewater treatment plant. This has health implications on receiving water bodies as some FLA are pathogenic and are also involved in the transmission and dissemination of pathogenic bacteria.

  14. Growth of Entamoeba invadens in sediments with metabolically repressed bacteria leads to multicellularity and redefinition of the amoebic cell system.

    PubMed

    Niculescu, Vladimir F

    2013-01-01

    Extracellular signaling and mechanisms of cell differentiation in Entamoeba are misunderstood. The main reason is the popular use of axenic media, which do not correspond to the natural habitats of Entamoeba. The axenic environment lacks the exogenous activators and repressors provided by natural habitats. Absent bacterial commensals understanding of the development of the amoebic cell system remains deficient. The present Aa(Sm) culture method using mixed sediments of antibiotically repressed Aerobacter aerogens and amoebae was developed to model in vitro extracellular signaling that induce multicellularity in cultures of E. invadens. Repressed oxygen consuming sediment bacteria supply E. invadens the hypoxic environment needed for differentiation and development. The amoebae themselves alter the environment by consuming the bacteria by phagocytosis thus reversing hypoxia. Exogenous activators are in this manner down regulated and suppressed. This feedback effect controls amoebic development and differentiation. Co-existing cell types and cell fractions with different life spans and cell cycle length could be identified. Aa(Sm) long term cultures contain continuous and non-continuous self renewing cell lines producing quiescent and terminally differentiated daughter cells (precysts) by asymmetric division. This culturing method helps to understand the intimate relationship between hypoxic environments and the multicellular behaviour of E. invadens and the interrelations existing between the distinct cell types.

  15. Amoebic PI3K and PKC is required for Jurkat T cell death induced by Entamoeba histolytica.

    PubMed

    Lee, Young Ah; Kim, Kyeong Ah; Min, Arim; Shin, Myeong Heon

    2014-08-01

    The enteric protozoan parasite Entamoeba histolytica is the causative agent of human amebiasis. During infection, adherence of E. histolytica through Gal/GalNAc lectin on the surface of the amoeba can induce caspase-3-dependent or -independent host cell death. Phosphorylinositol 3-kinase (PI3K) and protein kinase C (PKC) in E. histolytica play an important function in the adhesion, killing, or phagocytosis of target cells. In this study, we examined the role of amoebic PI3K and PKC in amoeba-induced apoptotic cell death in Jurkat T cells. When Jurkat T cells were incubated with E. histolytica trophozoites, phosphatidylserine (PS) externalization and DNA fragmentation in Jurkat cells were markedly increased compared to those of cells incubated with medium alone. However, when amoebae were pretreated with a PI3K inhibitor, wortmannin before being incubated with E. histolytica, E. histolytica-induced PS externalization and DNA fragmentation in Jurkat cells were significantly reduced compared to results for amoebae pretreated with DMSO. In addition, pretreatment of amoebae with a PKC inhibitor, staurosporine strongly inhibited Jurkat T cell death. However, E. histolytica-induced cleavage of caspase-3, -6, and -7 were not inhibited by pretreatment of amoebae with wortmannin or staurosporin. In addition, we found that amoebic PI3K and PKC have an important role on amoeba adhesion to host compartment. These results suggest that amebic PI3K and PKC activation may play an important role in caspase-independent cell death in Entamoeba-induced apoptosis.

  16. Amoebic PI3K and PKC is required for Jurkat T cell death induced by Entamoeba histolytica.

    PubMed

    Lee, Young Ah; Kim, Kyeong Ah; Min, Arim; Shin, Myeong Heon

    2014-08-01

    The enteric protozoan parasite Entamoeba histolytica is the causative agent of human amebiasis. During infection, adherence of E. histolytica through Gal/GalNAc lectin on the surface of the amoeba can induce caspase-3-dependent or -independent host cell death. Phosphorylinositol 3-kinase (PI3K) and protein kinase C (PKC) in E. histolytica play an important function in the adhesion, killing, or phagocytosis of target cells. In this study, we examined the role of amoebic PI3K and PKC in amoeba-induced apoptotic cell death in Jurkat T cells. When Jurkat T cells were incubated with E. histolytica trophozoites, phosphatidylserine (PS) externalization and DNA fragmentation in Jurkat cells were markedly increased compared to those of cells incubated with medium alone. However, when amoebae were pretreated with a PI3K inhibitor, wortmannin before being incubated with E. histolytica, E. histolytica-induced PS externalization and DNA fragmentation in Jurkat cells were significantly reduced compared to results for amoebae pretreated with DMSO. In addition, pretreatment of amoebae with a PKC inhibitor, staurosporine strongly inhibited Jurkat T cell death. However, E. histolytica-induced cleavage of caspase-3, -6, and -7 were not inhibited by pretreatment of amoebae with wortmannin or staurosporin. In addition, we found that amoebic PI3K and PKC have an important role on amoeba adhesion to host compartment. These results suggest that amebic PI3K and PKC activation may play an important role in caspase-independent cell death in Entamoeba-induced apoptosis. PMID:25246714

  17. Diagnostic tests for amoebic liver abscess: comparison of enzyme-linked immunosorbent assay (ELISA) and counterimmunoelectrophoresis (CIE).

    PubMed

    Restrepo, M I; Restrepo, Z; Elsa Villareal, C L; Aguirre, A; Restrepo, M

    1996-01-01

    The liver abscess is the most frequent extraintestinal complication of intestinal amoebiasis: its diagnosis is suggested by the clinical picture but it must be confirmed by paraclinic tests. Themost stringent diagnosis requires identification of E. histolytica. But this is possible only in a few cases. Serological tests greatly improve the diagnosis of this severe complication of amoebiasis. We compared the Enzyme Linfed Immunosorbent Assay and the Counterimmunoelectrophoresis techniques. Both techniques were used to detect amoebic antibodies in 50 control patients, 30 patients with liver abscess and 30 patients with intestinal amoebiasis. All the sera from control patients gave negative results in both techniques. When analysing the sera from patients with intestinal amoebiasis, 10% of them were positive by ELISA but non by CIE. The sera of patients with liver abscess, we found that 90% were positive by the ELISA method and 66.6% by the CIE technique. In patients with amoebic liver abscess, the results showed that the ELISA was more sensitive than the CIE, as it presented a higher sensitivity (100%) than that of the CIE technique (66%).

  18. Detection of Free-Living Amoebae Using Amoebal Enrichment in a Wastewater Treatment Plant of Gauteng Province, South Africa

    PubMed Central

    Muchesa, P.; Mwamba, O.; Barnard, T. G.; Bartie, C.

    2014-01-01

    Free-living amoebae pose a potential health risk in water systems as they may be pathogenic and harbor potential pathogenic bacteria known as amoebae resistant bacteria. Free-living amoebae were observed in 150 (87.2%) of the environmental water samples. In particular, Acanthamoeba sp. was identified in 22 (12.8%) using amoebal enrichment and confirmed by molecular analysis. FLA were isolated in all 8 stages of the wastewater treatment plant using the amoebal enrichment technique. A total of 16 (9.3%) samples were positive for FLA from influent, 20 (11.6%) from bioreactor feed, 16 (9.3%) from anaerobic zone, 16 (9.3%) from anoxic zone, 32 (18.6%) from aerators, 16 (9.3%) from bioreactor effluent, 11 (6.4%) from bioreactor final effluent, and 45 (26.2%) from maturation pond. This study provides baseline information on the occurrence of amoebae in wastewater treatment plant. This has health implications on receiving water bodies as some FLA are pathogenic and are also involved in the transmission and dissemination of pathogenic bacteria. PMID:25530964

  19. Meningoencephalitis in a Boelen's python (Morelia boeleni) associated with paramyxovirus infection.

    PubMed

    West, G; Garner, M; Raymond, J; Latimer, K S; Nordhausen, R

    2001-09-01

    An adult male Boelen's python, Morelia boeleni, presented with acute neurologic disease and was euthanatized. Histologic examination revealed nonsuppurative meningoencephalitis. Occasional eosinophilic intracytoplasmic inclusions were noted in glial cells. On the basis of clinical signs and histopathology, inclusion body disease of boid snakes was suspected, but inclusions were not seen in other organs commonly affected with the disease. Moreover, electron microscopy revealed that the inclusions contained stacks of filaments 13-14 nm wide. With the use of a generic paramyxovirus cDNA probe, sections of brain and esophageal ganglion demonstrated hybridization. The findings indicate that paramyxovirus was the likely cause of the encephalomyelitis in this python, and this virus should be included in the differential diagnosis of pythons exhibiting central nervous system disease.

  20. Autoantibodies against glial fibrillary acidic protein (GFAP) in cerebrospinal fluids from Pug dogs with necrotizing meningoencephalitis.

    PubMed

    Shibuya, Masahiro; Matsuki, Naoaki; Fujiwara, Kaori; Imajoh-Ohmi, Shinobu; Fukuda, Hiroyuki; Pham, Ngoc T; Tamahara, Satoshi; Ono, Kenichiro

    2007-03-01

    Cerebrospinal fluids (CSFs) from 9 Pug dogs with necrotizing meningoencephalitis (NME: Pug dog encephalitis) were examined to identify the antigens for anti-astrocyte autoantibodies. Each CSF exhibited a positive reaction to the cytoplasm of cultured canine astrocytes by an indirect fluorescent antibody test. In an immunoblotting analysis on normal canine brain proteins, eight of 9 CSFs showed a common band of 52 kDa, corresponding to glial fibrillary acidic protein (GFAP), and all of 9 CSFs reacted with purified bovine GFAP. From these results, GFAP is one of the common autoantigens in Pug dogs with NME. On the other hand, the reactivity of CSFs to chymotrypsin-digested bovine GFAP fragments were variable among dogs, indicating that the antibodies in the CSFs recognized different epitopes on GFAP.

  1. Serum glial fibrillary acidic protein as a specific marker for necrotizing meningoencephalitis in Pug dogs.

    PubMed

    Miyake, Hizuru; Inoue, Akiko; Tanaka, Miho; Matsuki, Naoaki

    2013-11-01

    To evaluate the ability of serum glial fibrillary acidic protein (GFAP) concentration as a diagnostic marker for canine central nervous system (CNS) disorders, sera from dogs with various CNS (n=47) and non-CNS (n=56) disorders were measured for GFAP by using an ELISA kit. Healthy Beagles (n=15) and Pug dogs (n=12) were also examined as controls. Interestingly, only Pug dogs with necrotizing meningoencephalitis (NME) showed elevated serum GFAP concentrations (<0.01 to 1.14 ng/ml), while other breeds of dogs with NME did not. Among the Pug dogs with NME, serum GFAP concentrations did not correlate with their clinical features, such as ages or survival times. Our data indicate the usefulness of serum GFAP as a novel marker for Pug dogs with NME.

  2. Meningoencephalitis in a polar bear caused by equine herpesvirus 9 (EHV-9).

    PubMed

    Donovan, T A; Schrenzel, M D; Tucker, T; Pessier, A P; Bicknese, B; Busch, M D M; Wise, A G; Maes, R; Kiupel, M; McKnight, C; Nordhausen, R W

    2009-11-01

    A 12-year-old female polar bear (Ursus maritimus) developed a sudden onset of muscle tremors, erratic circling, increased blinking, head shaking, and ptyalism, which progressed to partial and generalized seizures. Ancillary diagnostic tests were inconclusive, and the only significant laboratory finding was nonsuppurative pleocytosis of cerebrospinal fluid. Euthanasia was elected. Microscopic evaluation demonstrated multifocal, random nonsuppurative meningoencephalitis involving most prominently the rostral cerebral cortex, as well as the thalamus, midbrain, and rostral medulla. Lesions consisted of inflammation, neuronal necrosis, gliosis, and both neuronal and glial basophilic intranuclear inclusion bodies. Immunohistochemistry with a polyclonal antibody reactive to several equine herpesviruses was positive within affected areas of the brain, and polymerase chain reaction conclusively demonstrated the presence of only equine herpesvirus 9. The clinical and morphologic features of this case resemble other fatal herpesvirus encephalitides derived from interspecies transmission and underscore the need for extreme caution when managing wild or captive equids. PMID:19605910

  3. Birds of a feather: an uncommon cause of pneumonia and meningoencephalitis.

    PubMed

    Ionescu, Anne-Marie; Khare, Divya; Kavi, Jay

    2016-09-12

    A 61-year-old man was admitted with a 1-week history of influenza-like symptoms during a period of increased influenza virus activity. He soon developed type 2 respiratory failure and became increasingly drowsy. He later suffered a convulsive episode in the intensive care unit (ICU) which self-terminated. Initial clinical findings suggested community-acquired pneumonia and meningoencephalitis. However, a detailed history revealed that he was a pet bird-keeper, which raised a suspicion of ornithosis. Chlamydia psittaci DNA was detected in sputum by PCR. He was started on appropriate antibiotics and made a full recovery. We present this uncommon cause of pneumonia as an example of the importance of accurate history-taking to ensure a correct diagnosis for optimal management.

  4. Immunohistochemical characterization of the initial stages of Naegleria fowleri meningoencephalitis in mice.

    PubMed

    Rojas-Hernández, Saul; Jarillo-Luna, Adriana; Rodríguez-Monroy, Marco; Moreno-Fierros, Leticia; Campos-Rodríguez, Rafael

    2004-09-01

    The initial stages of Naegleria fowleri meningoencephalitis in mice were immunohistochemically characterized following the first 8 h post-intranasal inoculation. The events found after 8 h were: (1) amebas in contact with the mucous layer of the olfactory epithelium, (2) numerous parasites eliminated by extensive shedding of the mucous layer, and (3) many organisms reaching the nasal epithelium. In contrast to other works, we observed that after 24 h, amebas invaded the epithelium, without evidence of the disruption of the nasal mucosa. In addition some trophozoites invading through the respiratory epithelium were observed, suggesting an additional invasion route. The inflammatory response detected was scarce until 30 h post-inoculation. After 96 h, the inflammatory response was severe in the olfactory bulb and brain, and the tissue damage great. Consequently, an inflammatory reaction may enhance tissue damage but apparently does not destroy amebas which seem to proliferate in the olfactory bulb.

  5. Birds of a feather: an uncommon cause of pneumonia and meningoencephalitis.

    PubMed

    Ionescu, Anne-Marie; Khare, Divya; Kavi, Jay

    2016-01-01

    A 61-year-old man was admitted with a 1-week history of influenza-like symptoms during a period of increased influenza virus activity. He soon developed type 2 respiratory failure and became increasingly drowsy. He later suffered a convulsive episode in the intensive care unit (ICU) which self-terminated. Initial clinical findings suggested community-acquired pneumonia and meningoencephalitis. However, a detailed history revealed that he was a pet bird-keeper, which raised a suspicion of ornithosis. Chlamydia psittaci DNA was detected in sputum by PCR. He was started on appropriate antibiotics and made a full recovery. We present this uncommon cause of pneumonia as an example of the importance of accurate history-taking to ensure a correct diagnosis for optimal management. PMID:27620382

  6. Amebic meningoencephalitis.

    PubMed

    Culbertson, C G

    1981-01-01

    As the result of research by many workers, information as to the accurate diagnosis and possibly effective treatment has accumulated. While much more definitive academic investigation will aid in improving the results of medical management, the next objective should be the serious study of patients with suggestive histories and with acute and chronic respiratory ailments for the possible role of free-living amebas therein. The state of the art has reached the point where the two free-living amebic infections can probably be diagnosed by direct examination of exudates from the respiratory tract before the diseases become serious and beyond treatment. At present, the lack of effort to do this is as if one were trying to diagnose amebic dysentery histolytica in the diagnosis of entamebiasis. There is need for increased effort by local health officials, parents, clinicians and laboratory scientists to attempt to prevent the tragic consequences of naegleramebiasis by all possible means, at facilities near the patient's home. While the prospects of effectively handling the problem of acanthamoebiasis are less promising, earlier recognition of it in patients now known likely to develop such an infection might lead to better understanding the approaches to its treatment. PMID:7259134

  7. Long-term survival in a dog with meningoencephalitis and epidural abscessation due to Actinomyces species.

    PubMed

    Song, Rachel B; Vitullo, Carina A; da Costa, Ronaldo C; Daniels, Joshua B

    2015-07-01

    A 2-year-old, female spayed Golden Retriever dog was presented to The Ohio State University Veterinary Medical Center for evaluation of ataxia, cervical pain, 1 episode of acute collapse, dull mentation, and inappetence. Physical examination revealed an elevated temperature of 39.7°C and severe cervical pain. Blood work revealed a mature neutrophilia. Cerebrospinal fluid (CSF) analysis revealed nondegenerative neutrophilic pleocytosis with no infectious agents. A presumptive diagnosis of steroid-responsive meningitis-arteritis was made, and corticosteroid therapy was started. The patient improved initially but experienced a vestibular episode characterized by falling and vertical nystagmus. A magnetic resonance imaging of the brain revealed an epidural abscess in the cervical vertebral canal and diffuse meningeal enhancement in the brain and cranial cervical spine. Abscess drainage revealed degenerate neutrophils and several filamentous, branching organisms. Culture of the initial CSF using an enrichment broth revealed growth of a Gram-positive organism 5 days after fluid collection. The isolate was identified by partial 16S ribosomal DNA sequencing as Actinomyces spp. The patient was successfully treated with long-term antibiotics. Our study reports the long-term survival after medical treatment of bacterial meningoencephalitis and epidural abscessation due to Actinomyces sp. infection in a dog. Bacterial meningoencephalitis should be included as a differential diagnosis in patients with cervical pain and fever, even when a nondegenerative neutrophilic pleocytosis is found on CSF analysis. Culture of the CSF with use of an enrichment broth should be considered in all cases of neutrophilic pleocytosis to rule out infections of the central nervous system.

  8. [Successful treatment for cryptococcal meningoencephalitis complicated by cerebral salt-wasting syndrome in a patient with chronic lymphocytic leukemia: A clinical case].

    PubMed

    Potapenko, V G; Konovalenko, I B; Oksema, E V; Filippova, L N; Dulaeva, E N; Derevyannykh, N A; Krasnoruzhsky, A I; Klimovich, A V; Klimko, N N; Medvedeva, N V

    2015-01-01

    Cryptococcus neoformans is a common agent of fungal meningoencephalitis in immunocompromised patients. Cerebral salt-wasting syndrome is one of the rare causes of severe hyponatremia in patients with CNS diseases. The paper describes the first clinical case of a patient, whose onset of chronic lymphocytic leukemia was complicated by cryptococcal meningoencephalitis presenting with mental disorders and severe electrolytic imbalance. Antifungal treatment with amphotericin B and fluconazole could alleviate an infectious process and metabolic disturbances. PMID:26821425

  9. [Successful treatment for cryptococcal meningoencephalitis complicated by cerebral salt-wasting syndrome in a patient with chronic lymphocytic leukemia: A clinical case].

    PubMed

    Potapenko, V G; Konovalenko, I B; Oksema, E V; Filippova, L N; Dulaeva, E N; Derevyannykh, N A; Krasnoruzhsky, A I; Klimovich, A V; Klimko, N N; Medvedeva, N V

    2015-01-01

    Cryptococcus neoformans is a common agent of fungal meningoencephalitis in immunocompromised patients. Cerebral salt-wasting syndrome is one of the rare causes of severe hyponatremia in patients with CNS diseases. The paper describes the first clinical case of a patient, whose onset of chronic lymphocytic leukemia was complicated by cryptococcal meningoencephalitis presenting with mental disorders and severe electrolytic imbalance. Antifungal treatment with amphotericin B and fluconazole could alleviate an infectious process and metabolic disturbances.

  10. Draft Genome Sequence of High-Temperature-Adapted Protochlamydia sp. HS-T3, an Amoebal Endosymbiotic Bacterium Found in Acanthamoeba Isolated from a Hot Spring in Japan.

    PubMed

    Yamaguchi, Hiroyuki; Matsuo, Junji; Yamazaki, Tomohiro; Ishida, Kasumi; Yagita, Kenji

    2015-02-05

    Here, we report the draft genome sequence of high-temperature-adapted Protochlamydia sp. strain HS-T3, an environmental chlamydia. This bacterium is an amoebal endosymbiont, found in Acanthamoeba isolated from a hot spring in Japan. Strain HS-T3 readily grew in mammalian cells at 37°C, a characteristic not previously reported for environmental chlamydiae.

  11. Necrotizing Meningoencephalitis in a Captive Black and White Ruffed Lemur (Varecia variegata variegata) Caused by Acanthamoeba T4 Genotype.

    PubMed

    Gaide, N; Pelandakis, M; Robveille, C; Albaric, O; Jouvion, G; Souchon, M; Risler, A; Abadie, J

    2015-11-01

    A mature male, black and white ruffed lemur (Varecia variegata variegata) died in a zoological garden after a 4-day history of lethargy and non-responsive convulsions. Necropsy and histopathological examinations revealed acute necrotizing and haemorrhagic meningoencephalitis with intralesional amoebas confirmed by immunohistochemistry. Acanthamoeba T4 genotype was identified as the causative agent of the brain lesion, based on amplification and sequencing of 18S ribosomal RNA genes. The presence of free-living amoebas in water and mud from the lemur's environment was investigated by morphological and molecular analyses. The two predominant genera, representing 80% of isolated amoebas, were Naegleria spp. and Acanthamoeba spp. All Acanthamoeba isolates belonged to the T4 genotype. To the author's knowledge, this is the first report of a meningoencephalitis due to Acanthamoeba T4 genotype in Lemuridae with concurrent analysis of pathological tissues and environment.

  12. Necrotizing Meningoencephalitis in a Captive Black and White Ruffed Lemur (Varecia variegata variegata) Caused by Acanthamoeba T4 Genotype.

    PubMed

    Gaide, N; Pelandakis, M; Robveille, C; Albaric, O; Jouvion, G; Souchon, M; Risler, A; Abadie, J

    2015-11-01

    A mature male, black and white ruffed lemur (Varecia variegata variegata) died in a zoological garden after a 4-day history of lethargy and non-responsive convulsions. Necropsy and histopathological examinations revealed acute necrotizing and haemorrhagic meningoencephalitis with intralesional amoebas confirmed by immunohistochemistry. Acanthamoeba T4 genotype was identified as the causative agent of the brain lesion, based on amplification and sequencing of 18S ribosomal RNA genes. The presence of free-living amoebas in water and mud from the lemur's environment was investigated by morphological and molecular analyses. The two predominant genera, representing 80% of isolated amoebas, were Naegleria spp. and Acanthamoeba spp. All Acanthamoeba isolates belonged to the T4 genotype. To the author's knowledge, this is the first report of a meningoencephalitis due to Acanthamoeba T4 genotype in Lemuridae with concurrent analysis of pathological tissues and environment. PMID:26297109

  13. [Long central apnea as the chief symptom of aseptic meningoencephalitis in a 6-week-old infant].

    PubMed

    Kurz, H; Jakelj, J; Aberle, S W; Rohrbach, D E; Dremsek, P A; Sacher, M

    1999-04-01

    Viral infections can cause apnoea, bradycardia, and desaturation events in preterm and new born infants. These symptoms do not always occur in older infants. A link between virus infection, apnoea, apparent life threatening events (ALTE) and sudden infant death (SID) is speculated. We report a 6-week-old infant with long central apnoea as the first and main symptom of meningoencephalitis caused by enterovirus. PMID:10355041

  14. Fatal human eosinophilic meningo-encephalitis caused by CNS co-infection with Halicephalobus gingivalis and West Nile virus.

    PubMed

    Anwar, M A; Gokozan, H N; Ball, M K; Otero, J; McGwire, B S

    2015-10-01

    The saprophytic nematode Halicephalobus is a rare cause of fatal human meningo-encephalitis, and West Nile virus is neurotropic flavivirus implicated in a variety of clinical neurologic syndromes. Here we report a case of rapidly progressive CNS encephalopathy and death. Serologic, immuno-histochemical, histopathologic and nucleic acid studies demonstrate the presence of active Halicephalobus and West Nile virus in the CNS tissue. This is the first reported case of co-infection with these neurotropic pathogens. PMID:26050925

  15. Entamoeba histolytica: inflammatory process during amoebic liver abscess formation involves cyclooxygenase-2 expression in macrophages and trophozoites.

    PubMed

    Gutiérrez-Alarcón, A; Moguel-Torres, M; Mata-Leyva, O; Cuellar-Nevárez, G; Siqueiros-Cendón, T; Erosa, G; Ramos-Martínez, E; Talamás-Rohana, P; Sánchez-Ramírez, B

    2006-11-01

    It has been demonstrated that expression of cyclooxygenase-2 (COX-2) isoform is induced by Entamoeba histolytica in macrophages and polymorphonuclear cells during amoebic liver abscess (ALA) formation in hamsters. Trophozoites present in the lesion were also positive for COX-2 signal. However, no cross reactivity of the anti-COX-2 antibody with protein extract of cultivated trophozoites was found. To clarify if trophozoites are involved in PGE(2) production during ALA development, COX-2 expression was detected by in situ hybridization and RT-PCR in liver tissue from intrahepatically infected hamsters. COX-2 mRNA was in polymorphonuclear cells since 4h postinfection, and subsequently, local macrophages expressed COX-2 mRNA in a similar way. Additionally, a positive signal for COX-2 mRNA expression was detected in E. histolytica trophozoites, suggesting that, in vivo, parasite COX expression may be an important mechanism to promote inflammation.

  16. Intrathecal synthesis of IgE in children with eosinophilic meningoencephalitis caused by Angiostrongylus cantonensis

    PubMed Central

    Padilla-Docal, Barbara; Dorta-Contreras, Alberto J; Bu-Coifiu-Fanego, Raisa; Hernández, Hermes Fundora; Barroso, Jesús Callol; Sanchez-Martinez, Consuelo

    2008-01-01

    Background Eosinophilic meningoencephalitis caused by the helminth Angiostrongylus cantonensis, is an emerging infectious disease in America. The objective of this paper was to determine if the intrathecal synthesis of immunoglobulin E is produced during the acute phase of the disease. Methods Thirteen patients, mean age 4.5 years were studied; a diagnostic lumbar puncture was performed and serum samples taken. Immunoglobulin E (IgE) in serum and in cerebrospinal fluid (CSF) was quantified by nephelometry. Control patients had other infections or other neurological diseases. Results The mean cell count in the CSF was 500 × 10-6 cells/L and of these 23% were eosinophils. In blood the eosinophils were 13%. The chief symptoms of the patients were migraine, vomiting and fever and 50% presented some meningeal signs. IgE intrathecal synthesis analyzed by the corresponding quotient diagram (Reibergram) was observed in all patients. No intrathecal IgE synthesis was seen in control patients. Conclusion Intrathecal synthesis of IgE demonstrates the participation of this immunoglobulin in the destruction of the third stage larvae of the parasite in the CSF. The test should be considered in our environment as a tool to aid diagnosis. PMID:19032790

  17. Severe meningoencephalitis due to late reactivation of Varicella-Zoster virus in an immunocompetent child.

    PubMed

    Spiegel, Ronen; Miron, Dan; Lumelsky, Dmitry; Horovitz, Yoseph

    2010-01-01

    Recurrent reactivation of latent Varicella-Zoster virus may cause various neurological complications including encephalitis, myelitis, stroke episodes, and meningitis. It occurs mainly in elderly or immunocompromised patients and is very rare in children. We report a 14-year girl who presented with meningoencephalitis due to reactivation of Varicella-Zoster virus 10 years after she had chickenpox and 4 years after she had zoster. Characteristic skin lesions of varicella were absent. Varicella-Zoster virus DNA was detected in cerebrospinal fluid and magnetic resonance imaging (MRI) findings were consistent with small vessel cerebral vasculitis. Treatment with acyclovir and high dose methylprednisolone resulted in near-complete neurological recovery. Although rare, Varicella-Zoster virus may reactivate to cause significant central nervous system disease even in immunocompetent children. Diagnosis depends on a high degree of suspicion because the typical rash may not associate the disease. Characteristic lesions on MRI and the presence of Varicella-Zoster virus DNA in cerebrospinal fluid are key findings for the correct diagnosis.

  18. Cerebrospinal fluid Th1/Th2 cytokine profiles in children with enterovirus 71-associated meningoencephalitis.

    PubMed

    Li, Huajun; Li, Shuxian; Zheng, Jianfeng; Cai, Chunyan; Ye, Bin; Yang, Jun; Chen, Zhimin

    2015-03-01

    Enterovirus 71 (EV71) infection can cause severe neurological complications including meningoencephalitis (ME) in some patients with hand, foot and mouth disease (HFMD). However, to date no studies have reported changes in cytokine concentrations and their correlations with clinical variables in patients with ME following EV71 infection. In this study, responses of Th1/Th2 cytokine, including IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ, in cerebrospinal fluid (CSF) from patients with EV71-related HFMD with ME and patients with febrile convulsions (FC) were analyzed using cytometric bead array technology. It was found that CSF IL-6 and IFN-γ concentrations were significantly higher in patients with EV71-related ME than in those with FC. Additionally, both CSF IL-6 and IFN-γ concentrations were correlated with CSF cytology, fever duration and duration of hospital stay. More interestingly, a positive correlation between CSF IL-6 and IFN-γ concentrations was observed. Finally, receiver operating characteristic analysis revealed that when a cutoff value of 9.40 pg/mL was set for IL-6, the sensitivity and specificity were 84.5% and 85.5%, respectively, for discriminating EV71-related ME from FC. In conclusion, IL-6 and IFN-γ may be associated with EV71-induced neuropathology. PMID:25611005

  19. Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study.

    PubMed

    Erdem, H; Kilic, S; Sener, B; Acikel, C; Alp, E; Karahocagil, M; Yetkin, F; Inan, A; Kecik-Bosnak, V; Gul, H C; Tekin-Koruk, S; Ceran, N; Demirdal, T; Yilmaz, G; Ulu-Kilic, A; Ceylan, B; Dogan-Celik, A; Nayman-Alpat, S; Tekin, R; Yalci, A; Turhan, V; Karaoglan, I; Yilmaz, H; Mete, B; Batirel, A; Ulcay, A; Dayan, S; Seza Inal, A; Ahmed, S S; Tufan, Z K; Karakas, A; Teker, B; Namiduru, M; Savasci, U; Pappas, G

    2013-02-01

    No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

  20. Retrospective study of etiologic agents associated with nonsuppurative meningoencephalitis in stranded cetaceans in the canary islands.

    PubMed

    Sierra, Eva; Sánchez, Susan; Saliki, Jeremiah T; Blas-Machado, Uriel; Arbelo, Manuel; Zucca, Daniele; Fernández, Antonio

    2014-07-01

    Nineteen natural cases of etiologically undetermined encephalitides in free-ranging cetaceans were studied retrospectively. Histological examination of the brains revealed variable degrees of nonsuppurative encephalitis or meningoencephalitis, characterized predominantly by perivascular lymphohistiocytic infiltrates. A PCR assay was used on brain and other available tissues to detect the presence of morbillivirus, herpesvirus, West Nile virus, Toxoplasma gondii, and Brucella spp. In addition, immunohistochemical (IHC) staining was performed on selected tissues to determine the presence of morbilliviral antigens. Six animals (5 striped dolphins and 1 common dolphin) showed IHC and/or molecular evidence of morbilliviral antigens and/or genomes, mainly in brain tissue. Conventional nested PCR detected herpesviral DNA in brain tissue samples from two striped dolphins. There was no evidence of West Nile virus, T. gondii, or Brucella spp. in any of the brain tissue samples examined. The information presented here increases the number of confirmed morbillivirus-positive cases within the Canarian archipelago from two previously reported cases to eight. Furthermore, a new nested-PCR method for the detection of morbillivirus is described here. Regarding herpesvirus, the phylogenetic analysis performed in the current study provides valuable information about a possible pathogenic branch of cetacean alphaherpesviruses that might be responsible for some fatal cases worldwide. PMID:24759718

  1. Cryptococcus neoformans Hyperfilamentous Strain Is Hypervirulent in a Murine Model of Cryptococcal Meningoencephalitis

    PubMed Central

    Feretzaki, Marianna; Hardison, Sarah E.; Wormley, Floyd L.; Heitman, Joseph

    2014-01-01

    Cryptococcus neoformans is a human fungal pathogen that causes lethal infections of the lung and central nervous system in immunocompromised individuals. C. neoformans has a defined bipolar sexual life cycle with a and α mating types. During the sexual cycle, which can occur between cells of opposite mating types (bisexual reproduction) or cells of one mating type (unisexual reproduction), a dimorphic transition from yeast to hyphal growth occurs. Hyphal development and meiosis generate abundant spores that, following inhalation, penetrate deep into the lung to enter the alveoli, germinate, and establish a pulmonary infection growing as budding yeast cells. Unisexual reproduction has been directly observed only in the Cryptococcus var. neoformans (serotype D) lineage under laboratory conditions. However, hyphal development has been previously associated with reduced virulence and the serotype D lineage exhibits limited pathogenicity in the murine model. In this study we show that the serotype D hyperfilamentous strain XL280α is hypervirulent in an animal model. It can grow inside the lung of the host, establish a pulmonary infection, and then disseminate to the brain to cause cryptococcal meningoencephalitis. Surprisingly, this hyperfilamentous strain triggers an immune response polarized towards Th2-type immunity, which is usually observed in the highly virulent sibling species C. gattii, responsible for the Pacific Northwest outbreak. These studies provide a technological advance that will facilitate analysis of virulence genes and attributes in C. neoformans var. neoformans, and reveal the virulence potential of serotype D as broader and more dynamic than previously appreciated. PMID:25093333

  2. Meningoencephalitis associated with Carnobacterium maltaromaticum-like bacteria in stranded juvenile salmon sharks (Lamna ditropis).

    PubMed

    Schaffer, P A; Lifland, B; Van Sommeran, S; Casper, D R; Davis, C R

    2013-05-01

    Juvenile salmon sharks beach yearly along the California coast, primarily during late summer and early fall. Fresh, frozen, and formalin-fixed tissues from 19 stranded salmon sharks were collected for examination. Histopathology revealed meningitis or meningoencephalitis in 18 of 19 shark brains with intralesional bacteria observed in 6 of the affected brains. Bacterial culture of fresh or frozen brain, liver, and/or heart blood from 13 sharks yielded pure cultures characterized molecularly and/or biochemically as belonging to the genus Carnobacterium. The 16s ribosomal DNA sequence of 7 tissue isolates from 7 separate sharks was 99% homologous to C. maltaromaticum (GenBank FJ656722.1). Sequence of the large ribosomal DNA intergenic spacer region (ISR) was 97% homologous to C. maltaromaticum (AF374295.1). This is the first report of Carnobacterium infection in any shark species, and the authors posit that brain infection caused by Carnobacterium is a significant cause of morbidity and mortality in juvenile salmon sharks found stranded along the Pacific coast of California.

  3. Retrospective Study of Etiologic Agents Associated with Nonsuppurative Meningoencephalitis in Stranded Cetaceans in the Canary Islands

    PubMed Central

    Sánchez, Susan; Saliki, Jeremiah T.; Blas-Machado, Uriel; Arbelo, Manuel; Zucca, Daniele; Fernández, Antonio

    2014-01-01

    Nineteen natural cases of etiologically undetermined encephalitides in free-ranging cetaceans were studied retrospectively. Histological examination of the brains revealed variable degrees of nonsuppurative encephalitis or meningoencephalitis, characterized predominantly by perivascular lymphohistiocytic infiltrates. A PCR assay was used on brain and other available tissues to detect the presence of morbillivirus, herpesvirus, West Nile virus, Toxoplasma gondii, and Brucella spp. In addition, immunohistochemical (IHC) staining was performed on selected tissues to determine the presence of morbilliviral antigens. Six animals (5 striped dolphins and 1 common dolphin) showed IHC and/or molecular evidence of morbilliviral antigens and/or genomes, mainly in brain tissue. Conventional nested PCR detected herpesviral DNA in brain tissue samples from two striped dolphins. There was no evidence of West Nile virus, T. gondii, or Brucella spp. in any of the brain tissue samples examined. The information presented here increases the number of confirmed morbillivirus-positive cases within the Canarian archipelago from two previously reported cases to eight. Furthermore, a new nested-PCR method for the detection of morbillivirus is described here. Regarding herpesvirus, the phylogenetic analysis performed in the current study provides valuable information about a possible pathogenic branch of cetacean alphaherpesviruses that might be responsible for some fatal cases worldwide. PMID:24759718

  4. Post-operative Streptococcus pneumoniae meningoencephalitis complicating surgery for acromegaly in an identical twin.

    PubMed

    Cote, David J; Iuliano, Sherry L; Smith, Timothy R; Laws, Edward R

    2015-06-01

    This case report provides provocative and useful data regarding two aspects of acromegaly and its management. The patient, who is one of a pair of identical twins, has no known hereditary, genetic or otherwise potentially etiologic factors as compared to her unaffected sister. Secondly, transsphenoidal surgery, which was ultimately successful, was complicated by pneumococcal meningitis, an unusual event with only four previously reported patients, three of whom ended in death or major neurologic deficits. In this case, a 57-year-old woman gradually developed classical signs and symptoms of acromegaly while her identical twin sister remained normal with no evidence of endocrine disease. Endoscopic transsphenoidal surgery was complicated by the development of meningitis 25 days after surgery. This was controlled following a difficult hospital course. Streptococcus pneumoniae meningoencephalitis is a rare but life-threatening complication of transsphenoidal surgery. A high index of suspicion for incipient meningitis should be maintained when patients present with severe headache and increased intracranial pressure, even if they initially lack the typical symptoms and signs. Immediate and aggressive treatment is necessary to avoid significant neurologic deficit.

  5. Prognostic factors for 1-week survival in dogs diagnosed with meningoencephalitis of unknown aetiology.

    PubMed

    Cornelis, I; Volk, H A; Van Ham, L; De Decker, S

    2016-08-01

    Although long-term outcomes of meningoencephalitis of unknown aetiology (MUA) in dogs have been evaluated, little is known about short-term survival and initial response to therapy. The aim of this study was to evaluate possible prognostic factors for 7-day survival after diagnosis of MUA in dogs. Medical records were reviewed for dogs diagnosed with MUA between 2006 and 2015. Previously described inclusion criteria were used, as well as 7-day survival data for all dogs. A poor outcome was defined as death within 1 week. Of 116 dogs that met inclusion criteria, 30 (26%) died within 7 days of diagnosis. Assessed variables included age, sex, bodyweight, duration of clinical signs and treatment prior to diagnosis, venous blood glucose and lactate levels, white blood cell count on complete blood count, total nucleated cell count/total protein concentration/white blood cell differentiation on cerebrospinal fluid (CSF) analysis, presence of seizures and cluster seizures, mentation at presentation, neuroanatomical localisation, imaging findings and treatment after diagnosis. Multivariate analysis identified three variables significantly associated with poor outcome; decreased mentation at presentation, presence of seizures, and increased percentage of neutrophils on CSF analysis. Despite initiation of appropriate treatment, more than a quarter of dogs died within 1 week of diagnosis of MUA, emphasising the need for evaluation of short-term prognostic factors. Information from this study could aid clinical staff to provide owners of affected dogs with prognostic information. PMID:27387733

  6. An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan.

    PubMed

    Itoh, Kyoko; Yagita, Kenji; Nozaki, Tomoyoshi; Katano, Harutaka; Hasegawa, Hideki; Matsuo, Koushun; Hosokawa, Youhei; Tando, So; Fushiki, Shinji

    2015-02-01

    Balamuthia mandrillaris is an amoeba found in fresh water and soil that causes granulomatous amoebic encephalitis. We report herein an autopsy case of B. mandrillaris amoebic encephalitis, which was definitely diagnosed by PCR. An 81-year-old man, who had Sjögren's syndrome, manifested drowsiness 2 months before his death with progressive deterioration. Neuroimaging demonstrated foci of T2- and fluid-attenuated inversion recovery high and T1 low-intensity with irregular post-contrast ring enhancement in the cerebral hemisphere, thalamus and midbrain. Pathologically, multiple hemorrhagic and necrotic lesions were found in the cerebrum, thalamus, midbrain, pons, medulla and cerebellum, which were characterized by liquefactive necrosis, marked edema, hemorrhage and necrotizing vasculitis associated with the perivascular accumulation of amoebic trophozoites, a few cysts, and the infiltration of numerous neutrophils and microglia/macrophages. The trophozoites were ovoid or round, 10-60 μm in diameter, and they showed foamy cytoplasm and a round nucleus with small karyosome in the center. The PCR and immunohistochemistry from paraffin-embedded brain specimens revealed angioinvasive encephalitis due to B. mandrillaris. Human cases of B. mandrillaris brain infection are rare in Japan, with only a few brief reports in the literature. PMID:25186798

  7. Mucosal delivery of ACNPV baculovirus driving expression of the Gal-lectin LC3 fragment confers protection against amoebic liver abscess in hamster.

    PubMed

    Meneses-Ruiz, D M; Laclette, J P; Aguilar-Díaz, H; Hernández-Ruiz, J; Luz-Madrigal, A; Sampieri, A; Vaca, L; Carrero, J C

    2011-01-01

    Mucosal vaccination against amoebiasis using the Gal-lectin of E. histolytica has been proposed as one of the leading strategies for controlling this human disease. However, most mucosal adjuvants used are toxic and the identification of safe delivery systems is necessary. Here, we evaluate the potential of a recombinant Autographa californica baculovirus driving the expression of the LC3 fragment of the Gal-lectin to confer protection against amoebic liver abscess (ALA) in hamsters following oral or nasal immunization. Hamsters immunized by oral route showed complete absence (57.9%) or partial development (21%) of ALA, resulting in some protection in 78.9% of animals when compared with the wild type baculovirus and sham control groups. In contrast, nasal immunization conferred only 21% of protection efficacy. Levels of ALA protection showed lineal correlation with the development of an anti-amoebic cellular immune response evaluated in spleens, but not with the induction of seric IgG anti-amoeba antibodies. These results suggest that baculovirus driving the expression of E. histolytica vaccine candidate antigens is useful for inducing protective cellular and humoral immune responses following oral immunization, and therefore it could be used as a system for mucosal delivery of an anti-amoebic vaccine.

  8. Mucosal Delivery of ACNPV Baculovirus Driving Expression of the Gal-Lectin LC3 Fragment Confers Protection against Amoebic Liver Abscess in Hamster

    PubMed Central

    Meneses-Ruiz, DM; Laclette, JP; Aguilar-Díaz, H; Hernández-Ruiz, J; Luz-Madrigal, A; Sampieri, A; Vaca, L; Carrero, JC

    2011-01-01

    Mucosal vaccination against amoebiasis using the Gal-lectin of E. histolytica has been proposed as one of the leading strategies for controlling this human disease. However, most mucosal adjuvants used are toxic and the identification of safe delivery systems is necessary. Here, we evaluate the potential of a recombinant Autographa californica baculovirus driving the expression of the LC3 fragment of the Gal-lectin to confer protection against amoebic liver abscess (ALA) in hamsters following oral or nasal immunization. Hamsters immunized by oral route showed complete absence (57.9%) or partial development (21%) of ALA, resulting in some protection in 78.9% of animals when compared with the wild type baculovirus and sham control groups. In contrast, nasal immunization conferred only 21% of protection efficacy. Levels of ALA protection showed lineal correlation with the development of an anti-amoebic cellular immune response evaluated in spleens, but not with the induction of seric IgG anti-amoeba antibodies. These results suggest that baculovirus driving the expression of E. histolytica vaccine candidate antigens is useful for inducing protective cellular and humoral immune responses following oral immunization, and therefore it could be used as a system for mucosal delivery of an anti-amoebic vaccine. PMID:22110386

  9. Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids.

    PubMed

    Jorens, Philippe G; Parizel, Paul M; Demey, Hendrik E; Smets, Katrien; Jadoul, Kris; Verbeek, M M; Wevers, R A; Cras, Patrick

    2005-10-01

    Streptococcus pneumoniae is a common cause of bacterial meningitis but only rarely causes other infections such as brain abscess, encephalitis, encephalomyelitis or meningoencephalitis. We report on three adult patients with meningoencephalitis caused by S. pneumoniae. In all three, CT and MRI revealed widespread brain lesions, suggesting extensive parenchymal injury. Diffusion-weighted MRI showed lesions with restricted diffusion, reflecting local areas of ischaemia with cytotoxic oedema secondary to an immunologically mediated necrotising vasculitis and thrombosis. High levels of markers of neuronal, glial and myelin damage were found in the cerebrospinal fluid. According to the literature, brain parenchyma lesions in adults with pneumococcal meningoencephalitis are often associated with death or severe neurological deficit. Our patients were treated with pulse doses of glucocorticoids: this resulted in dramatic clinical improvement and an excellent final neurological recovery.

  10. Tackling infection owing to brain-eating amoeba.

    PubMed

    Baig, Abdul Mannan; Khan, Naveed Ahmed

    2015-02-01

    In view of the devastating nature of primary amoebic meningoencephalitis caused by Naegleria fowleri and the problems associated with diagnostic delays and chemotherapeutic failures, here we propose a noninvasive diagnostic method using the 'reverse transcribrial route device', a novel strategy in the management of this life-threatening infection with a case fatality rate of more than 90%. The proposed rationale should stimulate interest in this emerging infection that almost always proves fatal. PMID:25445746

  11. PCR-Based Diagnosis of Naegleria sp. Infection in Formalin-Fixed and Paraffin-Embedded Brain Sections▿

    PubMed Central

    Schild, Marc; Gianinazzi, Christian; Gottstein, Bruno; Müller, Norbert

    2007-01-01

    We developed a real-time PCR which allowed the highly sensitive detection of Naegleria fowleri in histological brain tissue sections from experimentally infected mice. This genus-specific small-subunit (18S) rRNA gene-based PCR can complement conventional (immuno-) histology for the diagnosis of primary amoebic meningoencephalitis in paraffin-embedded brain necropsy specimens that had been fixed in formalin buffered with phosphate-buffered saline. PMID:17121998

  12. Tackling infection owing to brain-eating amoeba.

    PubMed

    Baig, Abdul Mannan; Khan, Naveed Ahmed

    2015-02-01

    In view of the devastating nature of primary amoebic meningoencephalitis caused by Naegleria fowleri and the problems associated with diagnostic delays and chemotherapeutic failures, here we propose a noninvasive diagnostic method using the 'reverse transcribrial route device', a novel strategy in the management of this life-threatening infection with a case fatality rate of more than 90%. The proposed rationale should stimulate interest in this emerging infection that almost always proves fatal.

  13. A Retrospective Cohort Study of Lesion Distribution of HIV-1 Infection Patients With Cryptococcal Meningoencephalitis on MRI

    PubMed Central

    Xia, Shuang; Li, Xueqin; Shi, Yanbin; Liu, Jinxin; Zhang, Mengjie; Gu, Tenghui; Pan, Shinong; Song, Liucun; Xu, Jinsheng; Sun, Yan; Zhao, Qingxia; Lu, Zhiyan; Lu, Puxuan; Li, Hongjun

    2016-01-01

    Abstract The objective of this paper is to correlate the MRI distribution of cryptococcal meningoencephalitis in HIV-1 infection patients with CD4 T cell count and immune reconstitution effect. A large retrospective cohort study of HIV patients from multi-HIV centers in China was studied to demonstrate the MRI distribution of cryptococcal meningoencephalitis and its correlation with the different immune status. The consecutive clinical and neuroimaging data of 55 HIV-1-infected patients with cryptococcal meningoencephalitis collected at multi-HIV centers in China during the years of 2011 to 2014 was retrospectively analyzed. The enrolled patients were divided into 2 groups based on the distribution of lesions. One group of patients had their lesions at the central brain (group 1, n = 34) and the other group of patients had their lesions at the superficial brain (group 2, n = 21). We explored their MRI characterization of brain. In addition, we also compared their CD4 T cell counts and immune reconstitution effects between the 2 groups based on the imaging findings. No statistical difference was found in terms of age and gender between the 2 groups. The medians of CD4 T cell counts were 11.67 cells/mm3 (3.00–52.00 cells/mm3) in group 1 and 42.00 cells/mm3 (10.00–252.00 cells/mm3) in group 2. Statistical difference of CD4 T cell count was found between the 2 groups (P = 0.023). Thirteen patients in group 1 (13/34) and 12 patients in group 2 (12/21) received highly active antiretroviral treatment (HAART). Patients of group 2 received HAART therapy more frequently than patients of group 1 (P = 0.021). Central and superficial brain lesions detected by MR imaging in HIV-1-infected patients with cryptococcal meningoencephalitis are in correlation with the host immunity and HAART therapy. PMID:26871791

  14. First report of Brucella ceti-associated meningoencephalitis in a long-finned pilot whale Globicephala melas.

    PubMed

    Davison, Nicholas J; Brownlow, Andrew; McGovern, Barry; Dagleish, Mark P; Perrett, Lorraine L; Dale, Emma-Jane; Koylass, Mark; Foster, Geoffrey

    2015-10-27

    Fatal Brucella ceti infection with histological lesions specific to the central nervous system has been described in only 3 species of cetaceans: striped dolphins Stenella coeruleoalba, Atlantic white-sided dolphins Lagenorhynchus acutus and short-beaked common dolphins Delphinus delphis. This paper describes the first report of a B. ceti-associated meningoencephalitis in a long-finned pilot whale Globicephala melas, showing the increasing range of species susceptibility. Brucella was recovered in larger numbers from cerebrospinal fluid than from brain tissue and is the sample of choice for isolation. PMID:26503778

  15. Diagnosis of Listeria monocytogenes Meningoencephalitis by Real-Time PCR for the hly Gene ▿ §

    PubMed Central

    Le Monnier, Alban; Abachin, Eric; Beretti, Jean-Luc; Berche, Patrick; Kayal, Samer

    2011-01-01

    Listeria monocytogenes is a bacterial pathogen that can invade the central nervous system (CNS), causing meningoencephalitis and brain abscesses. The diagnosis of CNS listeriosis, based on the isolation of the bacteria in the cerebrospinal fluid (CSF), can be difficult because of previous antibiotic treatment and a low number of bacteria in the CSF. To improve the sensitivity of microbiological diagnosis, we have developed a real-time PCR assay for detecting and quantifying L. monocytogenes DNA in the CSF. The designed primers specifically amplify the L. monocytogenes hly gene, which encodes listeriolysin O, a pore-forming cytolysin. The PCR assay for the hly gene (PCR-hly) provides reproducible quantitative results over a wide dynamic range of concentrations and was highly sensitive while detecting a single gene copy/ml. By assaying a large panel of bacterial species, including species secreting pore-forming cytolysin, we determined the specificity of the PCR-hly, which exclusively detects the L. monocytogenes DNA. We then analyzed 214 CSF samples from patients suspected of having CNS listeriosis. PCR-hly was positive in all cases in which L. monocytogenes was isolated by culture. Positive PCR-hly of the CSF was also obtained for five additional, clinically confirmed cases of CNS listeriosis for which bacterial cultures were negative presumably due to previous treatment with antibiotics. As a complement to classical bacteriological CSF culture, our designed real-time PCR-hly assay proved to be valuable by enhancing the rapidity and the accuracy of the diagnosis of CNS infection by L. monocytogenes. In addition, the quantitative results provided may, in some instances, be useful for the follow-up of patients under treatment. PMID:21918022

  16. Cytokine mRNA profiles in mononuclear cells in acute aseptic meningoencephalitis.

    PubMed Central

    Navikas, V; Haglund, M; Link, J; He, B; Lindqvist, L; Fredrikson, S; Link, H

    1995-01-01

    Cytokines are important modulators of inflammation and immune responses. Using in situ hybridization with radiolabelled cDNA oligonucleotide probes, we studied the expression of mRNA encoding the cytokines gamma interferon (IFN-gamma), interleukin 4 (IL-4), IL-6, IL-10, transforming growth factor beta (TGF-beta), tumor necrosis factor alpha (TNF-alpha), lymphotoxin, and perforin in mononuclear cells (MNC) from blood and cerebrospinal fluid (CSF) of patients with acute aseptic meningoencephalitis (AM) and from blood of healthy controls. Patients in the acute phase of AM had elevated numbers of IFN-gamma mRNA-expressing cells in the blood compared with that of controls and higher numbers of IFN-gamma mRNA-expressing cells in their CSF compared with that of convalescent-phase patients, which is in accordance with the antiviral effects of this cytokine. Upregulation of IL-4, IL-6, and IL-10 was found in convalescent-phase patients, which is consistent with the longstanding B-cell response found in AM. TGF-beta and perforin were upregulated in both stages of AM, while the numbers of blood and CSF MNC expressing cytokine mRNA of the TNF family (TNF-alpha and lymphotoxin) did not differ between patients with AM and controls. An even higher elevation in CSF was noticed for MNC expressing most of the cytokines, particularly IL-4 and TGF-beta, reflecting the autonomy of the immune response in the CSF. The definition of cytokine profiles in AM, a self-limiting and benign disease, provides a foundation for future comparisons with other infectious and inflammatory nervous system diseases. PMID:7890425

  17. In vivo programmed cell death of Entamoeba histolytica trophozoites in a hamster model of amoebic liver abscess.

    PubMed

    Villalba-Magdaleno, José D'Artagnan; Pérez-Ishiwara, Guillermo; Serrano-Luna, Jesús; Tsutsumi, Víctor; Shibayama, Mineko

    2011-05-01

    Entamoeba histolytica trophozoites can induce host cell apoptosis, which correlates with the virulence of the parasite. This phenomenon has been seen during the resolution of an inflammatory response and the survival of the parasites. Other studies have shown that E. histolytica trophozoites undergo programmed cell death (PCD) in vitro, but how this process occurs within the mammalian host cell remains unclear. Here, we studied the PCD of E. histolytica trophozoites as part of an in vivo event related to the inflammatory reaction and the host-parasite interaction. Morphological study of amoebic liver abscesses showed only a few E. histolytica trophozoites with peroxidase-positive nuclei identified by terminal deoxynucleotidyltransferase enzyme-mediated dUTP nick end labelling (TUNEL). To better understand PCD following the interaction between amoebae and inflammatory cells, we designed a novel in vivo model using a dialysis bag containing E. histolytica trophozoites, which was surgically placed inside the peritoneal cavity of a hamster and left to interact with the host's exudate components. Amoebae collected from bags were then examined by TUNEL assay, fluorescence-activated cell sorting (FACS) and transmission electron microscopy. Nuclear condensation and DNA fragmentation of E. histolytica trophozoites were observed after exposure to peritoneal exudates, which were mainly composed of neutrophils and macrophages. Our results suggest that production of nitric oxide by inflammatory cells could be involved in PCD of trophozoites. In this modified in vivo system, PCD appears to play a prominent role in the host-parasite interaction and parasite cell death.

  18. Amoebicidal Activity of Essential Oil of Dysphania ambrosioides (L.) Mosyakin & Clemants in an Amoebic Liver Abscess Hamster Model

    PubMed Central

    Ávila-Blanco, Manuel Enrique; Rodríguez, Martín Gerardo; Moreno Duque, José Luis; Muñoz-Ortega, Martin; Ventura-Juárez, Javier

    2014-01-01

    Amebiasis is a parasitic disease that extends worldwide and is a public health problem in developing countries. Metronidazole is the drug recommended in the treatment of amebiasis, but its contralateral effects and lack of continuity of treatment induce low efficiency, coupled with the appearance of resistant amoebic strains. Therefore, the search of new compounds with amoebicidal activity is urgent and important. In this study, we evaluated the in vitro and in vivo antiamoebic activity of the essential oil Dysphania ambrosioides (L.) Mosyakin & Clemants. It exhibited an IC50 = 0.7 mg/mL against trophozoites. The oral administration of essential oil (8 mg/kg and 80 mg/kg) to hamster infected with Entamoeba histolytica reverted the infection. Ascaridole was identified as the main component of essential oil of D. ambrosioides. The identification of amoebicidal activity of Ascaridole gives support to the traditional use. Further studies with Ascaridole will be carried out to understand the mechanism involved. PMID:24757495

  19. Characterization of a New Pathogenic Acanthamoeba Species, A. byersi n. sp., Isolated from a Human with Fatal Amoebic Encephalitis

    PubMed Central

    Qvarnstrom, Yvonne; Nerad, Thomas A.; Visvesvara, Govinda S.

    2015-01-01

    Acanthamoeba spp. are free-living amoebae that are ubiquitous in natural environments. They can cause cutaneous, nasopharyngeal and disseminated infection, leading to granulomatous amebic encephalitis (GAE) in immunocompromised individuals. In addition, they can cause amoebic keratitis in contact lens wearers. Acanthamoeba GAE is almost always fatal because of difficulty and delay in diagnosis and lack of optimal antimicrobial therapy. Here we report the description of an unusual strain isolated from skin and brain of a GAE patient. The amoebae displayed large trophozoites and star-shaped cysts, characteristics for acanthamoebas belonging to morphology Group 1. However, its unique morphology and growth characteristics differentiated this new strain from other Group 1 species. DNA sequence analysis, secondary structure prediction and phylogenetic analysis of the 18S rRNA gene confirmed that this new strain belonged to Group 1 but that it was distinct from the other sequence types within that group. Thus, we hereby propose the establishment of a new species, Acanthamoeba byersi n. sp. as well as a new sequence type, T18, for this new strain. To our knowledge, this is the first report of a Group 1 Acanthamoeba that is indisputably pathogenic in humans. PMID:23879685

  20. Naeglaeria infection of the central nervous system, CT scan findings: a case series.

    PubMed

    Naqi, Rohana; Azeemuddin, Muhammad

    2013-03-01

    The imaging findings in four cases of a rare infection of the central nervous system caused by amoebae, Naeglaeria fowleri are presented. Naeglaeria fowleri are pathogenic free-living amoebae. They cause primary amoebic meningoencephalitis (PAM), a rapidly fatal disease of the central nervous system. The computed tomography brain findings in 3 (75%) of our cases of pan amoebic meningoencephalitis showed non-specific brain oedema; 2 (66%) of these cases also had moderate hydrocephalus and among that 1 (50%) case showed an old lacunar infarction in peri-ventricular region. In the remaining 1 (25%) case the scan was normal with no evidence of oedema or abnormal lesion. Out of three cases with diffuse brain oedema, postcontrast images showed abnormal meningeal enhancement throughout the brain parenchyma in 1 (33%) case. However, no definite focal enhancing lesion was noted. In the rest of the cases, no abnormal parenchymal or meningeal enhancement was seen on post-contrast images. PMID:23914650

  1. Acute lead poisoning with eosinophilic meningoencephalitis in calves on a farm receiving land application of sewage sludge

    SciTech Connect

    Dorn, C.R.; Tuomari, D.; Reddy, C.; Logan, T.J.

    1986-03-01

    A total of 3 cases of acute lead poisoning in calves was confirmed by atomic absorption spectrophotometric analysis of biological samples, presence of an acute lead exposure source, clinical signs of impaired vision in one case and eosinophilic meningoencephalitis in another case. One of two other calves which died approximately 2 months earlier had nervous signs and it is likely that they also had lead poisoning. Dams of two of the cases did not have elevated lead levels. Municipal sewage sludge had been applied to most fields on the farm during the preceding 5 year period. There had been approximately a doubling of the lead content in the soil; however, the foodstuffs produced on the farm had low lead concentrations. The extremely high lead levels in the abomasal contents and feces of calves eliminated sludge as the source of the lead in this acute poisoning episode. The contents of oil filters, accessible to calves but not to adult cattle, had lead levels as high as 26,922 micrograms/g and was the most likely lead source responsible for this lead intoxication. It appears that the manifestation of eosinophilic meningoencephalitis in lead poisoning cases may occur in young calves as well as in cows and in acute as well as in chronic intoxications.

  2. [The effect of silica on the development of experimental Acanthamoeba meningoencephalitis with reference to the macrophage role in mice].

    PubMed

    Lee, H S; Shin, H J; La, M S; Im, K

    1994-12-01

    The role of macrophages was observed in intranasally infected C3H/HeJ mice with trophozoites (3 x 10(5)) of Acanthamoeba culbertsoni which was a kind of free-living amoebae inducing meningoencephalitis in human and experimental animals. The mortality was 60% in the group of intraperitoneally injected mice with silica (0.5 mg/0.5 ml). It was much higher than that of 10% in the group of amoeba infected mice without silica administration. The phagocytic index of peritoneal macrophages co-cultured with Toxoplasma gondii was estimated daily. In contrast to the control and amoeba infected group which didn't show significant fluctuation of the phagocytic indices, the silica administrated group revealed under 3% until day 3, and gradual increase up to 24.7% in day 5 which was same level of amoeba infected group without silica administration. The level of interleukin-1b (IL-1b) measured by ELISA was the highest in the amoeba infected group without silica injection and the lowest in the amoeba infected group with silica administration. In the test of the amoebicidal activity of mice peritoneal macrophages in vitro, silica administration revealed reducing effect on amoebicidal activity of macrophages. In conclusion, macrophages were proven to play a significant role in defense mechanism against the development of experimentally induced Acanthamoeba meningoencephalitis. PMID:7834243

  3. sICAM-1 intrathecal synthesis and release during the acute phase in children suffering from Coxsackie A9 and S. pneumoniae meningoencephalitis.

    PubMed

    Dorta-Contreras, Alberto J; Lewczuk, Piotr; Padilla-Docal, Bárbara; Noris-García, Elena; Coifiu-Fanego, Raisa Bu; Sánchez-Martínez, Consuelo; Rodríguez-Rey, Alexis; González-Hernández, Marlén

    2008-09-01

    The intercellular adhesion molecule is a transmembrane glycoprotein belonging to the immunoglobulin superfamily. Serum and cerebrospinal fluid (CSF) soluble intercellular adhesion molecule 1 (sICAM-1) from normal control children as well as from children with Guillain-Barré syndrome (GBS), with Coxsackie A9 virus meningoencephalitis and with Streptococcus pneumoniae meningoencephalitis were studied. sICAM-1 was quantified using an immunoenzimatic assay and albumin using the immunodiffusion technique in both biological fluids. Increased sICAM-1 values in CSF in patients with GBS correspond to an increase of the albumin CSF/serum quotient. In contrast, in inflammatory diseases like S. pneumoniae and Coxsackie A9 virus meningoencephalitis an increased brain-derived fraction was observed. In particular cases these values are 60-65% and 70-75% respectively. The results indicate an additional synthesis of sICAM-1 in subarachnoidal space during central nervous system (CNS) inflammatory process. An important role of sICAM-1 in the transmigration of different cell types into CSF during CNS inflammation in children with S. pneumoniae and Coxsackie A9 meningoencephalitis may be suggested.

  4. Inherited CARD9 deficiency in otherwise healthy children and adults with meningo-encephalitis and/or colitis caused by Candida

    PubMed Central

    Lanternier, Fanny; Mahdaviani, Seyed Alireza; Barbati, Elisa; Chaussade, Hélène; Koumar, Yatrika; Levy, Romain; Denis, Blandine; Brunel, Anne-Sophie; Martin, Sophie; Loop, Michèle; Peeters, Julie; de Selys, Ariel; Vanclaire, Jean; Vermylen, Christiane; Nassogne, Marie-Cécile; Chatzis, Olga; Liu, Luyan; Migaud, Mélanie; Pedergnana, Vincent; Desoubeaux, Guillaume; Jouvion, Gregory; Chretien, Fabrice; Darazam, Ilad Alavi; Schäffer, Alejandro A.; Netea, Mihai G.; De Bruycker, Jean-Jacques; Bernard, Louis; Reynes, Jacques; Amazrine, Noureddine; Abel, Laurent; Van der Linden, Dimitri; Harrison, Tom; Picard, Capucine; Lortholary, Olivier; Mansouri, Davood; Casanova, Jean-Laurent; Puel, Anne

    2016-01-01

    Invasive infections of the central nervous system or digestive tract caused by commensal fungi of the genus Candida are rare and life-threatening. The known risk factors include acquired and inherited immunodeficiencies, with patients often displaying a history of multiple infections. Cases of meningo-encephalitis and/or colitis caused by Candida remain unexplained. We studied five previously healthy children and adults with unexplained invasive disease of the central nervous system, or the digestive tract, or both, caused by Candida spp. The patients were aged 39, 7, 17 37, and 26 years at the time of infection and were unrelated but each born to consanguineous parents of Turkish (two patients), Iranian, Moroccan or Pakistani origin. Meningo-encephalitis was isolated in three patients, associated with colitis in a fourth patient, and the fifth patient suffered from isolated colitis. Inherited CARD9 deficiency was recently reported in otherwise healthy patients with other forms of severe disease caused by Candida, Trichophyton, Phialophora, and Exophiala, including meningo-encephalitis, but not colitis, caused by Candida and Exophiala. We therefore sequenced CARD9 in the five patients. All were found to be homozygous for rare and deleterious mutant CARD9 alleles: R70W and Q289* for the three patients with isolated C. albicans meningo-encephalitis, R35Q for the patient with meningo-encephalitis and colitis caused by C. glabrata, and Q295* for the patient with C. albicans colitis. Regardless of their levels of mutant CARD9 protein, the patients’ monocyte-derived dendritic cells responded poorly to CARD9-dependent fungal agonists (curdlan, heat-killed C. albicans, Saccharomyces cerevisiae and Exophiala dermatitidis). Invasive infections of the CNS or digestive tract caused by Candida in previously healthy children and even adults may be caused by inherited CARD9 deficiency. PMID:25702837

  5. Differentially expressed proteins in gill and skin mucus of Atlantic salmon (Salmo salar) affected by amoebic gill disease.

    PubMed

    Valdenegro-Vega, Victoria A; Crosbie, Phil; Bridle, Andrew; Leef, Melanie; Wilson, Richard; Nowak, Barbara F

    2014-09-01

    The external surfaces of fish, such as gill and skin, are covered by mucus, which forms a thin interface between the organism and water. Amoebic gill disease (AGD) is a parasitic condition caused by Neoparamoeba perurans that affects salmonids worldwide. This disease induces excessive mucus production in the gills. The host immune response to AGD is not fully understood, and research tools such as genomics and proteomics could be useful in providing further insight. Gill and skin mucus samples were obtained from Atlantic salmon (Salmo salar) which were infected with N. perurans on four successive occasions. NanoLC tandem mass spectrometry (MS/MS) was used to identify proteins in gill and skin mucus of Atlantic salmon affected by AGD. A total of 186 and 322 non-redundant proteins were identified in gill and skin mucus respectively, based on stringent filtration criteria, and statistics demonstrated that 52 gill and 42 skin mucus proteins were differentially expressed in mucus samples from AGD-affected fish. By generating protein-protein interaction networks, some of these proteins formed part of cell to cell signalling and inflammation pathways, such as C-reactive protein, apolipoprotein 1, granulin, cathepsin, angiogenin-1. In addition to proteins that were entirely novel in the context in the host response to N. perurans, our results have confirmed the presence of protein markers in mucus that have been previously predicted on the basis of modified mRNA expression, such as anterior gradient-2 protein, annexin A-1 and complement C3 factor. This first proteomic analysis of AGD-affected salmon provides new information on the effect of AGD on protein composition of gill and skin mucus. Future research should focus on better understanding of the role these components play in the response against infection with N. perurans. PMID:24979223

  6. Differentially expressed proteins in gill and skin mucus of Atlantic salmon (Salmo salar) affected by amoebic gill disease.

    PubMed

    Valdenegro-Vega, Victoria A; Crosbie, Phil; Bridle, Andrew; Leef, Melanie; Wilson, Richard; Nowak, Barbara F

    2014-09-01

    The external surfaces of fish, such as gill and skin, are covered by mucus, which forms a thin interface between the organism and water. Amoebic gill disease (AGD) is a parasitic condition caused by Neoparamoeba perurans that affects salmonids worldwide. This disease induces excessive mucus production in the gills. The host immune response to AGD is not fully understood, and research tools such as genomics and proteomics could be useful in providing further insight. Gill and skin mucus samples were obtained from Atlantic salmon (Salmo salar) which were infected with N. perurans on four successive occasions. NanoLC tandem mass spectrometry (MS/MS) was used to identify proteins in gill and skin mucus of Atlantic salmon affected by AGD. A total of 186 and 322 non-redundant proteins were identified in gill and skin mucus respectively, based on stringent filtration criteria, and statistics demonstrated that 52 gill and 42 skin mucus proteins were differentially expressed in mucus samples from AGD-affected fish. By generating protein-protein interaction networks, some of these proteins formed part of cell to cell signalling and inflammation pathways, such as C-reactive protein, apolipoprotein 1, granulin, cathepsin, angiogenin-1. In addition to proteins that were entirely novel in the context in the host response to N. perurans, our results have confirmed the presence of protein markers in mucus that have been previously predicted on the basis of modified mRNA expression, such as anterior gradient-2 protein, annexin A-1 and complement C3 factor. This first proteomic analysis of AGD-affected salmon provides new information on the effect of AGD on protein composition of gill and skin mucus. Future research should focus on better understanding of the role these components play in the response against infection with N. perurans.

  7. Burden of major diarrheagenic protozoan parasitic co-infection among amoebic dysentery cases from North East India: a case report.

    PubMed

    Nath, Joyobrato; Hussain, Gulzar; Singha, Baby; Paul, Jaishree; Ghosh, Sankar Kumar

    2015-09-01

    Intestinal diarrheagenic polyparasitic infections are among the major public health concerns in developing countries. Here we examined stool specimens by microscopy, DNA dot blot and polymerase chain reaction (PCR) to evaluate the co-infection of four principal protozoans among amoebic dysentery cases from Northeast Indian population. The multiplex PCR confirmed Entamoeba histolytica (8.1%), Entamoeba dispar (4.8%) and mixed infection of both the parasites (3.4%) in 68 of 356 stool specimens that were positive in microscopy and/or HMe probe based DNA dot blot screening. The prevailing parasite that co-exists with E. histolytica was Giardia duodenalis (34.1%), followed by Enterocytozoon bieneusi (22.0%), Cryptosporidium parvum (14.6%) and Cyclospora cayetanensis (7.3%, P = 0.017). Symptomatic participants (odds ratio (OR) = 4.07; 95% confidence interval (CI) = 1.06, 15.68; P = 0.041), monsoon season (OR = 7.47; 95% CI = 1.40, 39.84; P = 0.046) and participants with family history of parasitic infection (OR = 4.50; 95% CI = 1.16, 17.51; P = 0.030) have significant association with overall co-infection rate. According to molecular consensus, comprehensive microscopy yielded 3.4% (12/356) false-negative and 7.6% (27/356) false-positive outcome, suggesting an improved broad-spectrum PCR-based diagnostic is required to scale down the poor sensitivity and specificity as well as implementation of integrated control strategy.

  8. Sequential pathology after initial freshwater bath treatment for amoebic gill disease in cultured Atlantic salmon, Salmo salar L.

    PubMed

    Adams, M B; Nowak, B F

    2004-03-01

    Freshwater bathing is essential for control of amoebic gill disease (AGD) during the marine phase of the Tasmanian Atlantic salmon production cycle, a practice that is costly, production limiting and increasing in frequency. Although the pathogenesis of gill infection with Neoparamoeba sp. in naïve Atlantic salmon, Salmo salar, is now understood, the progression of re-infection (post-treatment) required elucidation. Here, we describe the weekly histopathological progression of AGD from first to second freshwater bath. Halocline cessation and increased water temperature appeared to drive the rapid onset of initial infection prior to bathing. Freshwater bathing cleared lesions of attached trophozoites and associated cellular debris. Subsequent gill re-infection with Neoparamoeba sp. was evident at 2 weeks post-bath and had significantly increased (P < 0.001), in severity by 4 weeks post-bath. No significant difference in gross pathology was observed until 4 weeks post-bath (P < 0.05). The re-infective progression of AGD was characterized by localized host tissue responses juxtaposed to adhered trophozoites (epithelial oedema, hypertrophy and hyperplasia), non-specific inflammatory cell infiltration (macrophages, neutrophils and eosinophilic granule cells) and finally advanced hyperplasia with epithelial fortification. During the post-bath period, non-AGD lesions including haemorrhage, necrosis and regenerative hyperplasia were occasionally observed, although no evidence of secondary colonization of these lesions by Neoparamoeba sp. was noted. We conclude that pathogenesis during the inter-bath period was identical to initial infection although the source of re-infection remains to be established. PMID:15009242

  9. [Parasitic amoebae and amoebo-flagellates from the Lobosea and heterolobosea classes].

    PubMed

    Sopinina, V A

    1998-01-01

    Different cited evidences on parasitic amoebae and amoebo-flagellates belonging to the Lobosea and Heterolobosea classes (Pages, 1987) have been reviewed. Special attention is paid to various degree of their adaptation to parasitic mode of life, which ranges from a parasitism on a border with commensalism to true parasitism (both facultative and obligatory ones). Besides the coprophilous and commensal species, the number of true parasites among the Lobosea and Heterolobosea classes is comparatively small. In many cases, both facultative and obligatory parasites cause the death of their hosts. Apparently this strongly pronounced pathogenicity of parasitic amoebae and amoebo-flagellates suggest a recent origin of such parasite-host systems. Pathogens of amoebic dysentry, primary amoebic meningoencephalitis and granulomatous amoebic encephalitis are specially considered. In the Russian text-books on a parasitology the information on most of them, except Entamoeba hystolytica, is either totally absent or very scare and out of date. PMID:9813884

  10. Meningoencephalitis with secondary obstructive hydrocephalus caused by probable coccidioides species in a buff-cheeked gibbon (Nomascus gabriellae).

    PubMed

    Goe, Alexandra; Swenson, Julie; West, Gary; Evans, Jason

    2013-09-01

    An 8-yr-old male buff-cheeked gibbon (Nomascus gabriellae) acutely developed abnormal behavior, decreased appetite, and dull mentation. Mild generalized muscle wasting and weight loss were the only other abnormalities noted on examination. Routine immunodiffusion serology for Coccidioides spp. were IgG and IgM positive. Magnetic resonance imaging of the brain was suggestive of an infectious meningoencephalitis with secondary obstructive hydrocephalus. A ventriculoperitoneal shunt was placed in standard fashion to reduce the imminent risk of mortality from increased intracranial pressure. Postoperative treatment included oral fluconazole, a tapered course of prednisolone, and physical therapy. Clinical signs improved steadily and the gibbon was fit to return to exhibit 8 wk post-shunt placement. This case of coccidioidomycosis demonstrates the complications that can occur with dissemination to the central nervous system and its management. It is the first published report describing the use of ventriculoperitoneal shunt placement in this species.

  11. CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA.

    PubMed

    Buccheri, Renata; Kassab, Maria José; Freitas, Vera Lucia Teixeira de; Silva, Sheila Cristina Vicente da; Bezerra, Rita C; Khoury, Zarifa; Shikanai-Yasuda, Maria Aparecida; Vidal, José E

    2015-12-01

    The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease. PMID:27049711

  12. CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

    PubMed Central

    BUCCHERI, Renata; KASSAB, Maria José; de FREITAS, Vera Lucia Teixeira; da SILVA, Sheila Cristina Vicente; BEZERRA, Rita C.; KHOURY, Zarifa; SHIKANAI-YASUDA, Maria Aparecida; VIDAL, José E.

    2015-01-01

    The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease. PMID:27049711

  13. Pharmacodynamics of Liposomal Amphotericin B and Flucytosine for Cryptococcal Meningoencephalitis: Safe and Effective Regimens for Immunocompromised Patients

    PubMed Central

    O'Connor, Lucy; Livermore, Joanne; Sharp, Andrew D.; Goodwin, Joanne; Gregson, Lea; Howard, Susan J.; Felton, Timothy W.; Schwartz, Julie A.; Neely, Michael N.; Harrison, Thomas S.; Perfect, John R.; Hope, William W.

    2013-01-01

    Background. Cryptococcal meningoencephalitis is a lethal infection with relatively few therapeutic options. The optimal dosage of liposomal amphotericin B (LAmB) alone or in combination with flucytosine is not known. Methods. A murine model of cryptococcal meningoencephalitis was used. The fungal density in the brain was determined using quantitative cultures. Pharmacokinetic–pharmacodynamic relationships were determined for LAmB and flucytosine administered alone. The effect of the combination was described using the Greco model and a mathematical model. The results were bridged to humans. Results. Inoculation resulted in hematogenous dissemination and logarithmic growth within the central nervous system. There was histological evidence of multifocal infection throughout the brain. Both LAmB and flucytosine produced a dose-dependent reduction in fungal burden. The effect of the combination of agents in the brain was additive. Bridging studies suggested that a human dosage of LAmB 3 mg/kg/d resulted in a submaximal antifungal effect. Regimens of LAmB 6 mg/kg/d alone, LAmB 3 mg/kg/d plus flucytosine 50 mg/kg/d, and LAmB 3 mg/kg/d plus flucytosine 100 mg/kg/d all resulted in near-maximal antifungal activity. Conclusions. Potential regimens for further study in clinical trials include LAmB 6 mg/kg/d alone, LAmB 3 mg/kg/d plus flucytosine 50 mg/kg/d, and LAmB 3 mg/kg/d plus flucytosine 100 mg/kg/d. PMID:23599314

  14. Suppurative otitis and ascending meningoencephalitis associated with Bacteroides tectus and Porphyromonas gulae in a captive Parma wallaby (Macropus parma) with toxoplasmosis.

    PubMed

    Giannitti, Federico; Schapira, Andrea; Anderson, Mark; Clothier, Kristin

    2014-09-01

    A 6-year-old female Parma wallaby (Macropus parma) at a zoo in California developed acute ataxia and left-sided circling. Despite intensive care, clinical signs progressed to incoordination and prostration, and the animal was euthanized. At necropsy, the left tympanic cavity was filled with homogeneous suppurative exudate that extended into the cranium expanding the meninges and neuroparenchyma in the lateral and ventral aspect of the caudal ipsilateral brainstem and medulla oblongata. Microscopically, the brainstem showed regional severe suppurative meningoencephalitis with large numbers of neutrophils, fewer macrophages, and lymphocytes admixed with fibrin, necrotic cellular debris, hemorrhage, and mineralization, with numerous intralesional Gram-negative bacilli. Bacteroides spp. and Porphyromonas spp. were isolated on anaerobic culture from the meninges, and the bacteria were further characterized by partial 16S ribosomal RNA gene sequencing as Bacteroides tectus and Porphyromonas gulae. Bacterial aerobic culture from the meninges yielded very low numbers of mixed flora and Proteus spp., which were considered contaminants. Culture of Mycoplasma spp. from middle ear and meninges was negative. Additionally, Toxoplasma gondii cysts were detected by immunohistochemistry in the heart and brain, and anti-Toxoplasma antibodies were detected in serum. The genera Bacteroides and Porphyromonas have been associated with oral disease in marsupials; but not with otitis and meningoencephalitis. The results of the present work highlight the importance of performing anaerobic cultures in the diagnostic investigation of cases of suppurative otitis and meningoencephalitis in macropods. PMID:25057163

  15. Endogenous amoebic endophthalmitis.

    PubMed

    Matsuo, T; Notohara, K; Shiraga, F; Yumiyama, S

    2001-01-01

    A 42-year-old man experienced abrupt reduction of vision in the left eye and had vitreous opacity and hypopyon on initial examination. He underwent an emergency vitrectomy and phacoemulsification with posterior capsulectomy, followed by a 2-week course of intravenous fluconazole and antibiotics. The final visual acuity was 20/20 OS. Amoebas, together with polymorphonuclear cells, were observed on examination of specimens of the aqueous humor and vitreous fluid obtained during the surgery. Staphylococcus epidermidis was also cultured from the vitreous fluid. The amoebas had a crescent-shaped periphery of the cytoplasm and ambiguous nuclei. Ultrastructurally, the cytoplasm was surrounded by a thick electron-dense coating. The early vitrectomy and combined use of antibiotics and antifungals might have led to the good visual outcome in this patient. PMID:11146738

  16. Primary varicella infection presenting with headache and elevated intracranial pressure.

    PubMed

    Gilad, Oded; Shefer-Averbuch, Noa; Garty, Ben Zion

    2015-05-01

    Primary varicella infection may be associated with neurologic complications, such as cerebritis and meningoencephalitis. Several cases of varicella infection with elevated intracranial pressure have been reported. We describe a 13-year-old immunocompetent girl who presented with a clinical picture of headaches and elevated intracranial pressure as the only manifestation of primary varicella zoster infection. The working diagnosis at first was pseudotumor cerebri based on complaints of headache of 2 weeks' duration, in addition to vomiting and papilledema, without fever or skin eruption. On lumbar puncture, opening pressure was 420 mmH2O, but mild pleocytosis and mildly elevated protein level ruled out the diagnosis of pseudotumor cerebri. Our patient had no history of previous varicella infection, and she did not receive the varicella zoster vaccine. Serology tests, done on admission and repeated 2 months later, suggested primary varicella infection. The literature on varicella infection associated with pseudotumor cerebri or elevated intracranial pressure is reviewed.

  17. Isolation of pure compound R/J/3 from Pluchea indica (L.) Less. and its anti-amoebic activities against Entamoeba histolytica.

    PubMed

    Biswas, Ria; Dutta, P K; Achari, B; Bandyopadhyay, Durba; Mishra, Moumita; Pramanik, K C; Chatterjee, T K

    2007-08-01

    The plant Pluchea indica is known for its anti-inflammatory, anti-ulcer, anti-pyretic, hypoglycemic, diuretic and anti-microbial activities besides many other pharmacological activities. We have isolated and purified seven compounds from the methanolic root extract of this plant by column chromatography. The compounds were identified by spectroscopic analyses. The anti-amoebic activities of the pure compound R/J/3 was investigated against the HM1 strain of Entamoeba histolytica. The compound, R/J/3 showed the most pronounced anti-proliferative activity at a dose of 50 microg/ml. It also showed a marked activity on cell lysis of trophozoites, 4h after administration. The cell lytic activity was compared with metronidazole (5 microg/ml) as positive control. PMID:17174538

  18. Lymphadenopathy and non-suppurative meningo-encephalitis in calves experimentally infected with bovine immunodeficiency-like virus (FL112).

    PubMed

    Munro, R; Lysons, R; Venables, C; Horigan, M; Jeffrey, M; Dawson, M

    1998-08-01

    In an experiment on bovine immunodeficiency-like virus (BIV), the virological and serological aspects of which were reported in an earlier paper, three groups (A, B and C) of three calves were inoculated subcutaneously with a recently isolated strain (FL112). For group B and group C, the virus was suspended in milk, and for group C (controls) the viral suspension was subjected to pasteurization before inoculation. The calves were killed for necropsy 12 months later. Clinical assessment revealed subtle ataxia in two group A calves, which took the form of an intermittent "shifting" (from one leg to another) lameness, and palpable enlargement of the pre-scapular lymph nodes in one group B animal. At necropsy, haemal lymph nodes (0.1 to 0.5 cm in diameter), occurring singly, were observed in all animals. However, in groups A and B (but not C), enlarged haemal lymph nodes (< or = 2 cm in diameter) were also seen, occurring singly and in chains; and in one group A animal they occurred in grape-like clusters. In groups A and B (but not C), histopathological examination revealed generalized hyperplastic changes in lymph nodes, especially the haemal lymph nodes. This finding was particularly striking in the two clinically ataxic animals from group A, which also showed a non-suppurative meningo-encephalitis; the latter was possibly the cause of the subtle clinical signs. This study supports previous findings on lymphadenopathy resulting from experimental infection with BIV. PMID:9749357

  19. Necrotizing meningoencephalitis of Pug dogs associates with dog leukocyte antigen class II and resembles acute variant forms of multiple sclerosis.

    PubMed

    Greer, K A; Wong, A K; Liu, H; Famula, T R; Pedersen, N C; Ruhe, A; Wallace, M; Neff, M W

    2010-08-01

    Necrotizing meningoencephalitis (NME) is a disorder of Pug Dogs that appears to have an immune etiology and high heritability based on population studies. The present study was undertaken to identify a genetic basis for the disease. A genome-wide association scan with single tandem repeat (STR) markers showed a single strong association near the dog leukocyte antigen (DLA) complex on CFA12. Fine resolution mapping with 27 STR markers on CFA12 further narrowed association to the region containing DLA-DRB1, -DQA1 and, -DQB1 genes. Sequencing confirmed that affected dogs were more likely to be homozygous for specific alleles at each locus and that these alleles were linked, forming a single high risk haplotype. The strong DLA class II association of NME in Pug Dogs resembles that of human multiple sclerosis (MS). Like MS, NME appears to have an autoimmune basis, involves genetic and nongenetic factors, has a relatively low incidence, is more frequent in females than males, and is associated with a vascularly orientated nonsuppurative inflammation. However, NME of Pug Dogs is more aggressive in disease course than classical human MS, appears to be relatively earlier in onset, and involves necrosis rather than demyelination as the central pathobiologic feature. Thus, Pug Dog encephalitis (PDE) shares clinical features with the less common acute variant forms of MS. Accordingly, NME of Pug Dogs may represent a naturally occurring canine model of certain idiopathic inflammatory disorders of the human central nervous system.

  20. A multiplex quantitative real-time polymerase chain reaction panel for detecting neurologic pathogens in dogs with meningoencephalitis.

    PubMed

    Han, Jae-Ik; Chang, Dong-Woo; Na, Ki-Jeong

    2015-01-01

    Meningoencephalitis (ME) is a common inflammatory disorder of the central nervous system in dogs. Clinically, ME has both infectious and non-infectious causes. In the present study, a multiplex quantitative real-time polymerase chain reaction (mqPCR) panel was optimized for the detection of eight canine neurologic pathogens (Blastomyces dermatitidis, Cryptococcus spp., Neospora caninum, Borrelia burgdorferi, Bartonella spp., Toxoplasma gondii, Ehrlichia canis, and canine distemper virus [CDV]). The mqPCR panel was subsequently applied to 53 cerebrospinal fluid (CSF) samples collected from dogs with ME. The analytic sensitivity (i.e., limit of detection, expressed as molecules per 1 mL of recombinant vector) was 3.8 for CDV, 3.7 for Ehrlichia canis, 3.7 for Bartonella spp., 3.8 for Borrelia burgdorferi, 3.7 for Blastomyces dermatitidis, 3.7 for Cryptococcus spp., 38 for Neospora caninum, and 3.7 for Toxoplasma gondii. Among the tested CSF samples, seven (15%) were positive for the following pathogens in decreasing order of frequency: Cryptococcus spp. (3/7), Blastomyces dermatitidis (2/7), and Borrelia burgdorferi (2/7). In summary, use of an mqPCR panel with high analytic sensitivity as an initial screen for infectious agents in dogs with ME could facilitate the selection of early treatment strategies and improve outcomes. PMID:26040611

  1. A fatal case of meningoencephalitis due to a free-living amoeba of uncertain identity--probably acanthamoeba sp.

    PubMed

    Carter, R F; Cullity, G J; Ojeda, V J; Silberstein, P; Willaert, E

    1981-01-01

    There are 2 main types of meningoencephalitis caused by free-living amoebae. The first is a well-defined acutely fatal disease resembling fulminating bacterial meningitis. It is caused by the single species Naegleria fowleri. The second is a more poorly defined disease that runs a subacute or chronic course and is characterized by focal granulomatous lesions in the brain. The causative organisms are probably Acanthamoeba sp. in most cases, but it is possible that other genera may be involved. The first case of the subacute form of the disease to be recognized in Australia is described. A 2 1/2-yr-old, previously well girl presented with ataxia and lower motor neurone paralyses. The cerebrospinal fluid was pleocytic and she was thought to be suffering from a relatively minor viral brain-stem encephalitis. Her symptoms persisted in a peculiarly fluctuating way for 30 d when she suddenly collapsed and died from an intracranial haemorrhage. Necropsy showed focal granulomatous lesions associated with necrotizing vasculitis in the basal regions of the brain. The lesions contained well preserved free-living amoebae which were morphologically different from N. fowleri and most closely resembled Acanthamoeba sp. The ultrastructure of the organisms was particularly well preserved and is described in some detail. Immunohistological studies also excluded N. fowleri but were inconclusive for Acanthamoeba or other genera of free-living amoebae. Difficulties with the diagnosis and treatment of this disease are discussed and some practical suggestions are made. PMID:6261208

  2. A multiplex quantitative real-time polymerase chain reaction panel for detecting neurologic pathogens in dogs with meningoencephalitis

    PubMed Central

    Han, Jae-Ik; Chang, Dong-Woo

    2015-01-01

    Meningoencephalitis (ME) is a common inflammatory disorder of the central nervous system in dogs. Clinically, ME has both infectious and non-infectious causes. In the present study, a multiplex quantitative real-time polymerase chain reaction (mqPCR) panel was optimized for the detection of eight canine neurologic pathogens (Blastomyces dermatitidis, Cryptococcus spp., Neospora caninum, Borrelia burgdorferi, Bartonella spp., Toxoplasma gondii, Ehrlichia canis, and canine distemper virus [CDV]). The mqPCR panel was subsequently applied to 53 cerebrospinal fluid (CSF) samples collected from dogs with ME. The analytic sensitivity (i.e., limit of detection, expressed as molecules per 1 µL of recombinant vector) was 3.8 for CDV, 3.7 for Ehrlichia canis, 3.7 for Bartonella spp., 3.8 for Borrelia burgdorferi, 3.7 for Blastomyces dermatitidis, 3.7 for Cryptococcus spp., 38 for Neospora caninum, and 3.7 for Toxoplasma gondii. Among the tested CSF samples, seven (15%) were positive for the following pathogens in decreasing order of frequency: Cryptococcus spp. (3/7), Blastomyces dermatitidis (2/7), and Borrelia burgdorferi (2/7). In summary, use of an mqPCR panel with high analytic sensitivity as an initial screen for infectious agents in dogs with ME could facilitate the selection of early treatment strategies and improve outcomes. PMID:26040611

  3. The presence of Brucella ceti ST26 in a striped dolphin (Stenella coeruleoalba) with meningoencephalitis from the Mediterranean Sea.

    PubMed

    Alba, Patricia; Terracciano, Giuliana; Franco, Alessia; Lorenzetti, Serena; Cocumelli, Cristiano; Fichi, Gianluca; Eleni, Claudia; Zygmunt, Michel S; Cloeckaert, Axel; Battisti, Antonio

    2013-05-31

    Brucella spp. was isolated from brain, lung and intestinal lymph nodes of a dead adult male striped dolphin (Stenella coeruleoalba) found stranded on the Tyrrhenian coast (Tuscany, Italy) of the Mediterranean Sea in February 2012. Brucella spp. was associated with moderate to severe lesions of meningoencephalitis. A co-infection by Toxoplasma gondii was also demonstrated at brain level by means of molecular and histopathologic methods. The Brucella isolate was further characterized based on a fragment-specific polymerase chain reaction (PCR) approach, consisting of a set of five specific PCRs, targeting specific chromosomal IS711 locations for marine mammal Brucellae, as described previously. The isolate was thus classified as Brucella ceti I; V fragment-positive (or B. ceti dolphin type), according to previous studies. Multi Locus Sequence Analysis demonstrated that the isolate belongs to Sequence Type 26, while omp2 (omp2a and omp2b genes) sequence analysis further confirmed the isolate belonged to this group of strains. This is the first report of Brucella spp. from marine mammals in the Mediterranean Sea, and represents a further observation that this strain group is associated with hosts of the Family Delphinidae, and particularly with the striped dolphins, also in the Mediterranean area, thus constituting a further biological hazard of concern for this vulnerable subpopulation. PMID:23419820

  4. Fatal equine meningoencephalitis in the United Kingdom caused by the panagrolaimid nematode Halicephalobus gingivalis: case report and review of the literature.

    PubMed

    Hermosilla, C; Coumbe, K M; Habershon-Butcher, J; Schöniger, S

    2011-11-01

    A fatal case of eosinophilic and granulomatous meningoencephalitis caused by the free-living panagrolaimid nematode Halicephalobus gingivalis is reported in a 10-year-old Welsh gelding in the United Kingdom. Clinical examination first revealed behavioural abnormalities which rapidly progressed to severe ataxia, reduced mentation status and cranial nerve signs. Despite symptomatic treatment no amelioration of neurological signs was achieved and the horse was subjected to euthanasia. A complete post mortem examination revealed eosinophilic and granulomatous meningoencephalitis mainly affecting the cerebellum and brain stem with intralesional adult nematodes, larvae and eggs. There was also eosinophilic meningitis of the cervical spinal cord. The intralesional nematodes were morphologically consistent with the panagrolaimid nematode H. gingivalis. Although infection by this facultative neurotropic parasite is extremely rare, it needs to be considered in the differential diagnosis of central nervous signs in horses and, in particular, other equine helminthic infection of the central nervous system. This fatal case is unusual since lesions were locally very extensive and the nematodes did not colonise haematogenously to other organs as seen often in equine halicephalobosis. As the taxonomy of H. gingivalis has changed and some recent reports in the literature still refer to this species as Micronema deletrix or Halicephalobus deletrix, we here provide a short update of the species and some insights on the order Tylenchida, which contains free-living nematodes with parasitic tendencies. PMID:21496093

  5. Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments.

    PubMed

    Pugh, J Jeffrey; Levy, Rebecca A

    2016-09-21

    Primary amoebic meningoencephalitis (PAM) is a very rare disease with a high mortality rate. PAM is caused by Naegleria fowleri, an amoeba which resides in freshwater lakes and ponds and can survive in inadequately chlorinated pools ( Lopez, C.; Budge, P.; Chen, J., et al. Primary amebic meningoencephalitis: a case report and literature review . Pediatr. Emerg. Care 2012 , 28 , 272 - 276 ). In the past 50 years, there have been over 130 cases of Naegleria induced PAM in the United States with only three known survivors; one survivor was diagnosed and treated at Arkansas Children's Hospital. Successful treatment of PAM started with a rapid diagnosis, extensive antimicrobial therapy including an investigational medication miltefosine, supportive care, an intraventricular shunt, and hypothermia. These treatments address different aspects of the disease process. Increased understanding of the diagnosis and treatment of PAM is important especially for patients who present with meningitis-like findings during the summer months. PMID:27525348

  6. Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments.

    PubMed

    Pugh, J Jeffrey; Levy, Rebecca A

    2016-09-21

    Primary amoebic meningoencephalitis (PAM) is a very rare disease with a high mortality rate. PAM is caused by Naegleria fowleri, an amoeba which resides in freshwater lakes and ponds and can survive in inadequately chlorinated pools ( Lopez, C.; Budge, P.; Chen, J., et al. Primary amebic meningoencephalitis: a case report and literature review . Pediatr. Emerg. Care 2012 , 28 , 272 - 276 ). In the past 50 years, there have been over 130 cases of Naegleria induced PAM in the United States with only three known survivors; one survivor was diagnosed and treated at Arkansas Children's Hospital. Successful treatment of PAM started with a rapid diagnosis, extensive antimicrobial therapy including an investigational medication miltefosine, supportive care, an intraventricular shunt, and hypothermia. These treatments address different aspects of the disease process. Increased understanding of the diagnosis and treatment of PAM is important especially for patients who present with meningitis-like findings during the summer months.

  7. Immunization with a tetramer derivative of an anti-inflammatory pentapeptide produced by Entamoeba histolytica protects gerbils (Meriones unguiculatus) against experimental amoebic abscess of the liver.

    PubMed

    Giménez-Scherer, Juan Antonio; Cárdenas, Guadalupe; López-Osuna, Martha; Velázquez, Juan Raymundo; Rico, Guadalupe; Isibasi, Armando; Maldonado, María del Carmen; Morales, María Esther; Fernández-Diez, Jorge; Kretschmer, Roberto R

    2004-01-01

    Axenically grown Entamoeba histolytica produces a pentapeptide (Met-Gln-Cys-Asn-Ser) with several anti-inflammatory properties, including the inhibition of human monocyte locomotion (Monocyte Locomotion Inhibitory Factor (MLIF)). A construct displays the same effects as the native material. It remains to be seen if MLIF is used, or even produced in vivo by the tissue-invading parasite. If MLIF were to be relevant in invasive amoebiasis, immunizing against it could diminish this parasite advantage and prevent lesions. KLH-linked MLIF mixed with Freund's adjuvant was too aggressive an immunizing material to answer this question. However, immunization with a tetramer of MLIF (but not a scrambled version of MLIF) around a lysine core (MLIF-MAPS), that displays increased antigenicity, yet lacks excessive innate immunity activation, completely protects gerbils against amoebic abscess of the liver caused by the intraportal injection of virulent E. histolytica. Liver abscesses caused by Listeria monocytogenes were not prevented. Invasive E. histolytica may produce the parent protein of MLIF in vivo, and if appropriately cleaved, it may play a role in invasive amoebiasis. MLIF may join new vaccination strategies against amoebiasis.

  8. Questionnaire-based risk assessment for amoebic gill disease (AGD) and evaluation of freshwater bathing efficacy of reared Atlantic salmon Salmo salar.

    PubMed

    Douglas-Helders, G M; Saksida, S; Nowak, B F

    2005-02-28

    Factors causing amoebic gill disease (AGD), the main disease affecting the salmonid industry in Tasmania, are largely unknown. Managers of 57 sites, from 4 countries, in both the Southern and Northern Hemisphere were questioned regarding the 2000 smolt year-class Atlantic salmon. Questions included site characteristics, fish population characteristics, husbandry and management programs, through to freshwater bathing characteristics. Possible risk factors for AGD outbreaks that were identified in this study using farm managers' opinions were mixed sex stocks (Tasmania), downstream positioning from other salmonid farming sites (pooled), tidal sites (Tasmania), depth of site (pooled), rate of salinity change in halocline and depth of halocline (pooled, Tasmania), phytoplankton blooms (pooled, Tasmania), antifouling paints (Tasmania, overseas) and automated feeding (pooled, overseas). The information from farm managers suggested that freshwater bathing is less effective with smaller bathing cages and lower levels of saturated oxygen in the bathing water. Risk factors could not always be determined due to the complex interactions between the biological and chemical environment, host and pathogenic factors, coupled with low sample numbers. PMID:15819433

  9. Computational identification of putative miRNAs and their target genes in pathogenic amoeba Naegleria fowleri.

    PubMed

    Padmashree, Dyavegowda; Swamy, Narayanaswamy Ramachandra

    2015-01-01

    Naegleria fowleri is a parasitic unicellular free living eukaryotic amoeba. The parasite spreads through contaminated water and causes primary amoebic meningoencephalitis (PAM). Therefore, it is of interest to understand its molecular pathogenesis. Hence, we analyzed the parasite genome for miRNAs (microRNAs) that are non-coding, single stranded RNA molecules. We identified 245 miRNAs using computational methods in N. fowleri, of which five miRNAs are conserved. The predicted miRNA targets were analyzed by using miRanda (software) and further studied the functions by subsequently annotating using AmiGo (a gene ontology web tool). PMID:26770029

  10. Computational identification of putative miRNAs and their target genes in pathogenic amoeba Naegleria fowleri.

    PubMed

    Padmashree, Dyavegowda; Swamy, Narayanaswamy Ramachandra

    2015-01-01

    Naegleria fowleri is a parasitic unicellular free living eukaryotic amoeba. The parasite spreads through contaminated water and causes primary amoebic meningoencephalitis (PAM). Therefore, it is of interest to understand its molecular pathogenesis. Hence, we analyzed the parasite genome for miRNAs (microRNAs) that are non-coding, single stranded RNA molecules. We identified 245 miRNAs using computational methods in N. fowleri, of which five miRNAs are conserved. The predicted miRNA targets were analyzed by using miRanda (software) and further studied the functions by subsequently annotating using AmiGo (a gene ontology web tool).

  11. Computational identification of putative miRNAs and their target genes in pathogenic amoeba Naegleria fowleri

    PubMed Central

    Padmashree, Dyavegowda; Swamy, Narayanaswamy Ramachandra

    2015-01-01

    Naegleria fowleri is a parasitic unicellular free living eukaryotic amoeba. The parasite spreads through contaminated water and causes primary amoebic meningoencephalitis (PAM). Therefore, it is of interest to understand its molecular pathogenesis. Hence, we analyzed the parasite genome for miRNAs (microRNAs) that are non-coding, single stranded RNA molecules. We identified 245 miRNAs using computational methods in N. fowleri, of which five miRNAs are conserved. The predicted miRNA targets were analyzed by using miRanda (software) and further studied the functions by subsequently annotating using AmiGo (a gene ontology web tool). PMID:26770029

  12. Isolation and identification of pathogenic Naegleria from Florida lakes.

    PubMed

    Wellings, F M; Amuso, P T; Chang, S L; Lewis, A L

    1977-12-01

    Five cases of primary amoebic meningoencephalitis associated with swimming in freshwater lakes have been recorded in Florida over the past 14 years. The present study demonstrated that pathogenic Naegleria, the causative agent, is relatively widespread. Twelve of 26 lakes sampled only once yielded the amoeba. Populations in three of five lakes sampled routinely reached levels of one amoeba per 25 ml of water tested during the hot summer months. Overwintering in freshwater lake bottom sediments was demonstrated, showing that thermal-discharge pollution of waters plays a miniscule, if any, role in the maintenance of pathogenic Naegleria in nature in this semitropical area.

  13. Reduced total hardness of fresh water enhances the efficacy of bathing as a treatment for amoebic gill disease in Atlantic salmon, Salmo salar L.

    PubMed

    Roberts, S D; Powell, M D

    2003-10-01

    The current treatment for amoebic gill disease (AGD)-affected Atlantic salmon involves bathing sea-caged fish in fresh water, often sourced from local dams, for 3-4 h. In both a small-scale laboratory and an on-farm field experiment, the effects of water hardness on the efficacy of freshwater bathing were assessed. Results showed that soft fresh water (19.3-37.4 mg L(-1) CaCO3), whether it be naturally soft city mains water or artificially softened dam water, was more efficacious at alleviating AGD in affected fish than hard fresh water (173-236.3 mg L(-1) CaCO3). Soft freshwater bathing significantly reduced viable gill amoebae numbers (from 73.9 to 40.9% of total count) and significantly alleviated gill pathology, both gross and histological. Following bathing, gross gill pathological scores of soft freshwater bathed fish lagged 2 weeks behind hard freshwater bathed fish. Significant gill lesion fragmentation, and shedding of lesion-associated hyperplastic tissue, was accompanied by a significant reduction in AGD-affected gill filaments in soft freshwater bathed fish. Furthermore, soft freshwater bathing alleviated the blood plasma electrolyte imbalance seen in control (sea water) and hard freshwater bathed fish. This study showed that the use of soft fresh water for bathing AGD-affected Atlantic salmon could be an improvement to the current method of treatment. Not only does it reduce gill amoeba numbers, but also, it is of a therapeutic advantage with the potential to reduce bathing frequency.

  14. Overexpression of Differentially Expressed Genes Identified in Non-pathogenic and Pathogenic Entamoeba histolytica Clones Allow Identification of New Pathogenicity Factors Involved in Amoebic Liver Abscess Formation.

    PubMed

    Meyer, Martin; Fehling, Helena; Matthiesen, Jenny; Lorenzen, Stephan; Schuldt, Kathrin; Bernin, Hannah; Zaruba, Mareen; Lender, Corinna; Ernst, Thomas; Ittrich, Harald; Roeder, Thomas; Tannich, Egbert; Lotter, Hannelore; Bruchhaus, Iris

    2016-08-01

    We here compared pathogenic (p) and non-pathogenic (np) isolates of Entamoeba histolytica to identify molecules involved in the ability of this parasite to induce amoebic liver abscess (ALA)-like lesions in two rodent models for the disease. We performed a comprehensive analysis of 12 clones (A1-A12) derived from a non-pathogenic isolate HM-1:IMSS-A and 12 clones (B1-B12) derived from a pathogenic isolate HM-1:IMSS-B. "Non-pathogenicity" included the induction of small and quickly resolved lesions while "pathogenicity" comprised larger abscess development that overstayed day 7 post infection. All A-clones were designated as non-pathogenic, whereas 4 out of 12 B-clones lost their ability to induce ALAs in gerbils. No correlation between ALA formation and cysteine peptidase (CP) activity, haemolytic activity, erythrophagocytosis, motility or cytopathic activity was found. To identify the molecular framework underlying different pathogenic phenotypes, three clones were selected for in-depth transcriptome analyses. Comparison of a non-pathogenic clone A1np with pathogenic clone B2p revealed 76 differentially expressed genes, whereas comparison of a non-pathogenic clone B8np with B2p revealed only 19 differentially expressed genes. Only six genes were found to be similarly regulated in the two non-pathogenic clones A1np and B8np in comparison with the pathogenic clone B2p. Based on these analyses, we chose 20 candidate genes and evaluated their roles in ALA formation using the respective gene-overexpressing transfectants. We conclude that different mechanisms lead to loss of pathogenicity. In total, we identified eight proteins, comprising a metallopeptidase, C2 domain proteins, alcohol dehydrogenases and hypothetical proteins, that affect the pathogenicity of E. histolytica. PMID:27575775

  15. Production and characterization of monoclonal antibodies against a highly immunogenic fraction of Entamoeba histolytica (NIH:200) and their application in the detection of current amoebic infection.

    PubMed

    Sengupta, K; Das, P; Johnson, T M; Chaudhuri, P P; Das, D; Nair, G B

    1993-01-01

    Six monoclonal antibodies (MAbs) were produced against a highly immunogenic fraction derived by the chromatographic separation of the soluble preparation of axenic Entamoeba histolytica (strain NIH:200) trophozoites. Isotype characterization of the six MAbs revealed that four belonged to the IgM class and one each to the IgG1 and the IgG2a subclasses. The immunoreactivity patterns and the specificity of the MAbs with homologous and heterologous antigens were analyzed by the enzyme-linked immunotransfer blot technique and by the enzyme-linked immunosorbent assay. The MAbs reacted intensely with isolates of E. histolytica (strain NIH:200 as well as a local isolate MX1) but showed no reactivity with Entamoeba coli, Iodamoeba butschlii, Endolimax nana, Entamoeba hartmanni, free-living amoeba (Acanthamoeba harticolus) and other enteric parasites. Using the IgG1 MAb as a detecting antibody, a polyclonal-monoclonal antibody-based enzyme-linked immunosorbent assay was developed for the detection of E. histolytica antigens in stool samples of infected patients. The detection limit of the assay was 8 ng of amoebic antigen. This test was found to be specific and sensitive and yielded 100% positive results in cases with amoebiasis but did not react with controls included in the evaluation. The MAb-based enzyme-linked immunosorbent assay developed in this study will be an important test for the diagnosis of E. histolytica in the feces of infected humans; however, the limitation of the test is the inability to discriminate the pathogenic status of the amoeba detected in the stool. PMID:8292992

  16. Reduced total hardness of fresh water enhances the efficacy of bathing as a treatment for amoebic gill disease in Atlantic salmon, Salmo salar L.

    PubMed

    Roberts, S D; Powell, M D

    2003-10-01

    The current treatment for amoebic gill disease (AGD)-affected Atlantic salmon involves bathing sea-caged fish in fresh water, often sourced from local dams, for 3-4 h. In both a small-scale laboratory and an on-farm field experiment, the effects of water hardness on the efficacy of freshwater bathing were assessed. Results showed that soft fresh water (19.3-37.4 mg L(-1) CaCO3), whether it be naturally soft city mains water or artificially softened dam water, was more efficacious at alleviating AGD in affected fish than hard fresh water (173-236.3 mg L(-1) CaCO3). Soft freshwater bathing significantly reduced viable gill amoebae numbers (from 73.9 to 40.9% of total count) and significantly alleviated gill pathology, both gross and histological. Following bathing, gross gill pathological scores of soft freshwater bathed fish lagged 2 weeks behind hard freshwater bathed fish. Significant gill lesion fragmentation, and shedding of lesion-associated hyperplastic tissue, was accompanied by a significant reduction in AGD-affected gill filaments in soft freshwater bathed fish. Furthermore, soft freshwater bathing alleviated the blood plasma electrolyte imbalance seen in control (sea water) and hard freshwater bathed fish. This study showed that the use of soft fresh water for bathing AGD-affected Atlantic salmon could be an improvement to the current method of treatment. Not only does it reduce gill amoeba numbers, but also, it is of a therapeutic advantage with the potential to reduce bathing frequency. PMID:14653317

  17. Overexpression of Differentially Expressed Genes Identified in Non-pathogenic and Pathogenic Entamoeba histolytica Clones Allow Identification of New Pathogenicity Factors Involved in Amoebic Liver Abscess Formation

    PubMed Central

    Lorenzen, Stephan; Schuldt, Kathrin; Bernin, Hannah; Zaruba, Mareen; Lender, Corinna; Ittrich, Harald; Roeder, Thomas; Tannich, Egbert; Lotter, Hannelore; Bruchhaus, Iris

    2016-01-01

    We here compared pathogenic (p) and non-pathogenic (np) isolates of Entamoeba histolytica to identify molecules involved in the ability of this parasite to induce amoebic liver abscess (ALA)-like lesions in two rodent models for the disease. We performed a comprehensive analysis of 12 clones (A1–A12) derived from a non-pathogenic isolate HM-1:IMSS-A and 12 clones (B1–B12) derived from a pathogenic isolate HM-1:IMSS-B. “Non-pathogenicity” included the induction of small and quickly resolved lesions while “pathogenicity” comprised larger abscess development that overstayed day 7 post infection. All A-clones were designated as non-pathogenic, whereas 4 out of 12 B-clones lost their ability to induce ALAs in gerbils. No correlation between ALA formation and cysteine peptidase (CP) activity, haemolytic activity, erythrophagocytosis, motility or cytopathic activity was found. To identify the molecular framework underlying different pathogenic phenotypes, three clones were selected for in-depth transcriptome analyses. Comparison of a non-pathogenic clone A1np with pathogenic clone B2p revealed 76 differentially expressed genes, whereas comparison of a non-pathogenic clone B8np with B2p revealed only 19 differentially expressed genes. Only six genes were found to be similarly regulated in the two non-pathogenic clones A1np and B8np in comparison with the pathogenic clone B2p. Based on these analyses, we chose 20 candidate genes and evaluated their roles in ALA formation using the respective gene-overexpressing transfectants. We conclude that different mechanisms lead to loss of pathogenicity. In total, we identified eight proteins, comprising a metallopeptidase, C2 domain proteins, alcohol dehydrogenases and hypothetical proteins, that affect the pathogenicity of E. histolytica. PMID:27575775

  18. Diagnosis of infections caused by pathogenic free-living amoebae.

    PubMed

    da Rocha-Azevedo, Bruno; Tanowitz, Herbert B; Marciano-Cabral, Francine

    2009-01-01

    Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, and Sappinia sp. are pathogenic free-living amoebae. N. fowleri causes Primary Amoebic Meningoencephalitis, a rapidly fatal disease of the central nervous system, while Acanthamoeba spp. and B. mandrillaris cause chronic granulomatous encephalitis. Acanthamoeba spp. also can cause cutaneous lesions and Amoebic Keratitis, a sight-threatening infection of the cornea that is associated with contact lens use or corneal trauma. Sappinia pedata has been identified as the cause of a nonlethal case of amoebic encephalitis. In view of the potential health consequences due to infection with these amoebae, rapid diagnosis is critical for early treatment. Microscopic examination and culture of biopsy specimens, cerebral spinal fluid (CSF), and corneal scrapings have been used in the clinical laboratory. For amoebic keratitis, confocal microscopy has been used to successfully identify amoebae in corneal tissue. More recently, conventional and real-time PCR assays have been developed that are sensitive and specific for the amoebae. In addition, multiplex PCR assays are available for the rapid identification of these pathogens in biopsy tissue, CSF, and corneal specimens.

  19. Diagnosis of Infections Caused by Pathogenic Free-Living Amoebae

    PubMed Central

    da Rocha-Azevedo, Bruno; Tanowitz, Herbert B.; Marciano-Cabral, Francine

    2009-01-01

    Naegleria fowleri, Acanthamoeba spp., Balamuthia mandrillaris, and Sappinia sp. are pathogenic free-living amoebae. N. fowleri causes Primary Amoebic Meningoencephalitis, a rapidly fatal disease of the central nervous system, while Acanthamoeba spp. and B. mandrillaris cause chronic granulomatous encephalitis. Acanthamoeba spp. also can cause cutaneous lesions and Amoebic Keratitis, a sight-threatening infection of the cornea that is associated with contact lens use or corneal trauma. Sappinia pedata has been identified as the cause of a nonlethal case of amoebic encephalitis. In view of the potential health consequences due to infection with these amoebae, rapid diagnosis is critical for early treatment. Microscopic examination and culture of biopsy specimens, cerebral spinal fluid (CSF), and corneal scrapings have been used in the clinical laboratory. For amoebic keratitis, confocal microscopy has been used to successfully identify amoebae in corneal tissue. More recently, conventional and real-time PCR assays have been developed that are sensitive and specific for the amoebae. In addition, multiplex PCR assays are available for the rapid identification of these pathogens in biopsy tissue, CSF, and corneal specimens. PMID:19657454

  20. A genomic island present along the bacterial chromosome of the Parachlamydiaceae UWE25, an obligate amoebal endosymbiont, encodes a potentially functional F-like conjugative DNA transfer system

    PubMed Central

    Greub, Gilbert; Collyn, François; Guy, Lionel; Roten, Claude-Alain

    2004-01-01

    the Parachlamydia-related symbiont was an intracellular bacteria. It suggests that this heterologous DNA was acquired from a phylogenetically-distant bacteria sharing an amoebal vacuole. Since Parachlamydiaceae are emerging agents of pneumonia, this GI might be involved in pathogenicity. In future, conjugative systems might be developed as genetic tools for Chlamydiales. PMID:15615594

  1. Comparison of nested-multiplex, Taqman & SYBR Green real-time PCR in diagnosis of amoebic liver abscess in a tertiary health care institute in India

    PubMed Central

    Dinoop, K.P.; Parija, Subhash Chandra; Mandal, Jharna; Swaminathan, R.P.; Narayanan, P.

    2016-01-01

    Background & objectives: Amoebiasis is a common parasitic infection caused by Entamoeba histolytica and amoebic liver abscess (ALA) is the most common extraintestinal manifestation of amoebiasis. The aim of this study was to standardise real-time PCR assays (Taqman and SYBR Green) to detect E. histolytica from liver abscess pus and stool samples and compare its results with nested-multiplex PCR. Methods: Liver abscess pus specimens were subjected to DNA extraction. The extracted DNA samples were subjected to amplification by nested-multiplex PCR, Taqman (18S rRNA) and SYBR Green real-time PCR (16S-like rRNA assays to detect E. histolytica/E. dispar/E. moshkovskii). The amplification products were further confirmed by DNA sequence analysis. Receiver operator characteristic (ROC) curve analysis was done for nested-multiplex and SYBR Green real-time PCR and the area under the curve was calculated for evaluating the accuracy of the tests to dignose ALA. Results: In all, 17, 19 and 25 liver abscess samples were positive for E. histolytica by nested-multiplex PCR, SYBR Green and Taqman real-time PCR assays, respectively. Significant differences in detection of E. histolytica were noted in the real-time PCR assays evaluated (P<0.0001). The nested-multiplex PCR, SYBR Green real-time PCR and Taqman real-time PCR evaluated showed a positivity rate of 34, 38 and 50 per cent, respectively. Based on ROC curve analysis (considering Taqman real-time PCR as the gold standard), it was observed that SYBR Green real-time PCR was better than conventional nested-multiplex PCR for the diagnosis of ALA. Interpretation & conclusions: Taqman real-time PCR targeting the 18S rRNA had the highest positivity rate evaluated in this study. Both nested multiplex and SYBR Green real-time PCR assays utilized were evaluated to give accurate results. Real-time PCR assays can be used as the gold standard in rapid and reliable diagnosis, and appropriate management of amoebiasis, replacing the

  2. Dog leukocyte antigen class II-associated genetic risk testing for immune disorders of dogs: simplified approaches using Pug dog necrotizing meningoencephalitis as a model.

    PubMed

    Pedersen, Niels; Liu, Hongwei; Millon, Lee; Greer, Kimberly

    2011-01-01

    A significantly increased risk for a number of autoimmune and infectious diseases in purebred and mixed-breed dogs has been associated with certain alleles or allele combinations of the dog leukocyte antigen (DLA) class II complex containing the DRB1, DQA1, and DQB1 genes. The exact level of risk depends on the specific disease, the alleles in question, and whether alleles exist in a homozygous or heterozygous state. The gold standard for identifying high-risk alleles and their zygosity has involved direct sequencing of the exon 2 regions of each of the 3 genes. However, sequencing and identification of specific alleles at each of the 3 loci are relatively expensive and sequencing techniques are not ideal for additional parentage or identity determination. However, it is often possible to get the same information from sequencing only 1 gene given the small number of possible alleles at each locus in purebred dogs, extensive homozygosity, and tendency for disease-causing alleles at each of the 3 loci to be strongly linked to each other into haplotypes. Therefore, genetic testing in purebred dogs with immune diseases can be often simplified by sequencing alleles at 1 rather than 3 loci. Further simplification of genetic tests for canine immune diseases can be achieved by the use of alternative genetic markers in the DLA class II region that are also strongly linked with the disease genotype. These markers consist of either simple tandem repeats or single nucleotide polymorphisms that are also in strong linkage with specific DLA class II genotypes and/or haplotypes. The current study uses necrotizing meningoencephalitis of Pug dogs as a paradigm to assess simple alternative genetic tests for disease risk. It was possible to attain identical necrotizing meningoencephalitis risk assessments to 3-locus DLA class II sequencing by sequencing only the DQB1 gene, using 3 DLA class II-linked simple tandem repeat markers, or with a small single nucleotide polymorphism array

  3. Scanning electron microscopic study of human neuroblastoma cells affected with Naegleria fowleri Thai strains.

    PubMed

    Tiewcharoen, Supathra; Rabablert, Jundee; Chetanachan, Pruksawan; Junnu, Virach; Worawirounwong, Dusit; Malainual, Nat

    2008-10-01

    In order to understand the pathogenesis of Naegleria fowleri in primary amoebic meningoencephalitis, the human neuroblastoma (SK-N-MC) and African green monkey kidney (Vero) cells were studied in vitro. Amoeba suspension in cell-culture medium was added to the confluent monolayer of SK-N-MC and Vero cells. The cytopathic activity of N. fowleri trophozoites in co-culture system was elucidated by scanning electron microscope at 3, 6, 9, 12, and 24 h. Two strains of N. fowleri displayed well-organized vigorous pseudopods in Nelson's medium at 37 degrees C. In co-culture, the target monolayer cells were damaged by two mechanisms, phagocytosis by vigorous pseudopods and engulfment by sucker-like apparatus. N. fowleri trophozoites produced amoebostomes only in co-culture with SK-N-MC cells. In contrast, we could not find such apparatus in the co-culture with Vero cells. The complete destruction time (100%) at 1:1 amoeba/cells ratio of SK-N-MC cells (1 day) was shorter than the Vero cells (12 days). In conclusion, SK-N-MC cells were confirmed to be a target model for studying neuropathogenesis of primary amoebic meningoencephalitis.

  4. Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment.

    PubMed

    Auxiliadora-Martins, M; Alkmim-Teixeira, G C; Machado-Viana, J; Nicolini, E A; Martins-Filho, O A; Bellissimo-Rodrigues, F; Carlotti, C G; Basile-Filho, A

    2010-08-01

    Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39 degrees C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.

  5. Results of a Multinational Study Suggest the Need for Rapid Diagnosis and Early Antiviral Treatment at the Onset of Herpetic Meningoencephalitis

    PubMed Central

    Cag, Yasemin; Ozturk-Engin, Derya; Defres, Sylviane; Kaya, Selcuk; Larsen, Lykke; Poljak, Mario; Barsic, Bruno; Argemi, Xavier; Sørensen, Signe Maj; Bohr, Anne Lisbeth; Tattevin, Pierre; Gunst, Jesper Damsgaard; Baštáková, Lenka; Jereb, Matjaž; Johansen, Isik Somuncu; Karabay, Oguz; Pekok, Abdullah Umut; Sipahi, Oguz Resat; Chehri, Mahtab; Beraud, Guillaume; Shehata, Ghaydaa; Del Vecchio, Rosa Fontana; Maresca, Mauro; Karsen, Hasan; Sengoz, Gonul; Sunbul, Mustafa; Yilmaz, Gulden; Yilmaz, Hava; Sharif-Yakan, Ahmad; Kanj, Souha Shararah; Parlak, Emine; Pehlivanoglu, Filiz; Korkmaz, Fatime; Komur, Suheyla; Kose, Sukran; Ulug, Mehmet; Bolukcu, Sibel; Coskuner, Seher Ayten; Ince, Nevin; Akkoyunlu, Yasemin; Halac, Gulistan; Sahin-Horasan, Elif; Tireli, Hulya; Kilicoglu, Gamze; Al-Mahdawi, Akram; Nemli, Salih Atakan; Inan, Asuman; Senbayrak, Seniha; Stahl, Jean Paul; Vahaboglu, Haluk

    2015-01-01

    Data in the literature regarding the factors that predict unfavorable outcomes in adult herpetic meningoencephalitis (HME) cases are scarce. We conducted a multicenter study in order to provide insights into the predictors of HME outcomes, with special emphasis on the use and timing of antiviral treatment. Samples from 501 patients with molecular confirmation from cerebrospinal fluid were included from 35 referral centers in 10 countries. Four hundred thirty-eight patients were found to be eligible for the analysis. Overall, 232 (52.9%) patients experienced unfavorable outcomes, 44 died, and 188 survived, with sequelae. Age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02 to 1.05), Glasgow Coma Scale score (OR, 0.84; 95% CI, 0.77 to 0.93), and symptomatic periods of 2 to 7 days (OR, 1.80; 95% CI, 1.16 to 2.79) and >7 days (OR, 3.75; 95% CI, 1.72 to 8.15) until the commencement of treatment predicted unfavorable outcomes. The outcome in HME patients is related to a combination of therapeutic and host factors. This study suggests that rapid diagnosis and early administration of antiviral treatment in HME patients are keys to a favorable outcome. PMID:25779579

  6. Trypanosoma cruzi necrotizing meningoencephalitis in a Venezuelan HIV⁺-AIDS patient: pathological diagnosis confirmed by PCR using formalin-fixed- and paraffin-embedded-tissues.

    PubMed

    Rossi Spadafora, Marcello Salvatore; Céspedes, Ghislaine; Romero, Sandra; Fuentes, Isabel; Boada-Sucre, Alpidio A; Cañavate, Carmen; Flores-Chávez, María

    2014-01-01

    Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV(+) patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas' disease.

  7. Role of the suppressor of cytokine signaling 2 (SOCS2) during meningoencephalitis caused by Bovine herpesvirus 5 (BoHV-5).

    PubMed

    Aparecida Silva Barbosa, Aline; Freitas Versiani, Alice; Fonseca da Cunha Sousa, Larissa; Silva de Miranda, Aline; Gasparini, Marcela Ribeiro; Brant, Fátima; Silva, Daniele Gonçalves; Luisa Quintino-de-Carvalho, Iracema; Marianetti Soriani, Frederico; Guimarães da Fonseca, Flávio; César Vasconcelos, Anilton; da Silva Barcelos, Lucíola; Martins Teixeira, Mauro; Lúcio Teixeira, Antônio; Machado, Fabiana Simão; Barbosa-Stancioli, Edel Figueiredo; Rachid, Milene Alvarenga

    2016-08-01

    The role of suppressors of cytokine signaling (SOCS) in meningoencephalitis caused by Bovine herpesvirus 5 (BoHV-5) was evaluated by intracranial infection in C57BL/6 wild-type mice (WT) and SOCS2 deficient mice (SOCS2(-/-)). Both infected groups presented weight loss, ruffled fur and hunched posture. Additionally, infected SOCS2(-/-) mice showed swollen chamfer and progressive depression. Infected WT animals developed mild meningitis, characterized by infiltration of mononuclear cells. Moreover, viral DNA was detected in liver and lung from infected WT group. This group also showed elevated brain levels of IFN-γ, IL-10, CXCL1 and CCL5, when compared with non-infected WT animals. Brain inflammation was exacerbated in infected SOCS2(-/-) mice with widespread distribution of the virus and increased brain levels of TNF-α, IFN-γ, IL-10, IL-12, CXCL1 and CCL5, when compared with WT infected mice. Moreover, infected SOCS2 deficient mice exhibited reduced brain mRNA expression of IFNα and IFNβ and increased expression of mRNA of SOCS1, compared with infected WT mice. Taken together, our study provides an insight into the role of SOCS2 in modulating the immune response to BoHV-5 infection. PMID:27477504

  8. Trypanosoma cruzi Necrotizing Meningoencephalitis in a Venezuelan HIV+-AIDS Patient: Pathological Diagnosis Confirmed by PCR Using Formalin-Fixed- and Paraffin-Embedded-Tissues

    PubMed Central

    Rossi Spadafora, Marcello Salvatore; Céspedes, Ghislaine; Romero, Sandra; Fuentes, Isabel; Boada-Sucre, Alpidio A.; Cañavate, Carmen; Flores-Chávez, María

    2014-01-01

    Coinfections with human immunodeficiency virus (HIV) and infectious agents have been recognized since the early 90s. In the central nervous system (CNS) of HIV+ patients, parasitic protozoans like Toxoplasma gondii have been described as responsible for the space occupying lesions (SOL) developed. However, the involvement of Trypanosoma cruzi is also described but appears to be less frequent in acquired immunodeficiency syndrome (AIDS) and transplant recipients, associated with necrotizing myocarditis and neurological symptoms related to the occurrence of necrotizing pseudotumoral encephalitis (NPE) and meningoencephalitis (NME). The present work aims to present a Venezuelan case of NME associated with the coinfection of HIV and a T. cruzi-like trypanosomatid as well as its evolution and diagnosis by histopathological techniques, electron microscopy, and PCR methods using formalin-fixed- (FF-) and paraffin-embedded- (PE-) tissues. Postmortem cytological studies of leptomeninges imprints reveal the presence of trypomastigotes of Trypanosoma sp. Histopathological and electron microscopy studies allowed us to identify an amastigote stage and to reject the involvement of other opportunistic microorganisms as the etiological agent of the SOL. The definitive confirmation of T. cruzi as the etiological agent was achieved by PCR suggesting that the NME by T. cruzi was due to a reactivation of Chagas' disease. PMID:25763312

  9. Syphilis - primary

    MedlinePlus

    Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis ... Syphilis is a sexually transmitted, infectious disease caused by the spirochete bacterium Treponema pallidum . This bacterium causes ...

  10. Cerebellar mutism caused by primary varicella infection in an immunocompetent child.

    PubMed

    Erol, Ilknur; Özkale, Yasemin; Saygi, Semra; Alehan, Füsun

    2014-06-01

    Varicella (chickenpox) is a common childhood infection caused by the varicella-zoster virus, which is often self-limiting and usually benign. Although uncommon, neurologic complications of varicella have been documented that include postinfectious cerebellar ataxia, meningoencephalitis, Reye syndrome, myelitis, optic neuritis, stroke, Guillain-Barré syndrome, seventh cranial nerve palsy, and Ramsay-Hunt syndrome. In this case study, the authors describe a 7-year-old girl who presented with varicella skin rash with unsteady gait and anarthria on day 2, and her condition was attributed to cerebellar mutism. To date, this complication has never been reported in a child with primary varicella infection. Therefore, this case study documents a rare but serious complication of childhood chickenpox.

  11. [Primary hyperparathyroidism].

    PubMed

    Maruani, G; Cornière, N; Nicolet, L; Baron, S; Courbebaisse, M; Renaud, S; Houillier, P

    2013-10-01

    For the past 40 years, primary hyperparathyroidism has been recognized as a common endocrine disease which is, most often, "non-symptomatic", without the occurrence of nephrolithiasis or osteitis fibrosa cystica. Our knowledge in the pathophysiology has increased largely and diagnosis of primary hyperparathyroidism is usually easy. The only radical treatment is surgery and the surgical indications have been codified by several consensus conferences. For patients who do not undergo surgery, prolonged medical monitoring is needed.

  12. A Novel α-Hemolytic Streptococcus Species (Streptococcus azizii sp. nov.) Associated with Meningoencephalitis in Naïve Weanling C57BL/6 Mice.

    PubMed

    Braden, Gillian C; Arbona, Rodolfo Ricart; Lepherd, Michelle; Monette, Sébastien; Toma, Aziz; Fox, James G; Dewhirst, Floyd E; Lipman, Neil S

    2015-06-01

    During 1 year, experimentally naïve C57BL/6NCrl weanlings born to timed-pregnant dams from a single vendor demonstrated markedly increased mortality associated with runting, abnormal gait, and decreased activity. Gram-positive, aerobic, α-hemolytic, coccoid bacteria were isolated from the meninges (n = 16), blood (n = 1), and kidneys (n = 1) of clinically affected weanlings (n = 15); from the uterus (n = 1), meninges (n = 1), and oral cavity (n = 2) of 3 dams; and from the meninges and oral cavity of a clinically affected 86-d-old mouse in the same colony. Multifocal, necrosuppurative meningoencephalitis and ventriculitis with intralesional gram-positive coccoid bacteria were present in all but 2 affected animals. The bacterium also was isolated from the oral cavity of an asymptomatic timed-pregnant dam (1 of 23) from the same vendor and from 8 mice at the vendor's facility. All isolates (n = 25) were identified by using 2 semiautomated rapid-identification systems, one of which consistently identified the causative bacterium as Aerococcus viridans 2 (n = 12) or 3 (n = 13), with probabilities of 55.7% to 98.3%. The bacterium did not grow in 6.5% NaCl at 10 °C, thus suggesting a Streptococcus species. Partial 16S rRNA sequencing of 4 isolates suggested S. hyointestinalis (probability, 93.4%) and S. gallinaceus (99.5%). Full 16S rRNA sequences for 3 isolates identified the bacterium as a novel Streptococcus species most closely related to S. acidominimus strain LGM (96.5%) and Streptococcus species strain Smarlab 3301444 (96.3%) and for which we propose the name S. azizii.

  13. A Novel α-Hemolytic Streptococcus Species (Streptococcus azizii sp. nov.) Associated with Meningoencephalitis in Naïve Weanling C57BL/6 Mice.

    PubMed

    Braden, Gillian C; Arbona, Rodolfo Ricart; Lepherd, Michelle; Monette, Sébastien; Toma, Aziz; Fox, James G; Dewhirst, Floyd E; Lipman, Neil S

    2015-06-01

    During 1 year, experimentally naïve C57BL/6NCrl weanlings born to timed-pregnant dams from a single vendor demonstrated markedly increased mortality associated with runting, abnormal gait, and decreased activity. Gram-positive, aerobic, α-hemolytic, coccoid bacteria were isolated from the meninges (n = 16), blood (n = 1), and kidneys (n = 1) of clinically affected weanlings (n = 15); from the uterus (n = 1), meninges (n = 1), and oral cavity (n = 2) of 3 dams; and from the meninges and oral cavity of a clinically affected 86-d-old mouse in the same colony. Multifocal, necrosuppurative meningoencephalitis and ventriculitis with intralesional gram-positive coccoid bacteria were present in all but 2 affected animals. The bacterium also was isolated from the oral cavity of an asymptomatic timed-pregnant dam (1 of 23) from the same vendor and from 8 mice at the vendor's facility. All isolates (n = 25) were identified by using 2 semiautomated rapid-identification systems, one of which consistently identified the causative bacterium as Aerococcus viridans 2 (n = 12) or 3 (n = 13), with probabilities of 55.7% to 98.3%. The bacterium did not grow in 6.5% NaCl at 10 °C, thus suggesting a Streptococcus species. Partial 16S rRNA sequencing of 4 isolates suggested S. hyointestinalis (probability, 93.4%) and S. gallinaceus (99.5%). Full 16S rRNA sequences for 3 isolates identified the bacterium as a novel Streptococcus species most closely related to S. acidominimus strain LGM (96.5%) and Streptococcus species strain Smarlab 3301444 (96.3%) and for which we propose the name S. azizii. PMID:26141443

  14. Development of a reliable dual-gene amplification RT-PCR assay for the detection of Turkey Meningoencephalitis virus in Turkey brain tissues.

    PubMed

    Davidson, Irit; Raibstein, Israel; Al-Tori, Amira; Khinich, Yevgeny; Simanov, Michael; Yuval, Chanoch; Perk, Shimon; Lublin, Avishai

    2012-11-01

    The Turkey Meningoencephalitis virus (TMEV) causes neuroparalytic signs, paresis, in-coordination, morbidity and mortality in turkeys. In parallel to the increased worldwide scientific interest in veterinary avian flaviviruses, including the Bagaza, Tembusu and Tembusu-related BYD virus, TMEV-caused disease also reemergence in commercial turkeys during late summer of 2010. While initially TMEV was detected by NS5-gene RT-PCR, subsequently, the env-gene RT-PCR was employed. As lately several inconsistencies were observed between the clinical, serological and molecular detection of the TMEV env gene, this study evaluated whether genetic changes occurred in the recently isolated viruses, and sought to optimize and improve the direct TMEV amplification from brain tissues of affected turkeys. The main findings indicated that no changes occurred during the years in the TMEV genome, but the PCR detection sensitivities of the env and NS5 genes differed. The RT-PCR and RNA purification were optimized for direct amplification from brain tissues without pre-replication of clinical samples in tissue cultures or in embryonated eggs. The amplification sensitivity of the NS5-gene was 10-100 times more than the env-gene when separate. The new dual-gene amplification RT-PCR was similar to that of the NS5 gene, therefore the assay can be considered as a reliable diagnostic assay. Cases where one of the two amplicons would be RT-PCR negative would alert and warn on the virus identity, and possible genetic changes. In addition, the biochemical environment of the dual-gene amplification reaction seemed to contribute in deleting non-specific byproducts that occasionally appeared in the singular RT-PCR assays on RNA purified from brain tissues.

  15. A Novel α-Hemolytic Streptococcus Species (Streptococcus azizii sp. nov.) Associated with Meningoencephalitis in Naïve Weanling C57BL/6 Mice

    PubMed Central

    Braden, Gillian C; Arbona, Rodolfo Ricart; Lepherd, Michelle; Monette, Sébastien; Toma, Aziz; Fox, James G; Dewhirst, Floyd E; Lipman, Neil S

    2015-01-01

    During 1 year, experimentally naïve C57BL/6NCrl weanlings born to timed-pregnant dams from a single vendor demonstrated markedly increased mortality associated with runting, abnormal gait, and decreased activity. Gram-positive, aerobic, α-hemolytic, coccoid bacteria were isolated from the meninges (n = 16), blood (n = 1), and kidneys (n = 1) of clinically affected weanlings (n = 15); from the uterus (n = 1), meninges (n = 1), and oral cavity (n = 2) of 3 dams; and from the meninges and oral cavity of a clinically affected 86-d-old mouse in the same colony. Multifocal, necrosuppurative meningoencephalitis and ventriculitis with intralesional gram-positive coccoid bacteria were present in all but 2 affected animals. The bacterium also was isolated from the oral cavity of an asymptomatic timed-pregnant dam (1 of 23) from the same vendor and from 8 mice at the vendor's facility. All isolates (n = 25) were identified by using 2 semiautomated rapid-identification systems, one of which consistently identified the causative bacterium as Aerococcus viridans 2 (n = 12) or 3 (n = 13), with probabilities of 55.7% to 98.3%. The bacterium did not grow in 6.5% NaCl at 10 °C, thus suggesting a Streptococcus species. Partial 16S rRNA sequencing of 4 isolates suggested S. hyointestinalis (probability, 93.4%) and S. gallinaceus (99.5%). Full 16S rRNA sequences for 3 isolates identified the bacterium as a novel Streptococcus species most closely related to S. acidominimus strain LGM (96.5%) and Streptococcus species strain Smarlab 3301444 (96.3%) and for which we propose the name S. azizii. PMID:26141443

  16. Primary hyperparathyroidism

    PubMed Central

    Madkhali, Tarıq; Alhefdhi, Amal; Chen, Herbert; Elfenbein, Dawn

    2016-01-01

    Primary hyperparathyroidism is a common endocrine disorder caused by overactivation of parathyroid glands resulting in excessive release of parathyroid hormone. The resultant hypercalcemia leads to a myriad of symptoms. Primary hyperparathyroidism may increase a patient’s morbidity and even mortality if left untreated. During the last few decades, disease presentation has shifted from the classic presentation of severe bone and kidney manifestations to most patients now being diagnosed on routine labs. Although surgery is the only curative therapy, many advances have been made over the past decades in the diagnosis and the surgical management of primary hyperparathyroidism. The aim of this review is to summarize the characteristics of the disease, the work up, and the treatment options. PMID:26985167

  17. Identification of novel genetic risk loci in Maltese dogs with necrotizing meningoencephalitis and evidence of a shared genetic risk across toy dog breeds.

    PubMed

    Schrauwen, Isabelle; Barber, Renee M; Schatzberg, Scott J; Siniard, Ashley L; Corneveaux, Jason J; Porter, Brian F; Vernau, Karen M; Keesler, Rebekah I; Matiasek, Kaspar; Flegel, Thomas; Miller, Andrew D; Southard, Teresa; Mariani, Christopher L; Johnson, Gayle C; Huentelman, Matthew J

    2014-01-01

    Necrotizing meningoencephalitis (NME) affects toy and small breed dogs causing progressive, often fatal, inflammation and necrosis in the brain. Genetic risk loci for NME previously were identified in pug dogs, particularly associated with the dog leukocyte antigen (DLA) class II complex on chromosome 12, but have not been investigated in other susceptible breeds. We sought to evaluate Maltese and Chihuahua dogs, in addition to pug dogs, to identify novel or shared genetic risk factors for NME development. Genome-wide association testing of single nucleotide polymorphisms (SNPs) in Maltese dogs with NME identified 2 regions of genome-wide significance on chromosomes 4 (chr4:74522353T>A, p = 8.1×10-7) and 15 (chr15:53338796A>G, p = 1.5×10-7). Haplotype analysis and fine-mapping suggests that ILR7 and FBXW7, respectively, both important for regulation of immune system function, could be the underlying associated genes. Further evaluation of these regions and the previously identified DLA II locus across all three breeds, revealed an enrichment of nominal significant SNPs associated with chromosome 15 in pug dogs and DLA II in Maltese and Chihuahua dogs. Meta-analysis confirmed effect sizes the same direction in all three breeds for both the chromosome 15 and DLA II loci (p = 8.6×10-11 and p = 2.5×10-7, respectively). This suggests a shared genetic background exists between all breeds and confers susceptibility to NME, but effect sizes might be different among breeds. In conclusion, we identified the first genetic risk factors for NME development in the Maltese, chromosome 4 and chromosome 15, and provide evidence for a shared genetic risk between breeds associated with chromosome 15 and DLA II. Last, DLA II and IL7R both have been implicated in human inflammatory diseases of the central nervous system such as multiple sclerosis, suggesting that similar pharmacotherapeutic targets across species should be investigated.

  18. Primary Epstein-Barr-virus infections in acute neurologic diseases.

    PubMed

    Grose, C; Henle, W; Henle, G; Feorino, P M

    1975-02-20

    Infectious mononucleosis has been associated with Guillain--Barré syndrome, Bell's palsy, meningoencephalitis and transverse myelitis. Since it is not known that many children with infectious mononucleosis do not develop heterophil antibodies, we looked for evidence of current or recent Epstein-Barr virus infection in young patients with these neurologic diseases by using serodiagnostic procedures for detection and titration of antibodies to various antigens related to Epstein-Barr virus. Seven of 24 cases with Guillain-Barre syndrome and three of 16 with facial palsy were definitely associated with primary infection with Epstein-Barr virus as were two cases each of the other two neurologic diseases. Only one of these patients had obvious clinical infectious mononucleosis, and only a few demonstrated heterophil agglutinins. It is evident that the virus must be considered in the diagnosis of various acute neurologic diseases affecting children and young adults, even in the absence of heterophil-antibody response or other signs of infectious mononucleosis.

  19. An enzyme-linked immunosorbent assay (ELISA) for the identification of Naegleria fowleri in environmental water samples.

    PubMed

    Reveiller, Fabienne L; Varenne, Marie-Pierre; Pougnard, Claire; Cabanes, Pierre-Andre; Pringuez, Emmanuelle; Pourima, Benedicte; Legastelois, Stephane; Pernin, Pierre

    2003-01-01

    Naegleria fowleri, a free-living amoeba, is the causative agent of primary amoebic meningoencephalitis, a fatal human disease of the central nervous system often contracted after swimming in fresh water. Identifying sites contaminated by N. fowleri is important in order to prevent the disease. An Enzyme-Linked ImmunoSorbent Assay (ELISA) has been developed for the specific identification of N. fawleri in primary cultures of environmental water samples. Of 939 samples isolated from artificially heated river water and screened by ELISA, 283 were positive. These results were subsequently confirmed by isoelectric focusing, the established reference method. A sensitivity of 97.4% and a specificity of 97% were obtained. These results indicate that this ELISA method is reliable and can be considered as a powerful tool for the detection of N. fowleri in environmental water samples. PMID:12744523

  20. An enzyme-linked immunosorbent assay (ELISA) for the identification of Naegleria fowleri in environmental water samples.

    PubMed

    Reveiller, Fabienne L; Varenne, Marie-Pierre; Pougnard, Claire; Cabanes, Pierre-Andre; Pringuez, Emmanuelle; Pourima, Benedicte; Legastelois, Stephane; Pernin, Pierre

    2003-01-01

    Naegleria fowleri, a free-living amoeba, is the causative agent of primary amoebic meningoencephalitis, a fatal human disease of the central nervous system often contracted after swimming in fresh water. Identifying sites contaminated by N. fowleri is important in order to prevent the disease. An Enzyme-Linked ImmunoSorbent Assay (ELISA) has been developed for the specific identification of N. fawleri in primary cultures of environmental water samples. Of 939 samples isolated from artificially heated river water and screened by ELISA, 283 were positive. These results were subsequently confirmed by isoelectric focusing, the established reference method. A sensitivity of 97.4% and a specificity of 97% were obtained. These results indicate that this ELISA method is reliable and can be considered as a powerful tool for the detection of N. fowleri in environmental water samples.

  1. Amebic meningoencephalitis in a sheep.

    PubMed

    Fuentealba, I C; Wikse, S E; Read, W K; Edwards, J F; Visvesvara, G S

    1992-02-01

    A 1.5-year-old Suffolk ewe with acute onset of incoordination and blindness unresponsive to antibiotic treatment was examined at necropsy. The meninges were congested, opaque, and thick. Microscopically, focal areas of hypercellularity in the left cortical gray matter and the meninges were observed. The inflammatory response consisted of gliosis and perivascular cuffing (lymphocytes, plasma cells, and variable numbers of eosinophils). An amebic organism in 2 life stages was found in the cerebral parenchyma. Numerous large (15 to 35 microns in diameter) organisms, interpreted as trophozoites, were characterized by vacuolated cytoplasm and small nuclei with a prominent eosinophilic nucleolus (karyosome). The smaller (10 to 17 microns in diameter) encysted stage was surrounded by a capsule-like membrane, and contained a large central body sometimes surrounded by a clear halo. Immunofluorescence studies for amebic antigens were strongly positive for an ameba recently isolated in human beings and baboons (Leptomyxid sp). PMID:1548173

  2. Primary hyperoxaluria.

    PubMed

    Lorenzo, Víctor; Torres, Armando; Salido, Eduardo

    2014-05-21

    Primary hyperoxaluria (PH) occurs due to an autosomal recessive hereditary disorder of the metabolism of glyoxylate, which causes excessive oxalate production. The most frequent and serious disorder is due to enzyme deficit of alanine-glyoxylate aminotransferase (PH type I) specific to hepatic peroxisome. As oxalate is not metabolised in humans and is excreted through the kidneys, the kidney is the first organ affected, causing recurrent lithiasis, nephrocalcinosis and early renal failure. With advance of renal failure, particularly in patients on haemodialysis (HD), calcium oxalate is massively deposited in tissues, which is known as oxalosis. Diagnosis is based on family history, the presence of urolithiasis and/or nephrocalcinosis, hyperoxaluria, oxalate deposits in tissue forming granulomas, molecular analysis of DNA and enzyme analysis if applicable. High diagnostic suspicion is required; therefore, unfortunately, in many cases it is diagnosed after its recurrence following kidney transplantation. Conservative management of this disease (high liquid intake, pyridoxine and crystallisation inhibitors) needs to be adopted early in order to delay kidney damage. Treatment by dialysis is ineffective in treating excess oxalate. After the kidney transplant, we normally observe a rapid appearance of oxalate deposits in the graft and the results of this technique are discouraging, with very few exceptions. Pre-emptive liver transplantation, or simultaneous liver and kidney transplants when there is already irreversible damage to the kidney, is the treatment of choice to treat the underlying disease and suppress oxalate overproduction. Given its condition as a rare disease and its genetic and clinical heterogeneity, it is not possible to gain evidence through randomised clinical trials. As a result, the recommendations are established by groups of experts based on publications of renowned scientific rigour. In this regard, a group of European experts (OxalEurope) has

  3. What do we know by now about the genus Naegleria?

    PubMed

    De Jonckheere, Johan F

    2014-11-01

    In this short overview of the genus Naegleria a brief historical sketch is given since the discovery of this amoeboflagellate in 1899 and the finding in 1970 that one species, Naegleria fowleri causes primary amoebic meningoencephalitis in man. Eight different types of this pathogen are known which have an uneven distribution over the world. Until now 47 different Naegleria spp. are described, of which two other species cause disease in experimental animals, and their geographical dispersal is indicated. The presence of group I introns in the SSU and in the LSU rDNA in the genus is discussed, as well as the possibility of sex or mating. It is also mentioned that the genome of N. fowleri should not be compared to that of Naegleria gruberi, to know why the former is pathogenic, but to the genome of its closest relative Naegleria lovaniensis. PMID:25108159

  4. Characterization of a Drinking Water Distribution Pipeline Terminally Colonized by Naegleria fowleri.

    PubMed

    Morgan, Matthew J; Halstrom, Samuel; Wylie, Jason T; Walsh, Tom; Kaksonen, Anna H; Sutton, David; Braun, Kalan; Puzon, Geoffrey J

    2016-03-15

    Free-living amoebae, such as Naegleria fowleri, Acanthamoeba spp., and Vermamoeba spp., have been identified as organisms of concern due to their role as hosts for pathogenic bacteria and as agents of human disease. In particular, N. fowleri is known to cause the disease primary amoebic meningoencephalitis (PAM) and can be found in drinking water systems in many countries. Understanding the temporal dynamics in relation to environmental and biological factors is vital for developing management tools for mitigating the risks of PAM. Characterizing drinking water systems in Western Australia with a combination of physical, chemical and biological measurements over the course of a year showed a close association of N. fowleri with free chlorine and distance from treatment over the course of a year. This information can be used to help design optimal management strategies for the control of N. fowleri in drinking-water-distribution systems. PMID:26853055

  5. Detection of the free living amoeba Naegleria fowleri by using conventional and real-time PCR based on a single copy DNA sequence.

    PubMed

    Régoudis, Estelle; Pélandakis, Michel

    2016-02-01

    The amoeba-flagellate Naegleria fowleri is a causative agent of primary amoebic meningoencephalitis (PAM). This thermophilic species occurs worldwide and tends to proliferate in warm aquatic environment. The PAM cases remain rare but this infection is mostly fatal. Here, we describe a single copy region which has been cloned and sequenced, and was used for both conventional and real-time PCR. Targeting a single-copy DNA sequence allows to directly quantify the N. fowleri cells. The real-time PCR results give a detection limit of 1 copy per reaction with high reproducibility without the need of a Taqman probe. This procedure is of interest as compared to other procedures which are mostly based on the detection of multi-copy DNA associated with a Taqman probe. PMID:26688582

  6. Occurrence and pathogenicity of Naegleria fowleri in artificially heated waters

    SciTech Connect

    Sykora, J.L.; Keleti, G.; Martinez, A.J.

    1983-03-01

    The occurrence of pathogenic Naegleria fowleri in thermal discharges, recipient waters, and cooling towers of eight power plants located in western Pennsylvania was investigated for 2 years in conjunction with several environmental measurements. Pathogenic N. fowleri was detected in one cooling tower and in the discharge, receiving waters, or both of five of eight localities. The occurrence of this organism was related to elevated temperatures, but no significant correlation was found for other biological and chemical parameters. Laboratory experiments on the effect of pH on pathogenic N. fowleri documented 100% survival at a range from 2.1 to 8.15. Higher pH reduced or killed the amoebae. No case of human primary amoebic meningoencephalitis occurred during the study.

  7. Swimming with death: Naegleria fowleri infections in recreational waters.

    PubMed

    Heggie, Travis W

    2010-07-01

    Naegleria fowleri is a free-living amoeba commonly found in warm freshwater environments such as hot springs, lakes, natural mineral water, and resort spas frequented by tourists. N. fowleri is the etiologic agent of primary amoebic meningoencephalitis (PAM), an acute fatal disease of the central nervous system that results in death in approximately seven days. Previously thought to be a rare condition, the number of reported PAM cases is increasing each year. PAM is difficult to diagnose because the clinical signs of the disease are similar to bacterial meningitis. Thus, the key to diagnosis is physician awareness and clinical suspicion. With the intent of creating awareness among travel medicine practitioners and the tourism industry, this review focuses on the presenting features of N. fowleri and PAM and offers insight into the prevention and treatment of the disease. PMID:20970721

  8. Concentration of Naegleria fowleri in natural waters used for recreational purposes in Sonora, Mexico (November 2007-October 2008).

    PubMed

    Lares-Villa, Fernando; Hernández-Peña, Claudia

    2010-09-01

    A survey was designed to know the concentration of Naegleria fowleri in recreational areas in Hornos, Sonora, during a year. Samples were taken monthly at La Isleta and Las Palmas and the total amoeba counts were obtained by the most probable number method (MPN). The identification of N. fowleri was made by PCR. The maximum concentration of total thermophilic amoebae was 9175 MPN/L for La Isleta and 3477 MPN/L for Las Palmas. Thermophilic Naegleria were present mainly during summer and fall. October's concentrations were up to 201 MPN/L, at both places. The maximum concentrations of N. fowleri were 201 MPN/L and 18 MPN/L for La Isleta and Las Palmas respectively, and were isolated from August to October. The presence of N. fowleri in these particular natural bodies of water reinforces the need for adaptation of preventive measures to avoid cases of primary amoebic meningoencephalitis.

  9. What do we know by now about the genus Naegleria?

    PubMed

    De Jonckheere, Johan F

    2014-11-01

    In this short overview of the genus Naegleria a brief historical sketch is given since the discovery of this amoeboflagellate in 1899 and the finding in 1970 that one species, Naegleria fowleri causes primary amoebic meningoencephalitis in man. Eight different types of this pathogen are known which have an uneven distribution over the world. Until now 47 different Naegleria spp. are described, of which two other species cause disease in experimental animals, and their geographical dispersal is indicated. The presence of group I introns in the SSU and in the LSU rDNA in the genus is discussed, as well as the possibility of sex or mating. It is also mentioned that the genome of N. fowleri should not be compared to that of Naegleria gruberi, to know why the former is pathogenic, but to the genome of its closest relative Naegleria lovaniensis.

  10. Swimming with death: Naegleria fowleri infections in recreational waters.

    PubMed

    Heggie, Travis W

    2010-07-01

    Naegleria fowleri is a free-living amoeba commonly found in warm freshwater environments such as hot springs, lakes, natural mineral water, and resort spas frequented by tourists. N. fowleri is the etiologic agent of primary amoebic meningoencephalitis (PAM), an acute fatal disease of the central nervous system that results in death in approximately seven days. Previously thought to be a rare condition, the number of reported PAM cases is increasing each year. PAM is difficult to diagnose because the clinical signs of the disease are similar to bacterial meningitis. Thus, the key to diagnosis is physician awareness and clinical suspicion. With the intent of creating awareness among travel medicine practitioners and the tourism industry, this review focuses on the presenting features of N. fowleri and PAM and offers insight into the prevention and treatment of the disease.

  11. Characterization of a Drinking Water Distribution Pipeline Terminally Colonized by Naegleria fowleri.

    PubMed

    Morgan, Matthew J; Halstrom, Samuel; Wylie, Jason T; Walsh, Tom; Kaksonen, Anna H; Sutton, David; Braun, Kalan; Puzon, Geoffrey J

    2016-03-15

    Free-living amoebae, such as Naegleria fowleri, Acanthamoeba spp., and Vermamoeba spp., have been identified as organisms of concern due to their role as hosts for pathogenic bacteria and as agents of human disease. In particular, N. fowleri is known to cause the disease primary amoebic meningoencephalitis (PAM) and can be found in drinking water systems in many countries. Understanding the temporal dynamics in relation to environmental and biological factors is vital for developing management tools for mitigating the risks of PAM. Characterizing drinking water systems in Western Australia with a combination of physical, chemical and biological measurements over the course of a year showed a close association of N. fowleri with free chlorine and distance from treatment over the course of a year. This information can be used to help design optimal management strategies for the control of N. fowleri in drinking-water-distribution systems.

  12. A real-time PCR diagnostic method for detection of Naegleria fowleri.

    PubMed

    Madarová, Lucia; Trnková, Katarína; Feiková, Sona; Klement, Cyril; Obernauerová, Margita

    2010-09-01

    Naegleria fowleri is a free-living amoeba that can cause primary amoebic meningoencephalitis (PAM). While, traditional methods for diagnosing PAM still rely on culture, more current laboratory diagnoses exist based on conventional PCR methods; however, only a few real-time PCR processes have been described as yet. Here, we describe a real-time PCR-based diagnostic method using hybridization fluorescent labelled probes, with a LightCycler instrument and accompanying software (Roche), targeting the Naegleria fowleriMp2Cl5 gene sequence. Using this method, no cross reactivity with other tested epidemiologically relevant prokaryotic and eukaryotic organisms was found. The reaction detection limit was 1 copy of the Mp2Cl5 DNA sequence. This assay could become useful in the rapid laboratory diagnostic assessment of the presence or absence of Naegleria fowleri.

  13. Detection of the free living amoeba Naegleria fowleri by using conventional and real-time PCR based on a single copy DNA sequence.

    PubMed

    Régoudis, Estelle; Pélandakis, Michel

    2016-02-01

    The amoeba-flagellate Naegleria fowleri is a causative agent of primary amoebic meningoencephalitis (PAM). This thermophilic species occurs worldwide and tends to proliferate in warm aquatic environment. The PAM cases remain rare but this infection is mostly fatal. Here, we describe a single copy region which has been cloned and sequenced, and was used for both conventional and real-time PCR. Targeting a single-copy DNA sequence allows to directly quantify the N. fowleri cells. The real-time PCR results give a detection limit of 1 copy per reaction with high reproducibility without the need of a Taqman probe. This procedure is of interest as compared to other procedures which are mostly based on the detection of multi-copy DNA associated with a Taqman probe.

  14. Pathogenic and free-living protozoa cultured from the nasopharyngeal and oral regions of dental patients.

    PubMed

    Rivera, F; Medina, F; Ramírez, P; Alcocer, J; Vilaclara, G; Robles, E

    1984-04-01

    Protozoa of nose, mouth, and pharynx of 30 randomly chosen female caries patients at an odontological clinic of the National Autonomous University of Mexico, were surveyed by culture from swabs. Culture tubes of swabs from each patient were observed every other day during 5 weeks. Pathogenic protozoa found included Entamoeba histolytica Schaudinn, 1903; Naegleria fowleri Carter, 1970; Acanthamoeba castelanii Douglas, 1930; Acanthamoeba culbertsoni Singh & Das, 1970; and Balantidium coli (Malmsten, 1857) Stein, 1862. This isolation of pathogens suggests that healthy patients may be healthy carriers of cysts of protozoa, mainly amoebae, responsible for several diseases, including primary amoebic meningoencephalitis. Small pathogenic free-living amoebae have not been isolated before from females in Mexico. Many species of free-living protozoa were also cultured from swabs from the patients. PMID:6370674

  15. The effect of thermal pollution on the distribution of Naegleria fowleri.

    PubMed

    De Jonckheere, J; Van Dijck, P; Van de Voorde, H

    1975-08-01

    The distribution in the environment of Naegleria fowleri, the causal agent of primary amoebic meningoencephalitis has been investigated in this study. N. fowleri was isolated only from a thermally polluted canal. These amoebaflagellates were not isolated from another thermally polluted canal in the neighbourhood indicating that, apart from high temperature, other factors are involved in the selective proliferation of N. fowleri. This species was absent in all other samples originating from two canals, a stream, two lakes, several reservoirs and slow sandfilters of a water supply service and also a water distribution network. Many other amoebae able to grow at 42 degrees C. were found in different places. Most of the N. fowleri strains isolated were not virulent for mice, although they showed all the characteristics of the pathogenic strains.

  16. Experimental pneumonitis induced by Naegleria fowleri in mice.

    PubMed

    Willaert, E; Stevens, A R

    1980-01-01

    An environmental Naegleria isolate, from a cooling lake receiving thermal additions from an electric power plant, caused both primary amoebic meningoencephalitis (PAM) and pneumonitis in mice after intranasal inoculation. Amoebae, recovered from brains and lungs of mice inoculated with the environmental isolate, produced both brain and lung infections in repeated mouse passages. Electron microscope examination of infected lungs revealed a moderate inflammatory reaction with slight necrosis. Amoebae re-isolated from mice with PAM and pneumonitis were identified as N. fowleri by the indirect immuno-fluorescent antibody technique using anti-N. fowleri serum. The results suggest that in addition to PAM, N. fowleri may be capable of causing subacute and acute respiratory infections in man.

  17. Naegleria fowleri: a free living amoeba of emerging medical importance.

    PubMed

    Parija, S C; Jayakeerthee, S R

    1999-09-01

    Naegleria fowleri, a free-living amoeba is ubiquitous and word-wide in distribution. Infection is due to inhalation or aspiration of aerosols containing cysts found in the environment. Of late, the amoeba is emerging as a pathogen of medical importance causing primary amoebic meningoencephalitis (PAM) in humans. The diagnosis of the condition is mainly parasitic which depends on the detection and identification of Naegleria trophozoites in the cerebro-spinal fluid (CSF) or biopsied brain tissue. Serological tests are not useful in the diagnosis of PAM. Most cases are fatal and various amoebicidal agents have been tried unsuccessfully. The present paper provides a review of the recent information on the biology and epidemiology of the disease caused by the amoeba Approaches in the diagnosis, pathophysiology and treatment of the condition are also discussed.

  18. Broadly reactive pan-paramyxovirus reverse transcription polymerase chain reaction and sequence analysis for the detection of Canine distemper virus in a case of canine meningoencephalitis of unknown etiology

    PubMed Central

    Schatzberg, Scott J.; Li, Qiang; Porter, Brian F.; Barber, Renee M.; Claiborne, Mary Kate; Levine, Jonathan M.; Levine, Gwendolyn J.; Israel, Sarah K.; Young, Benjamin D.; Kiupel, Matti; Greene, Craig; Ruone, Susan; Anderson, Larry; Tong, Suxiang

    2016-01-01

    Despite the immunologic protection associated with routine vaccination protocols, Canine distemper virus (CDV) remains an important pathogen of dogs. Antemortem diagnosis of systemic CDV infection may be made by reverse transcription polymerase chain reaction (RT-PCR) and/or immunohistochemical testing for CDV antigen; central nervous system infection often requires postmortem confirmation via histopathology and immunohistochemistry. An 8-month-old intact male French Bulldog previously vaccinated for CDV presented with multifocal neurologic signs. Based on clinical and postmortem findings, the dog’s disease was categorized as a meningoencephalitis of unknown etiology. Broadly reactive, pan-paramyxovirus RT-PCR using consensus-degenerate hybrid oligonucleotide primers, combined with sequence analysis, identified CDV amplicons in the dog’s brain. Immunohistochemistry confirmed the presence of CDV antigens, and a specific CDV RT-PCR based on the phosphoprotein gene identified a wild-type versus vaccinal virus strain. This case illustrates the utility of broadly reactive PCR and sequence analysis for the identification of pathogens in diseases with unknown etiology. PMID:19901287

  19. Amoebic liver abscess production by Entamoeba dispar.

    PubMed

    Dolabella, Silvio S; Serrano-Luna, Jesús; Navarro-García, Fernando; Cerritos, René; Ximénez, Cecilia; Galván-Moroyoqui, José Manuel; Silva, Edward F; Tsutsumi, Víctor; Shibayama, Mineko

    2012-01-01

    Although Entamoeba dispar displays a similar morphology to Entamoeba histolytica, cellular and molecular studies have revealed significant differences between these two amoebae, including the former being characterized as non-pathogenic and the later as pathogenic. However, recent in vivo and in vitro experiments have shown that E. dispar strains of different origin are capable of causing liver damage and destroying cell culture lines in the presence of common intestinal bacteria. These results suggested that E. dispar may present pathogenic behavior according to the specific E. dispar strain, culture and environmental conditions. To investigate this possibility, we carried out in vivo and in vitro studies using a xenic strain E. dispar (ICB-ADO) isolated from a symptomatic non-dysenteric Brazilian patient. This strain was able to induce liver necrosis in a hamster model that was more severe than that produced by E. histolytica. The ICB-ADO isolate also caused significantly more destruction of cultured MDCK cells and increased loss of transepithelial resistance than did the E. histolytica. Xenic E. dispar exhibited high proteolytic activity, which was partially inhibited by the addition of cysteine-protease inhibitors. Based on our biochemical and molecular characterization of E. dispar (ICB-ADO) xenic culture and its ability to produce liver abscesses, we conclude that this specific strain can indeed produce tissue damage, distinct from the frequently used non- pathogenic E. dispar SAW 760 strain.

  20. Amphizoic amoebae: pathogenic free-living protozoa; review of the literature and review of cases in Thailand.

    PubMed

    Siripanth, Chutatip

    2005-05-01

    A large variety of species of free-living amoebae (FLA) caused an indefinite form of these protozoa. Non-fixed form, as indicated by amoeboid movement and possed the bacteria to survive in nature. Two species of pathogenic FLA: Naegleria fowleri and Acanthamoeba spp. were identified as the causative agents of Primary Amoebic Meningoencephalitis (PAM) and Granulomatous Amoebic Encephalitis (GAE) respectively. They were suggested to amphizoic protozoa, capable of living as parasites or as free-living and they were also considered to be distributed worldwide. These amoebae were detected in lakes, rivers and ponds. The first case of meningoencephalitis was observed in 1961 by Fowler Many cases were reported later on and the pathogenicity was tested by nasal inoculation of mice. In fact, quite a number of FLA were isolated but only a few species were pathogenic to humans. The three typical features which allow recognition of Naegleria spp. flagellate stage, round cyst and promitotic trophozoite. This promitosis distinguishes the Naegleria genus from Acanthamoeba spp. The disease caused by PAM usually occurs with acute onset, whereas chronic for GAE. The GAE cases mentioned are mostly in debilitated patients, chronic alcoholics or patients under treatment with immunosuppressive methods. About 6 cases of PAM were reported in Thailand during 1982-1997. Four cases of GAE were reported in 1994 and two isolated cases ofAcanthamoebafrom keratitis patients were reported in 2000. Finally one case of PAM and one case of GAE were reported in 2001. The surveys of FLA were set up to study the distribution of these pathogenic amoebae and determine the prevalence of amoebae in aquatic habitats of human environments. About 40% were identified as Acanthamoeba spp., 30% were Naegleria spp., 20% were Hartmanella and 10% were Vahlkampfia. Only 10% of Naegleria spp. belonged to Naegleria fowleri.

  1. Effective PCR-based detection of Naegleria fowleri from cultured sample and PAM-developed mouse.

    PubMed

    Kang, Heekyoung; Seong, Gi-Sang; Sohn, Hae-Jin; Kim, Jong-Hyun; Lee, Sang-Eun; Park, Mi Yeoun; Lee, Won-Ja; Shin, Ho-Joon

    2015-10-01

    Increasing numbers of Primary Amoebic Meningoencephalitis (PAM) cases due to Naegleria fowleri are becoming a serious issue in subtropical and tropical countries as a Neglected Tropical Disease (NTD). To establish a rapid and effective diagnostic tool, a PCR-based detection technique was developed based on previous PCR methods. Four kinds of primer pairs, Nfa1, Nae3, Nf-ITS, and Naegl, were employed in the cultured amoebic trophozoites and a mouse with PAM experimentally developed by N. fowleri inoculation (PAM-mouse). For the extraction of genomic DNA from N. fowleri trophozoites (1×10(6)), simple boiling with 10μl of PBS (pH 7.4) at 100°C for 30min was found to be the most rapid and efficient procedure, allowing amplification of 2.5×10(2) trophozoites using the Nfa-1 primer. The primers Nfa1 and Nae3 amplified only N. fowleri DNA, whereas the ITS primer detected N. fowleri and N. gruberi DNA. Using the PAM-mouse brain tissue, the Nfa1 primer was able to amplify the N. fowleri DNA 4 days post infection with 1ng/μl of genomic DNA being detectable. Using the PAM-mouse CSF, amplification of the N. fowleri DNA with the Nae3 primer was possible 5 days post infection showing a better performance than the Nfa1 primer at day 6. PMID:26322498

  2. Mucins in the host defence against Naegleria fowleri and mucinolytic activity as a possible means of evasion.

    PubMed

    Cervantes-Sandoval, Isaac; Serrano-Luna, José de Jesús; García-Latorre, Ethel; Tsutsumi, Víctor; Shibayama, Mineko

    2008-12-01

    Naegleria fowleri is the aetiological agent of primary amoebic meningoencephalitis (PAM). This parasite invades its host by penetrating the olfactory mucosa. During the initial stages of infection, the host response is initiated by the secretion of mucus that traps the trophozoites. Despite this response, some trophozoites are able to reach, adhere to and penetrate the epithelium. In the present work, we evaluated the effect of mucins on amoebic adherence and cytotoxicity to Madin-Darby canine kidney (MDCK) cells and the MUC5AC-inducing cell line NCI-H292. We showed that mucins inhibited the adhesion of amoebae to both cell lines; however, this inhibition was overcome in a time-dependent manner. N. fowleri re-established the capacity to adhere faster than N. gruberi. Moreover, mucins reduced the cytotoxicity to target cells and the progression of the illness in mice. In addition, we demonstrated mucinolytic activity in both Naegleria strains and identified a 37 kDa protein with mucinolytic activity. The activity of this protein was inhibited by cysteine protease inhibitors. Based on these results, we suggest that mucus, including its major mucin component, may act as an effective protective barrier that prevents most cases of PAM; however, when the number of amoebae is sufficient to overwhelm the innate immune response, the parasites may evade the mucus by degrading mucins via a proteolytic mechanism.

  3. A biochemical comparison of proteases from pathogenic naegleria fowleri and non-pathogenic Naegleria gruberi.

    PubMed

    Serrano-Luna, Jesús; Cervantes-Sandoval, Isaac; Tsutsumi, Victor; Shibayama, Mineko

    2007-01-01

    Naegleria fowleri is the etiologic agent of primary amoebic meningoencephalitis (PAM). Proteases have been suggested to be involved in tissue invasion and destruction during infection. We analyzed and compared the complete protease profiles of total crude extract and conditioned medium of both pathogenic N. fowleri and non-pathogenic Naegleria gruberi trophozoites. Using SDS-PAGE, we found differences in the number and molecular weight of proteolytic bands between the two strains. The proteases showed optimal activity at pH 7.0 and 35 degrees C for both strains. Inhibition assays showed that the main proteolytic activity in both strains is due to cysteine proteases although serine proteases were also detected. Both N. fowleri and N. gruberi have a variety of different protease activities at different pH levels and temperatures. These proteases may allow the amoebae to acquire nutrients from different sources, including those from the host. Although, the role of the amoebic proteases in the pathogenesis of PAM is not clearly defined, it seems that proteases and other molecules of the parasite as well as those from the host, could be participating in the damage to the human central nervous system.

  4. Immunodominant antigens in Naegleria fowleri excretory--secretory proteins were potential pathogenic factors.

    PubMed

    Kim, Jong-Hyun; Yang, Ae-Hee; Sohn, Hae-Jin; Kim, Daesik; Song, Kyoung-Ju; Shin, Ho-Joon

    2009-11-01

    Naegleria fowleri, a ubiquitous pathogenic free-living amoeba, is the most virulent species and causes primary amoebic meningoencephalitis in laboratory animals and humans. The parasite secretes various inducing molecules as biological responses, which are thought to be involved in pathophysiological and immunological events during infection. To investigate what molecules of N. fowleri excretory-secretory proteins (ESPs) are related with amoebic pathogenicity, N. fowleri ESPs fractionated by two-dimensional electrophoresis were reacted with N. fowleri infection or immune sera. To identify immunodominant ESPs, six major protein spots were selected and analyzed by N-terminal sequencing. Finally, six proteins, 58, 40, 24, 21, 18, and 16 kDa of molecular weight, were partially cloned and matched with reference proteins as follow: 58 kDa of exendin-3 precursor, 40 kDa of secretory lipase, 24 kDa of cathepsin B-like proteases and cysteine protease, 21 kDa of cathepsin B, 18 kDa of peroxiredoxin, and 16 kDa of thrombin receptor, respectively. These results suggest that N. fowleri ESPs contained important proteins, which may play an important role in the pathogenicity of N. fowleri.

  5. Effective PCR-based detection of Naegleria fowleri from cultured sample and PAM-developed mouse.

    PubMed

    Kang, Heekyoung; Seong, Gi-Sang; Sohn, Hae-Jin; Kim, Jong-Hyun; Lee, Sang-Eun; Park, Mi Yeoun; Lee, Won-Ja; Shin, Ho-Joon

    2015-10-01

    Increasing numbers of Primary Amoebic Meningoencephalitis (PAM) cases due to Naegleria fowleri are becoming a serious issue in subtropical and tropical countries as a Neglected Tropical Disease (NTD). To establish a rapid and effective diagnostic tool, a PCR-based detection technique was developed based on previous PCR methods. Four kinds of primer pairs, Nfa1, Nae3, Nf-ITS, and Naegl, were employed in the cultured amoebic trophozoites and a mouse with PAM experimentally developed by N. fowleri inoculation (PAM-mouse). For the extraction of genomic DNA from N. fowleri trophozoites (1×10(6)), simple boiling with 10μl of PBS (pH 7.4) at 100°C for 30min was found to be the most rapid and efficient procedure, allowing amplification of 2.5×10(2) trophozoites using the Nfa-1 primer. The primers Nfa1 and Nae3 amplified only N. fowleri DNA, whereas the ITS primer detected N. fowleri and N. gruberi DNA. Using the PAM-mouse brain tissue, the Nfa1 primer was able to amplify the N. fowleri DNA 4 days post infection with 1ng/μl of genomic DNA being detectable. Using the PAM-mouse CSF, amplification of the N. fowleri DNA with the Nae3 primer was possible 5 days post infection showing a better performance than the Nfa1 primer at day 6.

  6. Antagonistic action of the bacterium Bacillus licheniformis M-4 toward the amoeba Naegleria fowleri.

    PubMed

    Cordovilla, P; Valdivia, E; Gonzalez-Segura, A; Galvez, A; Martinez-Bueno, M; Maqueda, M

    1993-01-01

    Free-living amoebae belonging to the species Naegleria fowleri are known to be the etiological agents for a form of fulminant meningoencephalitis that is generally fatal (primary amoebic meningoencephalitis). In a broad bacterial screening from soil and water we have isolated three strains (M-4, D-13 and A-12) belonging to the species Bacillus licheniformis that have remarkable amoebicidal activity against Naegleria sp. and also against different Gram-positive and Gram-negative bacteria. Physical-chemical characteristics, partial purification and biological activities of a substance produced by the M-4 strain have been investigated. This substance (m-4) is stable at high temperature (up to 100 degrees C) and extremes of pH (2.5-9.5) and also at -20 degrees C for months. Its production is greatly influenced by oxygenation of the cultures and is probably related to the sporulation process of the bacterium. Scanning electron microscope observations reveal that amoebae are lysed after a few minutes contact with m-4.

  7. Primary enzyme quantitation

    DOEpatents

    Saunders, G.C.

    1982-03-04

    The disclosure relates to the quantitation of a primary enzyme concentration by utilizing a substrate for the primary enzyme labeled with a second enzyme which is an indicator enzyme. Enzyme catalysis of the substrate occurs and results in release of the indicator enzyme in an amount directly proportional to the amount of primary enzyme present. By quantifying the free indicator enzyme one determines the amount of primary enzyme present.

  8. Primary Care's Dim Prognosis

    ERIC Educational Resources Information Center

    Alper, Philip R.

    2010-01-01

    Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its…

  9. Investigating Primary Source Literacy

    ERIC Educational Resources Information Center

    Archer, Joanne; Hanlon, Ann M.; Levine, Jennie A.

    2009-01-01

    Primary source research requires students to acquire specialized research skills. This paper presents results from a user study testing the effectiveness of a Web guide designed to convey the concepts behind "primary source literacy". The study also evaluated students' strengths and weaknesses when conducting primary source research. (Contains 3…

  10. Medics in Primary School

    ERIC Educational Resources Information Center

    Press, Colin

    2003-01-01

    Some time ago a flyer on "Medics in Primary School" came the author's way. It described a programme for making placements in primary schools available to medical students. The benefits of the program to medical students and participating schools were highlighted, including opportunities to develop communication skills and demystify medicine. It…

  11. Primary Science Focus

    ERIC Educational Resources Information Center

    Turner, Jane

    2011-01-01

    Liz Lawrence has recently finished her term as Chair of Primary Science Committee (PSC). She is one of the 41 hub leaders who have led and mentored 192 schools across England and British Forces' schools in Germany, to achieve the first ever nationally recognised awards to celebrate excellence in primary science. In this article, the author writes…

  12. Primary pulmonary leiomyoma.

    PubMed

    Wu, Peng; Venkatachalam, Jonathen; Lee, Victor Kwan Min; Tan, Sze Khen

    2016-05-01

    Leiomyoma is a smooth muscle neoplasm that commonly occurs in the genitourinary system and the gastrointestinal tract of the body. Primary pulmonary leiomyoma is rarely reported in literature. We report a rare case of primary pulmonary leiomyoma of a 55-year-old male patient presenting with symptoms of cough for six months. PMID:27516882

  13. Transforming Primary Mathematics

    ERIC Educational Resources Information Center

    Askew, Mike

    2011-01-01

    What is good mathematics teaching? What is mathematics teaching good for? Who is mathematics teaching for? These are just some of the questions addressed in "Transforming Primary Mathematics", a highly timely new resource for teachers which accessibly sets out the key theories and latest research in primary maths today. Under-pinned by findings…

  14. Using Primary Source Documents.

    ERIC Educational Resources Information Center

    Mintz, Steven

    2003-01-01

    Explores the use of primary sources when teaching about U.S. slavery. Includes primary sources from the Gilder Lehrman Documents Collection (New York Historical Society) to teach about the role of slaves in the Revolutionary War, such as a proclamation from Lord Dunmore offering freedom to slaves who joined his army. (CMK)

  15. EMR Curriculum Guide: Primary.

    ERIC Educational Resources Information Center

    Ruschmeier, Veronica M., Ed.; Rockwell, Linda, Ed.

    Presented is a curriculum guide for educable mentally retarded children in primary and intermediate grades which specifies behavioral and interim objectives in the areas of basic verbal and arithmetic skills, vocational competencies, social competencies, and physical skills. Objectives such as the following are identified at the primary level:…

  16. Visualizing renal primary cilia.

    PubMed

    Deane, James A; Verghese, Elizabeth; Martelotto, Luciano G; Cain, Jason E; Galtseva, Alya; Rosenblum, Norman D; Watkins, D Neil; Ricardo, Sharon D

    2013-03-01

    Renal primary cilia are microscopic sensory organelles found on the apical surface of epithelial cells of the nephron and collecting duct. They are based upon a microtubular cytoskeleton, bounded by a specialized membrane, and contain an array of proteins that facilitate their assembly, maintenance and function. Cilium-based signalling is important for the control of epithelial differentiation and has been implicated in the pathogenesis of various cystic kidney diseases and in renal repair. As such, visualizing renal primary cilia and understanding their composition has become an essential component of many studies of inherited kidney disease and mechanisms of epithelial regeneration. Primary cilia were initially identified in the kidney using electron microscopy and this remains a useful technique for the high resolution examination of these organelles. New reagents and techniques now also allow the structure and composition of primary cilia to be analysed in detail using fluorescence microscopy. Primary cilia can be imaged in situ in sections of kidney, and many renal-derived cell lines produce primary cilia in culture providing a simplified and accessible system in which to investigate these organelles. Here we outline microscopy-based techniques commonly used for studying renal primary cilia.

  17. Primary aldosteronism and pregnancy.

    PubMed

    Morton, Adam

    2015-10-01

    Primary aldosteronism is the most common cause of secondary hypertension. Less than 50 cases of pregnancy in women with primary aldosteronism have been reported, suggesting the disorder is significantly underdiagnosed in confinement. Accurate diagnosis is complicated by physiological changes in the renin-angiotensin-aldosterone axis in pregnancy, leading to a risk of false negative results on screening tests. The course of primary aldosteronism during pregnancy is highly variable, although overall it is associated with a very high risk of fetal and maternal morbidity and mortality. The optimal management of primary aldosteronism during pregnancy is unclear, with uncertainty regarding the safety of mineralocorticoid antagonists and amiloride, their relative efficacy compared with the antihypertensive medications commonly used during pregnancy, and as to whether prognosis is improved by laparoscopic adrenalectomy where an adrenal adenoma can be demonstrated.

  18. Brain tumor - primary - adults

    MedlinePlus

    ... tumor, relieve symptoms, and improve brain function or comfort. Surgery is often needed for most primary brain ... and pressure Anticonvulsants to reduce seizures Pain medicines Comfort measures, safety measures, physical therapy, and occupational therapy ...

  19. Staging Primary CNS Lymphoma

    MedlinePlus

    ... large vein near the heart. Having a weakened immune system may increase the risk of developing primary CNS ... immunodeficiency syndrome (AIDS) or other disorders of the immune system or who have had a kidney transplant . For ...

  20. Genetics of primary hyperaldosteronism.

    PubMed

    Dutta, Ravi Kumar; Söderkvist, Peter; Gimm, Oliver

    2016-10-01

    Hypertension is a common medical condition and affects approximately 20% of the population in developed countries. Primary aldosteronism is the most common form of secondary hypertension and affects 8-13% of patients with hypertension. The two most common causes of primary aldosteronism are aldosterone-producing adenoma and bilateral adrenal hyperplasia. Familial hyperaldosteronism types I, II and III are the known genetic syndromes, in which both adrenal glands produce excessive amounts of aldosterone. However, only a minority of patients with primary aldosteronism have one of these syndromes. Several novel susceptibility genes have been found to be mutated in aldosterone-producing adenomas: KCNJ5, ATP1A1, ATP2B3, CTNNB1, CACNA1D, CACNA1H and ARMC5 This review describes the genes currently known to be responsible for primary aldosteronism, discusses the origin of aldosterone-producing adenomas and considers the future clinical implications based on these novel insights. PMID:27485459

  1. Primary infertility (image)

    MedlinePlus

    Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy ... to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well ...

  2. Parenthood after Primary Infertility.

    ERIC Educational Resources Information Center

    Frances-Fischer, Jana E.; Lightsey, Owen Richard, Jr.

    2003-01-01

    Reviews the literature on the experience of parenting after primary infertility and describes construction and initial testing of an instrument for assessing characteristics of this understudied population. (Contains 52 references and 4 tables.) (GCP)

  3. Thanksgiving in Primary Literature.

    ERIC Educational Resources Information Center

    Branum, Nell Carter

    1996-01-01

    Examines how the holiday of Thanksgiving is treated in primary books and offers comparisons of 28 popular titles in print. Innovative classroom and media center projects are described, including discussions, drawings, bulletin boards, problem-solving activities, and cooking. (LRW)

  4. Primary actinomycosis of hand

    PubMed Central

    Padhi, Sanghamitra; Dash, Muktikesh; Turuk, Jyotirmayee; Sahu, Rani; Panda, Pritilata

    2014-01-01

    Actinomycosis is a chronic granulomatous suppurative disease having the propensity for extension to the contagious tissue with the formation of multiple discharging sinus tracts. Primary actinomycosis of extremity is a very uncommon clinical entity and is commonly considered as a soft-tissue infection. We report here, a case of primary actinomycosis of the upper extremity in a 24-year-old male who was treated successfully with surgical excision and extended period of antimicrobial treatment. PMID:25538911

  5. Primary headache disorders.

    PubMed

    Benoliel, Rafael; Eliav, Eli

    2013-07-01

    Primary headache disorders include migraine, tension-type headaches, and the trigeminal autonomic cephalgias (TACs). "Primary" refers to a lack of clear underlying causative pathology, trauma, or systemic disease. The TACs include cluster headache, paroxysmal hemicrania, and short-lasting neuralgiform headache attacks with conjunctival injection and tearing; hemicrania continua, although classified separately by the International Headache Society, shares many features of both migraine and the TACs. This article describes the features and treatment of these disorders.

  6. Treatment of primary syphilis.

    PubMed

    Elliott, W C

    1976-12-01

    Reports in the English language of the treatment of primary syphilis are reviewed. Except for benzathine penicillin, the efficacy of the currently recommended dosage schedules are documented only by Schroeter et al. Although these investigators reported generally acceptable failure rates, further study is necessary to determine: (1) if differences in efficacy exist among regimes; (2) if the current schedules are equally effective in both primary and secondary syphilis; and (3) if increased dosages reduce failure rates. PMID:1010777

  7. Primary biliary cirrhosis.

    PubMed

    Carey, Elizabeth J; Ali, Ahmad H; Lindor, Keith D

    2015-10-17

    Primary biliary cirrhosis is a chronic cholestatic liver disease characterised by destruction of small intrahepatic bile ducts, leading to fibrosis and potential cirrhosis through resulting complications. The serological hallmark of primary biliary cirrhosis is the antimitochondrial antibody, a highly disease-specific antibody identified in about 95% of patients with primary biliary cirrhosis. These patients usually have fatigue and pruritus, both of which occur independently of disease severity. The typical course of primary biliary cirrhosis has changed substantially with the introduöction of ursodeoxycholic acid (UDCA). Several randomised placebo-controlled studies have shown that UDCA improves transplant-free survival in primary biliary cirrhosis. However, about 40% of patients do not have a biochemical response to UDCA and would benefit from new therapies. Liver transplantation is a life-saving surgery with excellent outcomes for those with decompensated cirrhosis. Meanwhile, research on nuclear receptor hormones has led to the development of exciting new potential treatments. This Seminar will review the current understanding of the epidemiology, pathogenesis, and natural history of primary biliary cirrhosis, discuss management of the disease and its sequelae, and introduce research on new therapeutic options. PMID:26364546

  8. What is primary care?

    PubMed

    1983-06-01

    This discussion of primary care directs attention to quality of care and the primary care team. Primary care is the care provided by the 1st person the patient sees who has been trained in health care. The answer to the question of who should provide primary care should be based on the tasks and responsibilities which must be met. These are: correct diagnosis as the precondition for treatment; appropriate treatment to restore maximum possible restoration of function; relief of pain and suffering and alleviation of anxieties associated with illness; appropriate referral for specialized diagnostic, treatment, and rehabilitation services; management responsibility for the overall health of the patient; preventive services, i.e., immunization, multiphasic screening for early detection, and preventive supervision; and health education and advice for health promotion, disease prevention, treatment and rehabilitation. The need for highly trained primary care practitioners is illustrated by a study conducted by Ciocco, Hunt, and Altman as part of the 1946 survey of group practice by the US Public Health Service. In each of 16 medical groups, they abstracted the records of 200 new patients to obtain data on the services received for a period of 14 days following admission. When they compared the 5 groups with the greatest average amount of hospital training of physicians with the 5 groups with the lowest amount, siginificant differences were found. There were more general examinations among patients of the groups in the high set, 46% against 36%, and there were fewer patients for whom no examination was recorded. Significant differences were also found in treatment between the high and low sets. The study implications were clear. The old style general practitioner can hardly be considered competent to provide a high quality of primary care, yet these were the primary care practitioners that the United Mine Workers Association (UMWA) medical care program encountered in the

  9. Primary lymphoma of the brain

    MedlinePlus

    Brain lymphoma; Cerebral lymphoma; Primary lymphoma of the central nervous system; Lymphoma - brain ... The cause of primary brain lymphoma is not known. People with a weakened immune system are at high risk for primary lymphoma of the brain. ...

  10. [Cerebral venous thrombosis during tuberculous meningoencephalitis].

    PubMed

    Guenifi, W; Boukhrissa, H; Gasmi, A; Rais, M; Ouyahia, A; Hachani, A; Diab, N; Mechakra, S; Lacheheb, A

    2016-05-01

    Cerebral venous thrombosis is a rare disease characterized by its clinical polymorphism and multiplicity of risk factors. Infections represent less than 10% of etiologies. Tuberculosis is not a common etiology, only a few observations are published in the literature. Between January 2005 and March 2015, 61 patients were hospitalized for neuro-meningeal tuberculosis. Among them, three young women had presented one or more cerebral venous sinus thromboses. No clinical feature was observed in these patients; vascular localizations were varied: sagittal sinus (2 cases), lateral sinus (2 cases) and transverse sinus (1 case). With anticoagulant and antituberculosis drugs, the outcome was favorable in all cases. During neuro-meningeal tuberculosis, the existence of consciousness disorders or neurological focal signs is not always the translation of encephalitis, hydrocephalus, tuberculoma or ischemic stroke; cerebral venous sinus thrombosis may be the cause and therefore should be sought. PMID:27090100

  11. Primary cutaneous nocardiosis.

    PubMed

    Jiang, Shan; Jiang, Guan; Lei, Tie-Chi

    2014-11-01

    Nocardiosis is a rare human infection due to ubiquitous soil born gram-positive, filametous aerobic bacteria. First signs are frequently cutaneous either as part of systemic infection disseminated to the skin, or as primary cutaneous inoculation. An 88 years old man presented with a 3-day history of red papules and pustules with pain on his forehead. The combination of the unusual clinical presentation, laboratory examinations, and a favorable response to co-trimoxazole therapy were consistent with a diagnosis of primary cuteneous nocardiosis. Early recognition and treatment of the disease will improve the cure rate. PMID:25518763

  12. Primary retroperitoneal mucinous cystadenoma.

    PubMed

    Rifki Jai, S; Bouffetal, R; Chehab, F; Khaiz, D; Bouzidi, A

    2009-09-01

    Primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Traditionally, transabdominal laparotomy and enucleation of the cyst is the treatment of choice. The anatomopathological examination of the mass is imperative in the fact to eliminate malignant lesions. We report the case of a 43-year-old woman, with primary retroperitoneal mucinous cystic tumor, revealed by an abdomino-pelvic mass. During laparotomy, a totality of the tumor was removed. The anatomopathologic study permitted the diagnosis.

  13. Isolation, identification and increasing importance of 'free-living' amoebae causing human disease.

    PubMed

    Szénási, Z; Endo, T; Yagita, K; Nagy, E

    1998-01-01

    Amphizoic small amoebic protozoa are capable of existing both in 'free-living' and in 'parasitic' form depending on the actual conditions. Two genera (Naegleria and Acanthamoeba) have become recognised as opportunist human parasites. Since the first description in 1965 of a lethal case of primary amoebic meningoencephalitis (PAM) caused by Naegleria, many more (mostly lethal) cases have been reported, while granulomatous amoebic encephalitis (GAE), as well as eye (keratinitis, conjunctivitis, etc.), ear, nose, skin and internal organ infections caused by Acanthamoeba have also occurred in rapidly increasing numbers. Both pathogenic and non-pathogenic species of Naegleria and Acanthamoeba are found worldwide in water, soil and dust, where they provide a potential source of infection. Successful differential diagnosis and appropriate (specific) therapy depends on precise laboratory identification of the 'free-living' amoebae. In most cases, isolation from the environment can be achieved, but identification and differentiation of the pathogenic and non-pathogenic strains is not easy. The methods presently available do not fulfil completely the requirements for specificity, sensitivity and reliability. Morphological criteria are inadequate, while thermophilic character, pH dependency and even virulence in infected mice, are not unambiguous features of pathogenicity of the different strains. More promising are molecular methods, such as restriction endonuclease digestion of whole-cell DNA or mitochondrial DNA, as well as iso-enzyme profile analysis after iso-electric focusing and staining for acid phosphatase and propionyl esterase activity. Use of appropriate monoclonal antibodies has also yielded promising results in the differentiation of human pathogenic and non-pathogenic strains. However, quicker, simpler, more specific and reliable methods are still highly desirable. The significance of endosymbiosis (especially with Legionella strains) is not well understood

  14. Healthcare is primary.

    PubMed

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation. PMID:26985402

  15. GMT primary mirror support

    NASA Astrophysics Data System (ADS)

    Hull, Charlie

    2014-07-01

    The GMT primary mirror support draws on the heritage developed for the 3.5 m, 6.5 m, and 8.4 m mirrors from the Steward Observatory Mirror Lab. While similar in design philosophy and concept, each successive generation has incorporated refinements based on the experience gained from previous mirrors.

  16. Philosophy in Primary Schools?

    ERIC Educational Resources Information Center

    White, John

    2012-01-01

    The article is a critical discussion of the aims behind the teaching of philosophy in British primary schools. It begins by reviewing the recent Special Issue of the "Journal of Philosophy of Education" Vol 45 Issue 2 2011 on "Philosophy for Children in Transition", so as to see what light this might throw on the topic just mentioned. The result…

  17. Primary Premier for Belfast

    ERIC Educational Resources Information Center

    McAlister, Peter

    2009-01-01

    The author talks about the Association for Science Education (ASE) Primary Science Committee's (PSC) March 2009 meeting which was held in Belfast as guests of ASE Northern Ireland. To mark the auspicious occasion of a body that usually meets four times a year in the Hatfield HQ crossing the Irish Sea to be hosted by its Celtic cousins, a Lord…

  18. Primary Art Resource Guide.

    ERIC Educational Resources Information Center

    Newton Unified School District 373, KS.

    GRADES OR AGES: Primary Grades. SUBJECT MATTER: Art. ORGANIZATION AND PHYSICAL APPEARANCE: The guide begins with a list of topics for art expression. The main body of the guide contains 15 color-coded sections on the following subjects: 1) mobiles and folded paper; 2) collage and photo montage; 3) square paper and mosaics; 4) wax paper and…

  19. Primary galvanic cell

    SciTech Connect

    Bernstein, P.; Coffey, J.P.; Wilson, J.W.

    1981-03-03

    A primary galvanic cell displaying superior leak-resistant characteristics is described. A molded battery container having one open end is sealed by an end cap having both insulating and conducting properties. An electrode, integrally affixed to the end cap and in electrical registry therewith, is disposed within the cell.

  20. Primary hepatic angiosarcoma.

    PubMed

    Chaudhary, P; Bhadana, U; Singh, R A K; Ahuja, A

    2015-09-01

    Primary hepatic angiosarcoma is a rare, aggressive tumor; composed of spindle or pleomorphic cells that line, or grow into, the lumina of pre-existing vascular spaces like sinusoids and terminal hepatic venules; with only about 200 cases diagnosed annually worldwide but it is the most common primary malignant mesenchymal tumor of the liver in adults and accounts for 2% of all primary hepatic malignancies. HAS occurs in association with known chemical carcinogens, but 75% of the tumors have no known etiology. Patients present with vague symptoms like abdominal pain, weight loss, fatigue or an abdominal mass. Hepatic angiosarcoma is usually multicentric and involves both lobes, entire liver may also found to be involved. CD31 is the most reliable marker. These tumors lack specific features on imaging, so, pathological diagnosis is necessary. There are no established treatment guidelines because of low frequency and aggressive nature of tumor, chemotherapy is only palliative, liver resection is indicated for solitary mass and liver transplant is contraindicated. The aim of this article is to comprehensively review all the available literature and to present detailed information and an update on primary hepatic angiosarcoma. PMID:26008857

  1. Multiple Primary Cancer Monograph

    Cancer.gov

    To identify groups of cancer survivors that are at increased risk for multiple primary cancers, investigators led an effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S., resulting in a monograph.

  2. Primary Pulmonary Hodgkin Lymphoma

    PubMed Central

    Tanveer, Shumaila; El Damati, Ahmed; El Baz, Ayman; Alsayyah, Ahmed; ElSharkawy, Tarek

    2015-01-01

    Primary pulmonary Hodgkin lymphoma (PPHL) is a rare disease. Herein, we report a case of PPHL with diagnostic concerns encountered during initial evaluation which is of paramount importance to keep the differential diagnosis in cases with high index of suspicion for this rare entity. PMID:26788271

  3. [Primary retroperitoneal hydatidosis].

    PubMed

    Benejam Gual, J M; Rioja Sanz, C; Cuesta Presedo, J M; Gil Martínez, P; Bono Ariño, A; Rioja Sanz, L A

    1997-05-01

    Genitourinary involvement by the Echinococcus granulosus larvae (urinary hydatidosis) ranks third in order of frequency after liver and lung involvement. The finding of a primary hydatidic cyst with retroperitoneal location is an uncommon fact. This paper presents once case of this infrequent disease. A revision of the different etiopathogenic mechanisms, as well as diagnostic and therapeutic approaches is made.

  4. Healthcare is primary.

    PubMed

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  5. Healthcare is primary

    PubMed Central

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2nd National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on “healthcare” in India. The theme of this conference was “Healthcare is Primary.” The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the “general health system” instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, “family medicine” (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation. PMID:26985402

  6. Primary Keyboarding Curriculum.

    ERIC Educational Resources Information Center

    Peterson, Valery; And Others

    Beginning with a rationale for implementing a primary grade keyboarding course, this paper describes the implementation of such a course at the Bernardsville (New Jersey) Elementary School. The methods and procedures discussed include the essential concepts to consider when teaching keyboarding and the materials necessary to implement the program.…

  7. Primary Standards Laboratory report

    SciTech Connect

    Not Available

    1990-12-01

    Sandia National Laboratories operates the Primary Standards Laboratory (PSL) for the Department of Energy, Albuquerque Operations Office (DOE/AL). This report summarizes metrology activities that received emphasis in the first half of 1990 and provides information pertinent to the operation of the DOE/AL system-wide Standards and Calibration Program.

  8. Restoring primary anterior teeth.

    PubMed

    Waggoner, William F

    2002-01-01

    A variety of esthetic restorative materials are available for restoring primary incisors. Knowledge of the specific strengths, weakness, and properties of each material will enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Each has distinct advantages and disadvantages and the clinical conditions of placement may be a strong determining factor as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and those crowns that are luted onto the tooth and are some type of stainless steel crown. However, due to lack of supporting clinical data, none of the crowns can be said to be superior to the others under all circumstances. Though caries in the mandibular region is rare, restorative solutions for mandibular incisors are needed. Neither stainless steel crowns nor celluloid crown forms are made specifically for mandibular incisors. Many options exist to repair carious primary incisors, but there is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. This does not discount the fact that dentists have been using many of these crowns for years with much success. Operator preferences, esthetic demands by parents, the child's behavior, and moisture and hemorrhage control are all variables which affect the decision and ultimate outcome of whatever restorative treatment is chosen.

  9. Restoring primary anterior teeth.

    PubMed

    Waggoner, William F

    2002-01-01

    A variety of esthetic restorative materials are available for restoring primary incisors. Knowledge of the specific strengths, weakness, and properties of each material will enhance the clinician's ability to make the best choice of selection for each individual situation. Intracoronal restorations of primary teeth may utilize resin composites, glass ionomer cements, resin-modified ionomers, or polyacid-modified resins. Each has distinct advantages and disadvantages and the clinical conditions of placement may be a strong determining factor as to which material is utilized. Full coronal restoration of primary incisors may be indicated for a number of reasons. Crowns available for restoration of primary incisors include those that are directly bonded onto the tooth, which generally are a resin material, and those crowns that are luted onto the tooth and are some type of stainless steel crown. However, due to lack of supporting clinical data, none of the crowns can be said to be superior to the others under all circumstances. Though caries in the mandibular region is rare, restorative solutions for mandibular incisors are needed. Neither stainless steel crowns nor celluloid crown forms are made specifically for mandibular incisors. Many options exist to repair carious primary incisors, but there is insufficient controlled, clinical data to suggest that one type of restoration is superior to another. This does not discount the fact that dentists have been using many of these crowns for years with much success. Operator preferences, esthetic demands by parents, the child's behavior, and moisture and hemorrhage control are all variables which affect the decision and ultimate outcome of whatever restorative treatment is chosen. PMID:12412967

  10. Primary hyperparathyroidism and nephrolithiasis.

    PubMed

    Vestergaard, Peter

    2015-05-01

    Calcifications in the kidneys may occur in the parenchyma (nephrocalcinosis), pelvis renis (nephrolithiasis) or ureters (ureterolithiasis). Several factors may protect against stone formation or promote precipitation of stones. Most stones contain calcium, and the hypercalciuria seen in primary hyperparathyroidism is a contributing factor to stone formation in the kidneys and urinary tract. In early case series, renal stone formation was frequent, whereas the proportion of patients with symptomatic renal stones has declined in recent years. However, a substantial proportion of patients presents with asymptomatic nephrocalcinosis or nephrolithiasis. Before diagnosis and treatment of primary hyperparathyroidism, renal stone events are more frequent than in the general population. However, even after surgical cure, an increased rate of renal stone events may be seen. This may to some extent be the result of stones or calcifications already present at the time of diagnosis or sequelae to prior stones such as infections or ureter strictures. PMID:25911000

  11. Primary hypertension in childhood.

    PubMed

    Bucher, Barbara S; Ferrarini, Alessandra; Weber, Nico; Bullo, Marina; Bianchetti, Mario G; Simonetti, Giacomo D

    2013-10-01

    There is growing concern about elevated blood pressure in children and adolescents, because of its association with the obesity epidemic. Moreover, cardiovascular function and blood pressure level are determined in childhood and track into adulthood. Primary hypertension in childhood is defined by persistent blood pressure values ≥ the 95th percentile and without a secondary cause. Preventable risk factors for elevated blood pressure in childhood are overweight, dietary habits, salt intake, sedentary lifestyle, poor sleep quality and passive smoking, whereas non-preventable risk factors include race, gender, genetic background, low birth weight, prematurity, and socioeconomic inequalities. Several different pathways are implicated in the development of primary hypertension, including obesity, insulin resistance, activation of the sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system and altered vascular function. Prevention of adult cardiovascular disease should begin in childhood by regularly screening for high blood pressure, counseling for healthy lifestyle and avoiding preventable risk factors.

  12. Primary Retroperitoneal Mucinous Cystadenoma.

    PubMed

    Lee, Seok Youn; Han, Weon Cheol

    2016-02-01

    Mucinous cystadenomas and cystadenocarcinomas of the ovary are clinically and histopathologically well-established common tumors. However, primary retroperitoneal mucinous cystic tumors are extremely rare, and although their histopathogenesis is still uncertain, several theories have been proposed. Most authors suggest that they develop through mucinous metaplasia in a preexisting mesothelium-lined cyst. An accurate preoperative diagnosis of these tumors is difficult because no effective diagnostic measures have been established. Delay in diagnosis and treatment of this tumor may be fatal for the patient because of complications such as rupture, infection, and malignant transformation. We describe the case of a 31-year-old woman with abdominal pain and a palpable mass. Computed tomography of the abdomen revealed a retroperitoneal cystic mass, which was resected successfully through laparoscopy. Histopathological examination of the resected mass confirmed the diagnosis of a primary retroperitoneal mucinous cystadenoma. The patient was discharged on postoperative day 5 without any complications.

  13. Primary retroperitoneal mucinous cystadenoma.

    PubMed

    Abedalthagafi, Malak; Jackson, Patrick G; Ozdemirli, Metin

    2009-01-01

    Primary mucinous neoplasms of the retroperitoneum, including mucinous cystadenocarcinomas, mucinous borderline tumors, and mucinous cystadenomas are uncommon tumors found exclusively in women. Since the retroperitoneum does not contain mucinous epithelium, the origin, and histogenesis of these tumors remain unclear. It is speculated that these tumors can arise from teratomas, supernumerary ovaries, or mucinous metaplasia of the retroperitoneal mesothelium. We describe a case of a primary mucinous cystadenoma of the retroperitoneum in a 44 year-old female that presented as a palpable abdominal mass. There was no evidence of recurrence 16 months after complete laparoscopic excision of the tumor. The morphology and immunohistochemical analysis in this case support the hypothesis that mucinous metaplasia of the retroperitoneal mesothelium overlying a preceding inclusion cyst can give rise to retroperitoneal mucinous tumors.

  14. Primary periungual leiyomyosarcoma.

    PubMed

    Rachadi, Hanane; Derrabi, Nora; Marnissi, Farida; Chiheb, Soumaya

    2016-01-01

    Primary superficial leiomyosarcoma is a very uncommon malignant tumor which occurs most commonly the lower limbs. We report one case of unusual topography of this tumor. An 81-year-old female patient presented with a 2 year history of a periungual tumor of the left index finger. The histopathological and immunohistochemical examination of a biopsy specimen was compatible with the diagnosis of leiomyosarcoma. There was no evidence of metastatic disease. An amputation of the index was performed. PMID:27617944

  15. [Primary care in France].

    PubMed

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain.

  16. [Primary care in France].

    PubMed

    Sánchez-Sagrado, T

    2016-01-01

    The poor planning of health care professionals in Spain has led to an exodus of doctors leaving the country. France is one of the chosen countries for Spanish doctors to develop their professional career. The French health care system belongs to the Bismarck model. In this model, health care system is financed jointly by workers and employers through payroll deduction. The right to health care is linked to the job, and provision of services is done by sickness-funds controlled by the Government. Primary care in France is quite different from Spanish primary care. General practitioners are independent workers who have the right to set up a practice anywhere in France. This lack of regulation has generated a great problem of "medical desertification" with problems of health care access and inequalities in health. French doctors do not want to work in rural areas or outside cities because "they are not value for money". Medical salary is linked to professional activity. The role of doctors is to give punctual care. Team work team does not exist, and coordination between primary and secondary care is lacking. Access to diagnostic tests, hospitals and specialists is unlimited. Duplicity of services, adverse events and inefficiencies are the norm. Patients can freely choose their doctor, and they have a co-payment for visits and hospital care settings. Two years training is required to become a general practitioner. After that, continuing medical education is compulsory, but it is not regulated. Although the French medical Health System was named by the WHO in 2000 as the best health care system in the world, is it not that good. While primary care in Spain has room for improvement, there is a long way for France to be like Spain. PMID:26304179

  17. Primary Retroperitoneal Myxoid Liposarcomas

    PubMed Central

    Setsu, Nokitaka; Miyake, Mototaka; Wakai, Susumu; Nakatani, Fumihiko; Kobayashi, Eisuke; Chuman, Hirokazu; Hiraoka, Nobuyoshi; Kawai, Akira

    2016-01-01

    Myxoid liposarcomas (MLSs) are genetically defined by the presence of DDIT3 gene fusions and most commonly arise in the extremities of young adults. Whether MLSs develop primarily in the retroperitoneum is controversial, and a recent retrospective study found no molecularly confirmed examples. Because MLSs tend to metastasize to deep soft tissues, purported examples of primary retroperitoneal lesions might represent distant metastasis, most commonly from extremities. In addition, well-differentiated or dedifferentiated liposarcomas, which are characterized by MDM2 amplifications, may exhibit prominent myxoid changes and mimic MLSs. Here, we document 5 cases of MLSs that originated in the retroperitoneum that were identified through critical clinicopathologic reevaluation. These cases accounted for 2.3% of 214 primary retroperitoneal liposarcomas and 3.2% of 156 MLSs in our database. They occurred in 3 men and 2 women with a median age of 32 years. All tumors were localized to the retroperitoneum at presentation, and no patient developed extra-abdominal recurrences during the clinical course (median, 50 mo). All 5 cases exhibited at least focal classic histologic findings. All harbored DDIT3 gene rearrangements, and none harbored MDM2 amplifications according to fluorescence in situ hybridization. This study demonstrates that primary MLSs can occur in the retroperitoneum, albeit rarely, and can be accurately diagnosed through combined clinicopathologic and molecular analysis. PMID:27158758

  18. [Primary care in Sweden].

    PubMed

    Sánchez-Sagrado, T

    2016-09-01

    Sweden was one of the first European Union countries that saw the opportunity in the free movement of professionals. First offers for jobs were managed in 2000. Since then, a large number of professionals have taken the opportunity of a decent job and have moved from Spain to Sweden. The Swedish health care model belongs to the group of national health systems. The right to health care is linked to legal citizenship. Health is financed through regional taxes, but there is a compulsory co-payment regardless of the financial situation of the patient. The provision of health care is decentralised at a regional level, and there is a mixture of private and public medical centres. Primary care is similar to that in Spain. Health professionals work as a team with a division of tasks. Like in Spain, waiting lists and coordination between primary and specialised care are a great problem. Patients may register with any public or private primary care centre and hospital provider within their region. Access to diagnostic tests and specialists are restricted to those selected by specialists. Doctors are salaried and their job and salary depend on their experience, professional abilities and regional needs. Medicine is curative. General practitioners are the gateway to the system, but they do not act as gatekeeper. Hospitals offer a number of training post, and the access is through an interview. Continuing medical education is encouraged and financed by the health centre in order to increase its revenues.

  19. Primary haemostasis: newer insights.

    PubMed

    Berndt, M C; Metharom, P; Andrews, R K

    2014-05-01

    At the same time as biophysical and omics approaches are drilling deeper into the molecular details of platelets and other blood cells, as well as their receptors and mechanisms of regulation, there is also an increasing awareness of the functional overlap between human vascular systems. Together, these studies are redefining the intricate networks linking haemostasis and thrombosis with inflammation, infectious disease, cancer/metastasis and other vascular pathophysiology. The focus of this state-of-the-art review is some of the newer advances relevant to primary haemostasis. Of particular interest, platelet-specific primary adhesion-signalling receptors and associated activation pathways control platelet function in flowing blood and provide molecular links to other systems. Platelet glycoprotein (GP)Ibα of the GPIb-IX-V complex and GPVI not only initiate platelet aggregation and thrombus formation by primary interactions with von Willebrand factor and collagen, respectively, but are also involved in coagulation, leucocyte engagement, bacterial or viral interactions, and are relevant as potential risk markers in a range of human diseases. Understanding these systems in unprecedented detail promises significant advances in evaluation of individual risk, in new diagnostic or therapeutic possibilities and in monitoring the response to drugs or other treatment.

  20. Primary Intracranial Synovial Sarcoma

    PubMed Central

    Li, Luyuan; Sinson, Grant; Mueller, Wade

    2016-01-01

    Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression. PMID:27247811

  1. Primary Intracranial Synovial Sarcoma.

    PubMed

    Patel, Mohit; Li, Luyuan; Nguyen, Ha Son; Doan, Ninh; Sinson, Grant; Mueller, Wade

    2016-01-01

    Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression. PMID:27247811

  2. Primary care for refugees.

    PubMed

    Eckstein, Barbara

    2011-02-15

    Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients.

  3. The immune response induced by DNA vaccine expressing nfa1 gene against Naegleria fowleri.

    PubMed

    Kim, Jong-Hyun; Lee, Sang-Hee; Sohn, Hae-Jin; Lee, Jinyoung; Chwae, Yong-Joon; Park, Sun; Kim, Kyongmin; Shin, Ho-Joon

    2012-12-01

    The pathogenic free-living amoeba, Naegleria fowleri, causes fatal primary amoebic meningoencephalitis in experimental animals and in humans. The nfa1 gene that was cloned from N. fowleri is located on pseudopodia, especially amoebic food cups and plays an important role in the pathogenesis of N. fowleri. In this study, we constructed and characterized retroviral vector and lentiviral vector systems for nfa1 DNA vaccination in mice. We constructed the retroviral vector (pQCXIN) and the lentiviral vector (pCDH) cloned with the egfp-nfa1 gene. The expression of nfa1 gene in Chinese hamster ovary cell and human primary nasal epithelial cell transfected with the pQCXIN/egfp-nfa1 vector or pCDH/egfp-nfa1 vector was observed by fluorescent microscopy and Western blotting analysis. Our viral vector systems effectively delivered the nfa1 gene to the target cells and expressed the Nfa1 protein within the target cells. To evaluate immune responses of nfa1-vaccinated mice, BALB/c mice were intranasally vaccinated with viral particles of each retro- or lentiviral vector expressing nfa1 gene. DNA vaccination using viral vectors expressing nfa1 significantly stimulated the production of Nfa1-specific IgG subclass, as well as IgG levels. In particular, both levels of IgG2a (Th1) and IgG1 (Th2) were significantly increased in mice vaccinated with viral vectors. These results show the nfa1-vaccination induce efficiently Th1 type, as well as Th2 type immune responses. This is the first report to construct viral vector systems and to evaluate immune responses as DNA vaccination in N. fowleri infection. Furthermore, these results suggest that nfal vaccination may be an effective method for treatment of N. fowleri infection.

  4. [Primary pancreatic plasmacytoma].

    PubMed

    Sánchez Acevedo, Z; Pomares Rey, B; Alpera Tenza, M R; Andrada Becerra, E

    2014-01-01

    Extramedullary plasmacytomas are uncommon malignant plasma cell tumors that present outside the bone marrow; 80% of extramedullary plasmacytomas are located in the upper respiratory tract, and gastrointestinal plasmacytomas are rare. We present the case of an asymptomatic 65-year-old man in whom a pancreatic mass was found incidentally. The lesion was determined to be a pancreatic plasmacytoma after fine-needle aspiration cytology and surgical resection. No clinical, laboratory, or imaging findings indicative of multiple myeloma or association with other plasmacytomas were found, so the tumor was considered to be a primary pancreatic plasmacytoma. PMID:22738942

  5. [Primary cutaneous plasmacytoma].

    PubMed

    Dhouib Sellami, Rym; Sassi, Samia; Mrad, Karima; Abess, Imen; Driss, Maha; Ben Romdhane, Khaled

    2007-04-01

    Primary cutaneous plasmacytoma (PCP) is a rare cutaneous B cell lymphoma. We report a case of PCP in a 64 year old woman presenting with a nodular lesion of the left cheek. Histologically, the lesion was composed predominately of variably maturated plasma cells with monotypic expression of lambda chain. Extracutaneous localizations of the disease had been excluded. The prognosis of PCP is better than that of the metastatic cutaneous lesion of myeloma. The main prognosis factors are the size tumor and clinical presentation (solitary, versus multiple lesions). Solitary lesions of the PCP are treated by surgical excision and sometimes local radiotherapy. PMID:17909472

  6. Primary pulmonary cryptococcosis.

    PubMed

    Asadi Gharabaghi, Mehrnaz; Allameh, Seyyed Farshad

    2014-01-01

    Here, we report a case of primary cryptococcal pneumonia in a 25-year-old woman who presented with several weeks' history of cough, dyspnoea and night sweating. These symptoms started in the third trimester of her pregnancy. She was being treated for infertility and got pregnant with in vitro fertilisation. On chest imaging, there were bilateral air space consolidation and cavitary lesions. Fungal pulmonary infection was diagnosed after surgical lung biopsy. She received fluconazole 400 mg per day orally for 6 months and recovered completely. PMID:24692384

  7. Primary Gastric Chorioadenocarcinoma.

    PubMed

    Baraka, Bahaaeldin A; Al Kharusi, Suad S; Al Bahrani, Bassim J; Bhathagar, Gunmala

    2016-09-01

    Primary gastric chorioadenocarcinoma (PGC) is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), with a complete response and good tolerability. PMID:27602194

  8. [Primary glomerulonephritis in focus].

    PubMed

    Bourquin, Vincent; Ponte, Belén; Zellweger, Micheal; Levy, Marc; Moll, Solange

    2013-04-10

    The glomerulonephritis (GN) are responsible for a significant amount of end stage renal disease. They may be secondary to another disease or idiopathic. When a secondary etiology has been excluded, it is called primary glomerulonephritis (PGN). Glomerular damage may have different presentations and there are many way to classify them. It is thus difficult for the non-specialist to understand the terminology used. This article is a summary of the most frequently encountered PGN such as: IgA nephropathy, membranous GN, idiopathic nephrotic syndrome, extracapillary and membranoproliferative GN. A brief description is given for each one of the PGN including epidemiology, semiology, histology and a pathophysiology explanation. PMID:23659154

  9. Primary Ciliary Dyskinesia.

    PubMed

    Knowles, Michael R; Zariwala, Maimoona; Leigh, Margaret

    2016-09-01

    Primary ciliary dyskinesia (PCD) is a recessive genetically heterogeneous disorder of motile cilia with chronic otosinopulmonary disease and organ laterality defects in ∼50% of cases. The prevalence of PCD is difficult to determine. Recent diagnostic advances through measurement of nasal nitric oxide and genetic testing has allowed rigorous diagnoses and determination of a robust clinical phenotype, which includes neonatal respiratory distress, daily nasal congestion, and wet cough starting early in life, along with organ laterality defects. There is early onset of lung disease in PCD with abnormal airflow mechanics and radiographic abnormalities detected in infancy and early childhood. PMID:27514592

  10. Primary Epiploic Appendagitis.

    PubMed

    Matos, Hugo; Costa, Isidoro

    2015-12-01

    Primary epiploic appendagitis is an inflammation of the epiploic appendages occurring due to ischemic infarction as a result of appendage torsion or spontaneous thrombosis usually affecting patients from second to fifth decades, being more common in women and obese patients. It is a self-limiting entity with clinical features similar to other inflammatory abdominal processes and sometimes not remembered at clinical examinations. The awareness of this entity and its correct identification on imaging examinations could prevent unnecessary surgery. The authors present a clinical case complemented with ultrasound and CT images of this entity. PMID:27011574

  11. Primary retroperitoneal mucinous cystadenocarcinoma.

    PubMed

    Nelson, H; Benjamin, B; Alberty, R

    1988-05-15

    A case of primary retroperitoneal cystadenocarcinoma is presented as the fourth reported case in the world literature to date. The cyst was removed intact and demonstrated an infiltrating malignant process with nuclear pleomorphism and mitotic activity. No ovarian tissue was identified and a cancer antigen 125 (CA 125) test was normal. The patient underwent a staging procedure subsequently that included peritoneal washings, hysterectomy, bilateral salpingoophorectomy, and iliac node dissection. No metastases were found and the patient is without recurrence 22 months postoperative. The literature is reviewed to better define the origin and prognosis of these tumors.

  12. Primary tuberculosis of palate.

    PubMed

    Chen, Ihk; Jamal, S; Pua, K C

    2015-01-01

    Primary tuberculosis (TB) of the hard palate is very rare. A 74-year-old man was presented with 6-month history of dysphagia along with an irregular mass in the hard and soft palate. Magnetic resonance imaging (MRI) revealed thickened and increased signal intensity within hard and soft palate. Tissue biopsy showed focal caseating granulomatous-like lesion and the histochemical staining using Ziehl-Neelsen stain for acid-fast bacilli was positive. Positive histochemical studies provided evidences that the hard palate mass was most likely due to TB. Thus, the patient was started on antituberculous therapy.

  13. Primary Gastric Chorioadenocarcinoma

    PubMed Central

    Baraka, Bahaaeldin A.; Al Kharusi, Suad S.; Al Bahrani, Bassim J.; Bhathagar, Gunmala

    2016-01-01

    Primary gastric chorioadenocarcinoma (PGC) is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), with a complete response and good tolerability. PMID:27602194

  14. Primary cutaneous PEComa.

    PubMed

    Chaplin, Anna; Conrad, David M; Tatlidil, Cuneyt; Jollimore, Jason; Walsh, Noreen; Covert, Alan; Pasternak, Sylvia

    2010-05-01

    A 48-year-old woman attended a physician because of a solitary cutaneous nodule on the left lower leg. Microscopic examination of the excisional specimen revealed a dermal tumor composed of nests of epithelioid cells exhibiting clear cytoplasm. They had centrally located vesicular nuclei with distinct nucleoli. A rich network of capillaries was present throughout. The tumor showed an infiltrative border. There was no epidermal involvement. Periodic acid-Shif (PAS) and PAS-Diastase stains demonstrated glycogen deposition within the cytoplasm of the clear cells. Immunohistochemical evaluation revealed that the tumor cells were positive for HMB-45 and microftalmia associated transcription factor (MITF). Focal desmin positivity was also seen. The tumor cells were negative for S-100 protein, alfa smooth muscle actin, HHF-35, and various cytokeratins. The case is one of a primary cutaneous pecoma. Pecomas are rare, recently described mesenchymal tumors composed of perivascular epithelioid cells. They constitute a spectrum of lesions in different organs including angiomyolipoma of the kidney and liver, sugar tumor of the lung, lymphangiomatosis, and lymphangiomyoma. Primary cutaneous PEComas are exceptionally rare and have only recently been recognized. To date, these are approximately 22 cases in the English literature. Follow-up data is limited but they appear to behave in a benign fashion. We report an additional case with the goal of alerting dermatopathologists to this distinctive unusual neoplasm.

  15. [Relaunching primary healthcaree].

    PubMed

    Marcolongo, Adriano; Talarico, Francesco

    2014-01-01

    The health environment today is characterized by diffuse inequalities, the emergence of chronic diseases, and the introduction of new technologies, all of which, together with other factors are leading to a healthcare system that is becoming increasingly less sustainable from a financial point of view. Primary healthcare, public health and hospitals should work together to define a comprehensive healthcare delivery model characterized by continuity of care, information and management. The proposed model of disease management, in particular of chronic diseases, must reorganize health services around the needs of citizens and the community and involve patients and their families in the disease management process, by promoting self-help groups and patient organizations that cooperate with health services. In order to put this change into effect, evidence-based medicine and evidence-based practice need to be adopted. From an organizational point of view, it will be important to change wage rules, so as to implement a new payment system based upon performance. In this new contest, physicians specialized in hygiene and public health can play an important role that includes leadership, governance and coordination. By integrating the concepts of accountability, community intervention and training, we can acquire the tools to change the current hospital-based system to a new model of primary healthcare that works together with the community to move the focus from healthcare provider to patient. PMID:25715897

  16. Primary-Progressive MS (PPMS)

    MedlinePlus

    ... MS? Types of MS Primary progressive MS (PPMS) Primary progressive MS (PPMS) Share Smaller Text Larger Text Print In this article Overview PPMS is characterized by worsening neurologic function ( ...

  17. Professional Issues for Primary Teachers

    ERIC Educational Resources Information Center

    Browne, Ann, Ed.; Haylock, Derek, Ed.

    2004-01-01

    This book is intended to be a contribution to raising the awareness of primary teachers and trainee teachers as to what is involved in all the different professional dimensions of their work in schools. The book deals with the key professional issues in primary teaching that are addressed in primary teacher training courses. The book aims to…

  18. Primary Aluminum Plants Worldwide - 1998

    USGS Publications Warehouse

    1999-01-01

    The 1990 U.S. Bureau of Mines publication, Primary Aluminum Plants Worldwide, has been updated and is now available. The 1998 USGS edition of Primary Aluminum Plants Worldwide is published in two parts. Part I—Detail contains information on individual primary smelter capacity, location, ownership, sources of energy, and other miscellaneous information. Part II—Summary summarizes the capacity data by country

  19. Primary thrombocytosis in children

    PubMed Central

    Kucine, Nicole; Chastain, Katherine M.; Mahler, Michelle B.; Bussel, James B.

    2014-01-01

    Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study. PMID:24688110

  20. [Primary ciliary dyskinesia].

    PubMed

    Plavec, Goran; Tomić, Ilija; Skaro-Milić, Andelija; Radojcić, Branko; Aćimović, Slobodan

    2004-01-01

    In patients with chronic respiratory diseases that last since the early childhood, primary ciliary dyskinesia (PCD) needs to be considered. Four patients reviewed in this paper were with typical disease history and clinical picture, as well as clear ciliary axonema damage. Complete examination was performed in all the patients, including bronchoscopy with bronchography, and the examination of the biopsy samples of respiratory airways' mucous membrane, obtained by transmission electron microscope (TEM). In two of the patients spermatozoa were also examined by TEM. Large anatomic defects of airways were found in all the patients, but pulmonary function was normal (except in one case), representing one of PCD's significant characteristics. First two cases fulfilled the criteria for Kartagener's syndrome, which was initially sufficient for the diagnosis of PCD.

  1. Primary hyperparathyroidism in pregnancy.

    PubMed

    Kamenický, Peter; Lecoq, Anne-Lise; Chanson, Philippe

    2016-06-01

    Primary hyperparathyroidism (PHPT) is one of the most common endocrine disorders in the general population but is rarely diagnosed during pregnancy. Symptoms of gestational PHPT may be unrecognized, or masked by physiological changes in calcium homeostasis associated with pregnancy. Gestational PHPT may have severe consequences for both mother and fetus. However, nowadays, gestational PHPT is usually diagnosed in earlier stages and milder forms, with low complication rates. Treatment should be individually tailored according to gestational age, the severity of hypercalcemia, and the risk-benefit balance. The conservative approach is preferred in mild forms, whereas surgery, usually performed during the second trimester, is reserved for symptomatic hypercalcemic PHPT. Given the young age of the patients, genetic causes should be considered. PMID:27157105

  2. Primary scarring alopecias.

    PubMed

    Rigopoulos, Dimitrios; Stamatios, Gregoriou; Ioannides, Dimitrios

    2015-01-01

    Scarring alopecia or cicatricial alopecia results from follicular damage that is sufficient to cause the destruction and replacement of pilosebaceous structures by scar tissue. Primary scarring alopecias represent a group of disorders that primarily affect the hair follicles, as opposed to secondary scarring alopecias, which affect the dermis and secondarily cause follicular destruction. Inflammation may predominantly involve lymphocytes or neutrophils. Cicatricial alopecias that mainly involve lymphocytic inflammation include discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, central centrifugal alopecia, and pseudopelade (Brocq). Cicatricial alopecias that are due to predominantly neutrophilic inflammation include folliculitis decalvans, tufted folliculitis, and dissecting cellulitis of the scalp. Folliculitis keloidalis is a cicatricial alopecia with a mixed inflammatory infiltrate. PMID:26370646

  3. Accountability and Primary Healthcare

    PubMed Central

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B.

    2014-01-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  4. Primary and secondary hypohedonia.

    PubMed

    Meehl, P E

    2001-02-01

    Having shown taxometrically that there exists a hypohedonic schizotypal taxon in a college population, J. J. Blanchard, S. W. Gangestad, S. A. Brown, and W. P. Horan (2000) suggested that P. E. Meehl erred in revising his 1962 theory by postulating a normal-range individual differences variable of hedonic capacity that potentiates schizotypy into schizophrenia. The aversive drift and secondary anhedonia of Meehl's theory imply that the schizotypal taxon will generate hypohedonic taxonicity in an adult population. Psychometrically measurable hedonic disposition (as distinguished from genetic primary hedonic capacity) is "dragged along" by the schizogene, especially in the social domain. To choose between causal interpretations, it could be ascertained whether the schizotypal anhedonic taxon is composed of individuals who are schizotaxic on the basis of psychophysiological, cognitive, and soft neurologic indicators.

  5. Lithium peroxide primary element

    SciTech Connect

    Winsel, A.

    1985-03-12

    In a galvanic primary element of the system Li/H/sub 2/O/sub 2/, the aqueous cathode depolarizer H/sub 2/O/sub 2/ is fixated as a polyurethane gel. It can thereby be controlled and caused to react with anode metal in accordance with the current drain requirements. This is accomplished using a ram to press the gel toward a conductor which covers the lithium anode, which may take the form of a metal grid and/or a gas diffusion electrode. The oxygen which forms in the working layer through catalytic decomposition of hydrogen peroxide creates a gas bubble when the current is interrupted or the ram is stopped, thereby interrupting the further supply of hydrogen peroxide to the catalyst.

  6. Lithium peroxide primary element

    SciTech Connect

    Winsel, A.

    1982-05-04

    In a galvanic primary element of the system Li/H/sub 2/O/sub 2/, the aqueous cathode depolarizer H/sub 2/O/sub 2/ is fixated as a polyurethane gel. It can thereby be controlled and caused to react with the anode metal in accordance with the current drain requirements. This is accomplished using a ram to press the gel toward a conductor which covers the lithium anode, which may take the form of a metal grid and/or a gas diffusion electrode. The oxygen which forms in the working layer through catalytic decomposition of hydrogen peroxide creates a gas bubble when the current is interrupted or the ram is stopped, thereby interrupting the further supply of hydrogen peroxide to the catalyst.

  7. Accountability and primary healthcare.

    PubMed

    Mukhi, Shaheena; Barnsley, Jan; Deber, Raisa B

    2014-09-01

    This paper examines the accountability structures within primary healthcare (PHC) in Ontario; in particular, who is accountable for what and to whom, and the policy tools being used. Ontario has implemented a series of incremental reforms, using expenditure policy instruments, enforced through contractual agreements to provide a defined set of publicly financed services that are privately delivered, most often by family physicians. The findings indicate that reporting, funding, evaluation and governance accountability requirements vary across service provider models. Accountability to the funder and patients is most common. Agreements, incentives and compensation tools have been used but may be insufficient to ensure parties are being held responsible for their activities related to stated goals. Clear definitions of various governance structures, a cohesive approach to monitoring critical performance indicators and associated improvement strategies are important elements in operationalizing accountability and determining whether goals are being met. PMID:25305392

  8. [Pathophysiology of primary hyperparathyroidism].

    PubMed

    Kaji, Hiroshi

    2016-06-01

    Primary hyperparathyroidism is a disease with increased cell proliferation and enhanced PTH secretion due to the escape from negative feedback by calcium ion in parathyroid cells for their tumorization. Involvements of several gene abnormalities have been demonstrated in the pathogenesis of parathyroid tumor. First, an activation of cyclin D1 gene by the translocation of 11 chromosome was found as one of the cause of parathyroid tumorigenesis. Moreover, mutation of multiple endocrine type 1 gene is the most frequent as a genetic cause of sporadic parathyroid tumor. Its related tumor is developed by an inactivation mutation of tumor suppressor gene. Parafibromin, calcium-sensing receptor, vitamin D receptor, Klotho and RET might be related to the tumorigeneis of parathyroid tumor. PMID:27230836

  9. Primary hepatic benign schwannoma

    PubMed Central

    Hayashi, Michihiro; Takeshita, Atsushi; Yamamoto, Kazuhiro; Tanigawa, Nobuhiko

    2012-01-01

    Schwannoma is predominantly a benign neoplasm of the Schwann cells in the neural sheath of the peripheral nerves. Occurrence of schwannoma in parenchymatous organs, such as liver, is extremely rare. A 64-year-old man without neurofibromatosis was observed to have a space-occupying lesion of 23mm diameter in the liver during follow-up examination for a previously resected gastrointestinal stromal tumor (GIST) in the small intestine. He underwent lateral segmentectomy of the liver under a provisional diagnosis of hepatic metastatic recurrence of the GIST. Histological examination confirmed the diagnosis of a benign schwannoma, confirmed by characteristic pathological findings and positive immunoreactions with the neurogenic marker S-100 protein, but negative for c-kit, or CD34. The tumor was the smallest among the reported cases. When the primary hepatic schwannoma is small in size, preoperative clinical diagnosis is difficult. Therefore, this disease should be listed as differential diagnosis for liver tumor with clinically benign characteristics. PMID:22530081

  10. Primary pineal malignant melanoma

    PubMed Central

    Cedeño Diaz, Oderay Mabel; Leal, Roberto García; La Cruz Pelea, Cesar

    2011-01-01

    Primary pineal malignant melanoma is a rare entity, with only thirteen cases reported in the world literature to date. We report a case of a 70-year-old man, who consulted with gait disturbance of six months duration, associated in the last month with dizziness, visual abnormalities and diplopia. No other additional melanocytic lesions were found elsewhere. The magnetic resonance showed a 25 mm expansive mass in the pineal gland that was associated with hydrocephaly, ventricular and transependimary oedema. The lesion was partially excised by a supracerebellar infratentorial approach. The histological examination revealed a melanoma. The patient received radiation therapy, but died of disease 16 weeks later. We herein review the literature on this rare tumour and comment on its clinical, radiological and histopathological features and differential diagnosis. PMID:24765293

  11. Primary gastrointestinal lymphomas.

    PubMed

    Cooper, D L; Doria, R; Salloum, E

    1996-03-01

    Recent evidence suggests that a significant proportion of primary gastrointestinal lymphomas are driven by exogenous agents/antigens. In the stomach, Helicobacter pylori appears to be responsible for most cases of low-grade lymphomas (MALToma), whereas an infectious etiology is suspected in immunoproliferative small intestine disease (IPSID). Similarly, enteropathy-associated T-cell lymphomas appear to result from a disordered response to gluten, although this profile remains controversial. Accordingly, although traditional antineoplastic treatments, such as surgery and radiation, are still important for the treatment of primary GI lymphomas, antibiotics may be the first line of therapy for low-grade gastric MALToma, and they are often used alone or in combination with chemotherapy for IPSID. In patients with celiac sprue, a gluten-free diet appears to markedly reduce the risk for lymphoma. An important caveat for the treatment of gastric lymphomas is that only low-grade gastric MALTomas have consistently responded to antibiotics. Treatment of high-grade gastric lymphoma is evolving. Although surgery was once considered central to diagnosis, staging, and treatment of gastric lymphoma, most patients can now have a diagnosis established by endoscopic biopsy and are candidates for chemotherapy and adjuvant radiation. The risks of fatal hemorrhage and perforation have probably been vastly overestimated and appear to be equal or less than the mortality associated with surgery. In addition, the long-term effects of gastric resection on quality of life have been almost completely ignored. Systemic lymphomas involve the GI tract far more often than is clinically apparent. In most cases, treatment should not be affected.

  12. Primary intranodal cellular angiolipoma.

    PubMed

    Kazakov, Dmitry V; Hes, Ondrej; Hora, Milan; Sima, Radek; Michal, Michal

    2005-01-01

    Angiolipoma is a distinct, benign soft tissue tumor that most commonly occurs in young males as multiple small, subcutaneous, tender to painful nodules with predilection for the forearms. We report a case of angiolipoma that developed within a lymph node. The patient was a 67-year-old man who underwent radical retropubic prostatectomy with diagnostic pelvic lymphadenectomy because of adenocarcinoma of the prostate. The prostate and 3 lymph nodes located in the obturator fossa were removed. On gross examination, the cut surface of 1 of the lymph nodes revealed an 8 x 5 mm, ovoid, sharply demarcated, nonencapsulated, gray lesion being suspicious for adenocarcinoma metastasis. Microscopically, the major portion of the lymph node was replaced by mature metaplastic adipose tissue. The angiolipoma was seen as a well-demarcated, nonencapsulated lesion composed of numerous small blood vessels lined by monomorphous flattened or spindled endothelial cells. Many vascular lumina were filled with fibrin thrombi. There were scanty mature adipocytes. Focally, areas with increased cellularity and a suggestion of solid growth of the endothelial cells were seen. Lymph nodes are known to be a rare primary site of various tumors usually occurring in other organs. The knowledge of these tumors is important in order not to interpret them as metastatic lesions. The most recognized examples are pigmented nevi, palisading myofibroblastoma, various benign epithelial inclusions, serous cystic tumors of borderline malignancy, and hyperplastic mesothelial inclusions. As we present in this report, angiolipoma is another neoplasm whose primary occurrence in the lymph node should not be misinterpreted as a metastatic tumor or malignant vascular tumor.

  13. Independent bilateral primary bronchial carcinomas

    PubMed Central

    Chaudhuri, M. Ray

    1971-01-01

    Independent bilateral primary bronchial carcinomas are not common. Since Beyreuther's description in 1924, 16 well-documented cases of independent primary bronchial carcinomas of different histology have been described. From 1965 to 1970, eight cases were seen at the London Chest Hospital. In order to make the diagnosis of a second primary bronchial carcinoma, each tumour should be malignant and neither should be a metastasis from the other. To meet this last criterion, the histopathological features of the two tumours must be different. Many cases have been described in the literature as double primary bronchial carcinomas where the second primary had the same histological features as the first. Images PMID:4327711

  14. What Is Primary Care Informatics?

    PubMed Central

    de Lusignan, Simon

    2003-01-01

    Primary care informatics is an emerging academic discipline that remains undefined. The unique nature of primary care necessitates the development of its own informatics discipline. A definition of primary care informatics is proposed, which encompasses the distinctive nature of primary care. The core concepts and theory that should underpin it are described. Primary care informatics is defined as a science and as a subset of health informatics. The proposed definition is intended to focus the development of a generalizable core theory for this informatics subspecialty. PMID:12668690

  15. The Primary Headteacher's Handbook: The Essential Guide for Primary Heads. Primary Essentials Series.

    ERIC Educational Resources Information Center

    Smith, Roger

    Although the setting is British, the primary head's problems are similar to those faced by U.S. elementary principals. This is a guidebook for managing primary schools. It shows the day-to-day running of a primary school and the organizational structures in which staff and pupils can be inspired. Chapter 1 considers the creation of a positive…

  16. Primary pulmonary cavitating carcinomas

    PubMed Central

    Chaudhuri, M. Ray

    1973-01-01

    A primary lung cancer can produce a cavity in three ways. The first is `cavitary necrosis' due to breakdown of the growth itself. The second is `stenotic abscess' due to infection and breakdown of the lung parenchyma distal to bronchial obstruction caused by the growth. The third type is `spill-over abscess'. In the present series, necrosis and cavitation were observed in 100 cases out of a total of 632 primary bronchial carcinomas seen at the London Chest Hospital from July 1967 to June 1970. There were 91 males and nine females with an average age of 58·45 years. All except one smoked very heavily and had considerable symptoms. The size of the cavities ranged from 1 to 10 cm and their wall thickness from 0·5 to 3 cm. They were single in 92 cases and multiple (up to four) in eight. In 42 cases, the cancerous cavitation was central, in 38 intermediate, and in 20 peripheral. The segments most frequently affected were the apicoposterior segment of the left upper lobe and the superior segment of the left lower lobe. For descriptive purposes, these cavitating carcinomas were also divided into six broad groups on the basis of radiological and pathological correlations. Neoplastic cells in the sputum were found in 64 cases. Bronchoscopy revealed growth in 42 cases and biopsy was positive in 48. The main microscopic feature was vascular invasion of medium-sized muscular arteries and veins found in the vicinity of every cavitating bronchial carcinoma. Invasion along with tumour plugging of the vessels was observed in 75 cases and thrombosis alone in 55 cases. There were 82 squamous-cell carcinomas, 11 undifferentiated carcinomas of large polygonal-cell type, and seven adeno-alveolar cell carcinomas. The single most important and noteworthy feature in the present series was that oat-cell carcinoma hardly ever undergoes necrosis. Out of a total of 95 cases observed, only three showed necrosis, and this was minimal and characteristically devoid of cavitation. In oat

  17. Protective immunity against Naegleria fowleri infection on mice immunized with the rNfa1 protein using mucosal adjuvants.

    PubMed

    Lee, Jinyoung; Yoo, Jong-Kyun; Sohn, Hae-Jin; Kang, Hee-kyoung; Kim, Daesik; Shin, Ho-Joon; Kim, Jong-Hyun

    2015-04-01

    The free-living amoeba, Naegleria fowleri, causes a fatal disease called primary amoebic meningoencephalitis (PAM) in humans and experimental animals. Of the pathogenic mechanism of N. fowleri concerning host tissue invasion, the adherence of amoeba to hose cells is the most important. We previously cloned the nfa1 gene from N. fowleri. The protein displayed immunolocalization in the pseudopodia, especially the food-cups structure, and was related to the contact-dependent mechanism of the amoebic pathogenicity in N. fowleri infection. The cholera toxin B subunit (CTB) and Escherichia coli heat-labile enterotoxin B subunit (LTB) have been used as potent mucosal adjuvants via the parenteral route of immunization in most cases. In this study, to examine the effect of protective immunity of the Nfa1 protein for N. fowleri infection with enhancement by CTB or LTB adjuvants, intranasally immunized BALB/c mice were infected with N. fowleri trophozoites for the development of PAM. The mean time to death of mice immunized with the Nfa1 protein using LTB or CTB adjuvant was prolonged by 5 or 8 days in comparison with that of the control mice. In particular, the survival rate of mice immunized with Nfa1 plus CTB was 100% during the experimental period. The serum IgG levels were significantly increased in mice immunized with Nfa1 protein plus CTB or LTB adjuvants. These results suggest that the Nfa1 protein, with CTB or LTB adjuvants, induces strong protective immunity in mice with PAM due to N. fowleri infection. PMID:25604672

  18. Protective immunity against Naegleria fowleri infection on mice immunized with the rNfa1 protein using mucosal adjuvants.

    PubMed

    Lee, Jinyoung; Yoo, Jong-Kyun; Sohn, Hae-Jin; Kang, Hee-kyoung; Kim, Daesik; Shin, Ho-Joon; Kim, Jong-Hyun

    2015-04-01

    The free-living amoeba, Naegleria fowleri, causes a fatal disease called primary amoebic meningoencephalitis (PAM) in humans and experimental animals. Of the pathogenic mechanism of N. fowleri concerning host tissue invasion, the adherence of amoeba to hose cells is the most important. We previously cloned the nfa1 gene from N. fowleri. The protein displayed immunolocalization in the pseudopodia, especially the food-cups structure, and was related to the contact-dependent mechanism of the amoebic pathogenicity in N. fowleri infection. The cholera toxin B subunit (CTB) and Escherichia coli heat-labile enterotoxin B subunit (LTB) have been used as potent mucosal adjuvants via the parenteral route of immunization in most cases. In this study, to examine the effect of protective immunity of the Nfa1 protein for N. fowleri infection with enhancement by CTB or LTB adjuvants, intranasally immunized BALB/c mice were infected with N. fowleri trophozoites for the development of PAM. The mean time to death of mice immunized with the Nfa1 protein using LTB or CTB adjuvant was prolonged by 5 or 8 days in comparison with that of the control mice. In particular, the survival rate of mice immunized with Nfa1 plus CTB was 100% during the experimental period. The serum IgG levels were significantly increased in mice immunized with Nfa1 protein plus CTB or LTB adjuvants. These results suggest that the Nfa1 protein, with CTB or LTB adjuvants, induces strong protective immunity in mice with PAM due to N. fowleri infection.

  19. Primary aldosteronism and pregnancy.

    PubMed

    Landau, Ester; Amar, Laurence

    2016-06-01

    Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases.

  20. [Hemicrania: primary headache].

    PubMed

    Nattero, G; Allais, G; De Lorenzo, C

    1992-01-01

    Migraine is the commonest form among the so-called primary headaches and the description of its clinical picture is lost in the mists of time. On the contrary, headaches of organic origin have only recently received a proper nosological individuation thanks to the modern technological progress achieved in the field of medicine. The migraine crisis, both with and without aura, is so typical in its clinical features that it does not require subtle instrumental methodologies to be diagnosed. In most cases a careful anamnesis provides all the elements necessary to formulate a precise diagnosis: the positive family history, the time and mode of onset of crises, the nature of head pain, the chronological stages are quite constant whatever the trigger factor may be. Some other considerations add further evidence to the primitivity of migraine. First of all, migraine can be relieved by quite structurally different drugs with different mechanisms of action. In addition, no significant relationship has ever been found between migraine and other pathologies.

  1. Primary sclerosing cholangitis

    PubMed Central

    Silveira, Marina G; Lindor, Keith D

    2008-01-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts, resulting in end-stage liver disease and reduced life expectancy. PSC primarily affects young and middle-aged men, often in association with underlying inflammatory bowel disease. The etiology of PSC includes immune-mediated components and elements of undefined nature. A cholestatic picture of liver biochemistries with elevations in serum alkaline phosphatase, nonspecific autoantibodies such as perinuclear antineutrophilic antibody, antinuclear antibodies and smooth muscle antibodies, and diffuse multifocal biliary strictures, resulting in a ‘beaded’ appearance on radiographic studies, are the hallmarks of the disease. No effective medical therapy is currently available, although clinical studies are in progress. Ursodeoxycholic acid at high doses (28 mg/kg/day to 30 mg/kg/day) is the most promising agent but is unproven so far. Liver transplantation is currently the only life-extending therapy for patients with end-stage disease, although recurrent disease can be observed in the transplanted liver. The multiple complications of PSC include pruritus, fatigue, vitamin deficiencies, metabolic bone disease, peristomal varices, bacterial cholangitis, dominant biliary strictures, gallbladder stones and polyps, and malignancy, particularly cholangiocarcinoma, which is the most lethal complication of PSC. PMID:18701947

  2. Primary sclerosing cholangitis

    PubMed Central

    Worthington, Joy; Chapman, Roger

    2006-01-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown aetiology characterised by inflammation and fibrosis of the biliary tree. The mean age at diagnosis is 40 years and men are affected twice as often as women. There is a reported annual incidence of PSC of 0.9–1.31/100,000 and point prevalence of 8.5–13.6/100,000. The onset of PSC is usually insidious and many patients are asymptomatic at diagnosis or have mild symptoms only such as fatigue, abdominal discomfort and pruritus In late stages, splenomegaly and jaundice may be a feature. In most, the disease progresses to cirrhosis and liver failure. Cholangiocarcinoma develops in 8–30% of patients. PSC is thought to be immune mediated and is often associated with inflammatory bowel disease, especially ulcerative colitis. The disease is diagnosed on typical cholangiographic and histological findings and after exclusion of secondary sclerosing cholangitis. Median survival has been estimated to be 12 years from diagnosis in symptomatic patients. Patients who are asymptomatic at diagnosis, the majority of whom will develop progressive disease, have a survival rate greater than 70% at 16 years after diagnosis. Liver transplantation remains the only effective therapeutic option for patients with end-stage liver disease from PSC, although high dose ursodeoxycholic acid may have a beneficial effect. PMID:17062136

  3. Primary Ovarian Insufficiency.

    PubMed

    Laven, Joop S E

    2016-07-01

    Primary ovarian insufficiency (POI), also known as premature ovarian failure or premature menopause, is defined as cessation of menstruation before the expected age of menopause. Potential etiologies for POI can be divided into genetic, autoimmune, and iatrogenic categories. This review will try to summarize the genetic basis of POI focusing on recent data that are available using newer genetic techniques such as genome-wide association studies, whole-exome sequencing (WES), or next-generation sequencing techniques. By using these techniques, many genes have arisen that play some role in the pathophysiology of POI. Some of them have been replicated in other studies; however, the majority has not been proven yet to be unequivocally causative through functional validation studies. Elucidating the genetic and molecular basis of POI is of paramount importance not only in understanding ovarian physiology but also in providing genetic counseling and fertility guidance. Once additional variants are detected, it might become possible to predict the age of (premature) menopause in women at risk for POI. Women having certain perturbations of POI can be offered the option of oocyte cryopreservation, with later thawing and use in assisted reproductive technology at an appropriate age. PMID:27513024

  4. Primary hyperoxaluria in infants.

    PubMed

    Jellouli, Manel; Ferjani, Mariem; Abidi, Kamel; Zarrouk, Chokri; Naija, Ouns; Abdelmoula, J; Gargah, Tahar

    2016-05-01

    The infantile form of primary hyperoxaluria type-1 (PH-1) is characterized by a rapid progression to the end-stage renal disease (ESRD) due to both increased oxalate load and reduced glomerular filtration rate. In the literature, data on this form are limited. The purpose of this study is to analyze retrospectively the clinical, biological, and radiological features of children who were diagnosed with PH-1 during the 1(st) year of life. We reviewed the records of all children with PH-1 diagnosed and followed-up at our department between January 1995 and December 2013. Among them, only infants younger than 12 months of age were retrospectively enrolled in the study. Fourteen infants with the median age of two months were enrolled in the study. At diagnosis, 11 patients had ESRD. All patients had nephrocalcinosis and two of them had calculi. The diagnosis was established in nine patients on the basis of the positive family history of PH-1, bilateral nephrocalcinosis, and quantitative crystalluria. In four patients, the diagnosis was made with molecular analysis of DNA. Kidney biopsy contributed to the diagnosis in one patient. During follow-up, two patients were pyridoxine sensitive and preserved renal function. Seven among 11 patients who had ESRD died, four patients are currently undergoing peritoneal dialysis. Children with infantile PH and ESRD are at high risk of early death. Peritoneal dialysis is not a treatment of choice. Combined liver-kidney transplantation is mandatory. PMID:27215245

  5. [PRIMARY SCLEROSING CHOLANGITIS

    PubMed

    Dantas, Waldomiro

    2000-01-01

    Primary sclerosing cholangitis (PSC) is a chronic cholestatic and progressive disease, of unknown etiology, characterized by inflammation and fibrosis of intra-hepatic and extra-hepatic biliary tree. Two thirds of the patients have, simultaneously, ulcerative colitis (UC); on the other hand, PSC is the most common chronic hepatic disease in patients with inflammatory bowel disease (IBD). Patients who have both diseases simultaneously are prone to develop colorectal carcinoma and cholangiocarcinoma. The disease predominantly affects young men, may be asymptomatic or presented as fluctuating jaundice, pruritus and increased levels of the cholestasis biochemical markers, or as secondary billiary cirrhosis. The diagnostic gold standard are the cholangiographic abnormalities, consisting of multifocal stenosis and dilatations, involving both the intrahepatic and the extrahepatic biliary tree. Liver biopsy is useful only for staging the disease and to confirm the diagnosis, in the atypical forms. Ursodeoxycholic acid is a promising drug, nowadays, mainly in the first stages of the disease, in spite of doubtful efficacy. Combination therapy, using ursodeoxicolic acid, methotrexate and alternating antibiotics monthly may be sucessfull in PSC before bile strictures occur. Liver transplantation is the only life-saving therapeutic alternative, able to improve significantly the survival and the life quality of the patients. PMID:12140588

  6. [Primary and secondary hypocholesterolemia].

    PubMed

    Song, Jun-xian; Ren, Jing-yi; Chen, Hong

    2010-10-18

    Hypocholesterolemia is characterized by serum total cholesterol that is lower than the 5th percentile for age and sex, or the cut-off value which predicts the adverse prognosis by epidemiological study. Unlike hypercholesterolemia, physicians pay less attention to the morbidity, causes and consequences of hypocholesterolemia in clinical practice. In fact, hypocholesterolemia is a common dislipidemia, and mainly results from secondary factors. The causes of primary hypocholesterolemia are some disorders owing to genetic mutation in the pathway of cholesterol absorption, biosynthesis or metabolism, including abetalipoproteinemia, hypobetalipoproteinemia, Tangier disease, chylomicron retention disease and inherited disorders of cholesterol biosynthesis. The causes of secondary hypocholesterolemia comprise anemia, hyperthyroidism, malignancy, live disease, critical illness, serious stress, malabsorption or malnutrition, acute or chronic infection, chronic inflammation, and use of some drugs. In addition, what's more important is that hypocholesterolemia can result in some adverse events, such as increased mortality, intracerebral hemorrhage, cancer, infection, adrenal failure, suicide and mental disorder. Therefore, with the practice of intensive lipid-lowering treatment and the tendency to the increased indications of statins, it's high time that physicians attached more importance to hypocholesterolemia. PMID:20957025

  7. Neutropenia in primary immunodeficiency

    PubMed Central

    Sokolic, Robert

    2016-01-01

    Purpose of review Neutropenia is a feature of several primary immunodeficiency diseases (PIDDs). Because of the diverse pathophysiologies of the PIDDs and the rarity of each disorder, data are often lacking, leading to the necessity of empiric treatment. Recent developments in the understanding of neutropenia in several of the PIDDs make a review of the data timely. Recent findings The category of severe congenital neutropenia continues to expand. Mutations in G6PC3 have been identified as the cause of neutropenia in a minority of previously molecularly undefined cases. Recent advances have broadened our understanding of the pathophysiology and the clinical expression of this disorder. A possible function of the C16orf57 gene has been hypothesized that may explain the clinical overlap between Clerucuzio-type poikiloderma with neutropenia and other marrow diseases. Plerixafor has been shown to be a potentially useful treatment in the warts, hypogammaglobulinemia, infection, and myelokathexis syndrome. Investigations of patients with adenosine deaminase deficient severe combined immunodeficiency have identified neutropenia, and particularly susceptibility to myelotoxins, as a feature of this disorder. Granulocyte-colony stimulating factor is the treatment of choice for neutropenia in PIDD, whereas hematopoietic cell transplantation is the only curative option. Summary The number of PIDDs associated with neutropenia has increased, as has our understanding of the range of phenotypes. Additional data and hypotheses have been generated helping to explain the diversity of presentations of neutropenia in PIDDs. PMID:23196894

  8. Primary pleuropulmonary synovial sarcoma.

    PubMed

    Mirzoyan, Michael; Muslimani, Ala'a; Setrakian, Sebouh; Swedeh, Mohamed; Daw, Hamed A

    2008-09-01

    Pleuropulmonary synovial sarcoma (PPSS) is increasingly recognized as a subtype of sarcoma because of the recent identification of a distinctive chromosomal translocation specific to synovial sarcoma. Soft-tissue synovial sarcoma is far more common than PPSS and typically develops in para-articular locations of the extremities, affects young and middle-aged adults, with no difference in distribution between the sexes, and has well-documented radiologic manifestations. Pleuropulmonary synovial sarcoma can arise in the chest wall, heart, mediastinum, pleura, or lung, and it shares patient demographics and several imaging features with its soft-tissue counterpart. Patients present with a cough, chest pain, or dyspnea. On chest radiographs, PPSS typically appears as a sharply marginated mass with uniform opacity, based in the pleura or in the lung, and often accompanied by an ipsilateral pleural effusion. Computed tomographic images show a well-circumscribed, heterogeneously enhanced lesion without associated involvement of bone and without calcifications (except in the case of a chest wall primary tumor). Magnetic resonance imaging provides superior demonstration of nodular soft tissue and multilocular fluid-filled internal components of PPSS, in addition to peripheral rim enhancement after the intravenous administration of a gadoliniumbased contrast material such as gadopentetate dimeglumine. Current treatment consists of surgical resection followed by chemotherapy, radiation therapy, or both. PMID:18824448

  9. Primary duodenal carcinoma.

    PubMed Central

    Adedeji, O. A.; Trescoli-Serrano, C.; Garcia-Zarco, M.

    1995-01-01

    Eight cases of primary duodenal carcinoma in a district general hospital are presented. The cases highlight the advanced state of the disease at presentation, the difficulty in diagnosis, and its poor prognosis. Duodenal carcinoma occurs in both sexes worldwide with no predisposing factors in the majority of cases. There is an increased risk in patients with familial adenomatous polyposis and adenomas of the duodenum. Duodenal carcinoma occurs about 22 years from the diagnosis of familial adenomatous polyposis in about 2% of patients, forming over 50% of upper gastrointestinal cancers occurring in these patients. Carcinomatous changes occur in 30 to 60% of duodenal villous adenomas and much less in tubulo-villous and tubular adenomas. These categories of patients should be screened and adequately followed up. Aggressive and radical surgery, even in the presence of locally advanced disease and lymph node involvement, gives a better outcome. When curative surgery is not possible, chemotherapy must accompany palliation with or without radiotherapy. Pre-operative chemotherapy may facilitate a curative radical resection. The general five-year survival is 17-33% but some centres have achieved a five-year survival of 40-60% with aggressive management of these patients. PMID:7644397

  10. Primary aldosteronism and pregnancy.

    PubMed

    Landau, Ester; Amar, Laurence

    2016-06-01

    Hypertension (HT) is a complication of 8% of all pregnancies and 10% of HT cases are due to primary aldosteronism (PA). There is very little data on PA and pregnancy. Given the changes in the renin angiotensin system during pregnancy, the diagnosis of PA is difficult to establish during gestation. It may be suspected in hypertensive patients with hypokalemia. A comprehensive literature review identified reports covering 40 pregnancies in patients suffering from PA. Analysis of these cases shows them to be high-risk pregnancies leading to maternal and fetal complications. Pregnancy must be programmed, and if the patient has a unilateral form of PA, adrenalectomy should be performed prior to conception. It is customary to stop spironolactone prior to conception and introduce antihypertensive drugs that present no risk of teratogenicity. When conventional antihypertensive drugs used during pregnancy fail to control high blood pressure, diuretics, including potassium-sparing diuretics may be prescribed. Adrenalectomy can be considered during the second trimester of pregnancy exclusively in cases of refractory hypertension. A European retrospective study is currently underway to collect a larger number of cases. PMID:27156905

  11. Gross Primary Productivity

    NASA Technical Reports Server (NTRS)

    2002-01-01

    NASA's new Moderate-resolution Imaging Spectroradiometer (MODIS) allows scientists to gauge our planet's metabolism on an almost daily basis. GPP, gross primary production, is the technical term for plant photosynthesis. This composite image over the continental United States, acquired during the period March 26-April 10, 2000, shows regions where plants were more or less productive-i.e., where they 'inhaled' carbon dioxide and then used the carbon from photosynthesis to build new plant structures. This false-color image provides a map of how much carbon was absorbed out of the atmosphere and fixed within land vegetation. Areas colored blue show where plants used as much as 60 grams of carbon per square meter. Areas colored green and yellow indicate a range of anywhere from 40 to 20 grams of carbon absorbed per square meter. Red pixels show an absorption of less than 10 grams of carbon per square meter and white pixels (often areas covered by snow or masked as urban) show little or no absorption. This is one of a number of new measurements that MODIS provides to help scientists understand how the Earth's landscapes are changing over time. Scientists' goal is use of these GPP measurements to refine computer models to simulate how the land biosphere influences the natural cycles of water, carbon, and energy throughout the Earth system. The GPP will be an integral part of global carbon cycle source and sink analysis, an important aspect of Kyoto Protocol assessments. This image is the first of its kind from the MODIS instrument, which launched in December 1999 aboard the Terra spacecraft. MODIS began acquiring scientific data on February 24, 2000, when it first opened its aperture door. The MODIS instrument and Terra spacecraft are both managed by NASA's Goddard Space Flight Center, Greenbelt, MD. Image courtesy Steven Running, MODIS Land Group Member, University of Montana

  12. Primary intracranial lymphomas

    PubMed Central

    Mufti, Shagufta T.; Baeesa, Saleh S.; Al-Maghrabi, Jaudah A.

    2016-01-01

    Background: Primary CNS lymphoma (PCNSL), a rare form of aggressive extranodal non-Hodgkin's lymphoma (NHL), has increased in incidence during the last three decades and occurs in both immune compromised and immune competent hosts. It has an overall poor prognosis. Objective: This study attempts to further delineate the clinico-pathological, immunohistochemical and radiological profile of PCNSL at Jeddah to King Faisal Hospital and Research Center. Methods: Computerized search through the archives of King Faisal Hospital and Research Centre between July 2000- December 2012 identified 15 patients with pathologically confirmed PCNSL. These were analyzed retrospectively. Their clinico-pathological, immunohistochemical and radiological data were analyzed. Results: Of the 15 PCNSL patients, 8 (53.3%) were females and 7 (46.6%) were males. There was female predilection especially in the age group of 40-59 years. Mean age at diagnosis for all patients was 50.4 years. There was no patient in the pediatric age group. The most common location in the brain was the frontal region in 7 patients (46.6%), 7 (46.6%) had multiple intracranial masses; all 15 (100%) were Non Hodgkin B-cell lymphomas, among which 13 (86.6%) were diffuse large B-cell lymphomas. All 15 (100%) cases showed diffuse and strong positivity for CD 45, and CD 20. Fourteen patients were immune competent while one was immune compromised. Conclusions: PCNSL often occurs in middle-aged and aged patients. There is female predilection especially in the middle age. Frontal region is the most common location with diffuse large B-cell lymphoma being the predominant subtype. PMID:27366250

  13. Primary erythromelalgia: a review.

    PubMed

    Tang, Zhaoli; Chen, Zhao; Tang, Beisha; Jiang, Hong

    2015-01-01

    Primary erythromelalgia (PE ORPHA90026) is a rare autosomal dominant neuropathy characterized by the combination of recurrent burning pain, warmth and redness of the extremities. The incidence rate of PE ranges from 0.36 to 1.1 per 100,000 persons. Gender ratio differs according to different studies and no evidence showed a gender preference. Clinical onset of PE is often in the first decade of life. Burning pain is the most predominant symptom and is usually caused and precipitated by warmth and physical activities. Reported cases of PE contain both inherited and sporadic forms. Genetic etiology of PE is mutations on SCN9A, the encoding gene of a voltage-gated sodium channel subtype Nav1.7. Diagnosis of PE is made upon clinical manifestations and screening for mutations on SCN9A. Exclusion of several other treatable diseases/secondary erythromelalgia is also necessary because of the lack of biomarkers specifically for PE. Differential diagnoses can include Fabry disease, cellulites, Raynaud phenomenon, vasculitis and so on. Diagnostic methods often involve complete blood count, imaging studies and thermograph. Treatment for PE is unsatisfactory and highly individualized. Frequently used pain relieving drugs involve sodium channel blockers such as lidocaine, carbamazepine and mexiletine. Novel drugs such as PF-05089771 and TV-45070 could be promising in ameliorating pain symptoms due to their Nav1.7 selectivity. Patients' symptoms often worsen over time and many patients develop ulcerations and gangrenes caused by excessive exposure to low temperature in order to relieve pain. This review mainly focuses on PE and the causative gene SCN9A--its mutations and their effects on Nav1.7 channels' electrophysiological properties. We propose a genotype-channelopathy-phenotype correlation network underlying PE etiology which could provide guidance for future therapeutics. PMID:26419464

  14. Primary erythromelalgia: a review.

    PubMed

    Tang, Zhaoli; Chen, Zhao; Tang, Beisha; Jiang, Hong

    2015-01-01

    Primary erythromelalgia (PE ORPHA90026) is a rare autosomal dominant neuropathy characterized by the combination of recurrent burning pain, warmth and redness of the extremities. The incidence rate of PE ranges from 0.36 to 1.1 per 100,000 persons. Gender ratio differs according to different studies and no evidence showed a gender preference. Clinical onset of PE is often in the first decade of life. Burning pain is the most predominant symptom and is usually caused and precipitated by warmth and physical activities. Reported cases of PE contain both inherited and sporadic forms. Genetic etiology of PE is mutations on SCN9A, the encoding gene of a voltage-gated sodium channel subtype Nav1.7. Diagnosis of PE is made upon clinical manifestations and screening for mutations on SCN9A. Exclusion of several other treatable diseases/secondary erythromelalgia is also necessary because of the lack of biomarkers specifically for PE. Differential diagnoses can include Fabry disease, cellulites, Raynaud phenomenon, vasculitis and so on. Diagnostic methods often involve complete blood count, imaging studies and thermograph. Treatment for PE is unsatisfactory and highly individualized. Frequently used pain relieving drugs involve sodium channel blockers such as lidocaine, carbamazepine and mexiletine. Novel drugs such as PF-05089771 and TV-45070 could be promising in ameliorating pain symptoms due to their Nav1.7 selectivity. Patients' symptoms often worsen over time and many patients develop ulcerations and gangrenes caused by excessive exposure to low temperature in order to relieve pain. This review mainly focuses on PE and the causative gene SCN9A--its mutations and their effects on Nav1.7 channels' electrophysiological properties. We propose a genotype-channelopathy-phenotype correlation network underlying PE etiology which could provide guidance for future therapeutics.

  15. Primary biliary cirrhosis

    PubMed Central

    Kumagi, Teru; Heathcote, E Jenny

    2008-01-01

    Primary biliary cirrhosis (PBC) is a chronic and slowly progressive cholestatic liver disease of autoimmune etiology characterized by injury of the intrahepatic bile ducts that may eventually lead to liver failure. Affected individuals are usually in their fifth to seventh decades of life at time of diagnosis, and 90% are women. Annual incidence is estimated between 0.7 and 49 cases per million-population and prevalence between 6.7 and 940 cases per million-population (depending on age and sex). The majority of patients are asymptomatic at diagnosis, however, some patients present with symptoms of fatigue and/or pruritus. Patients may even present with ascites, hepatic encephalopathy and/or esophageal variceal hemorrhage. PBC is associated with other autoimmune diseases such as Sjogren's syndrome, scleroderma, Raynaud's phenomenon and CREST syndrome and is regarded as an organ specific autoimmune disease. Genetic susceptibility as a predisposing factor for PBC has been suggested. Environmental factors may have potential causative role (infection, chemicals, smoking). Diagnosis is based on a combination of clinical features, abnormal liver biochemical pattern in a cholestatic picture persisting for more than six months and presence of detectable antimitochondrial antibodies (AMA) in serum. All AMA negative patients with cholestatic liver disease should be carefully evaluated with cholangiography and liver biopsy. Ursodeoxycholic acid (UDCA) is the only currently known medication that can slow the disease progression. Patients, particularly those who start UDCA treatment at early-stage disease and who respond in terms of improvement of the liver biochemistry, have a good prognosis. Liver transplantation is usually an option for patients with liver failure and the outcome is 70% survival at 7 years. Recently, animal models have been discovered that may provide a new insight into the pathogenesis of this disease and facilitate appreciation for novel treatment in PBC

  16. Primary health care models

    PubMed Central

    Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric

    2012-01-01

    Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904

  17. Primary molt of California condors

    USGS Publications Warehouse

    Snyder, N.F.R.; Johnson, E.V.; Clendenen, D.A.

    1987-01-01

    Primary molt of the California Condor (Gymnogyps californianus) was studied intensively from 1982 through 1985, using repeated flight photographs of the remaining individuals in the wild population as a basis for most analyses. On the average, wild condors replaced 4.4 of the 8 emarginated primaries on each wing each year. The sepcific primaries molted were generally the ones missed in the previous year and were usually well-distributed among the eight possibilities, with a tendency for low-numbered primaries to molt earlier than high-numbered primaries. Within individuals, molt of one wing was commonly very different from that of the other wing. Primarily molt of captive juveniles was similar to that of wild juveniles. The interval from loss to full replacement of individual primary feathers was normally 3 1/2 to 4 months, with the primaries closest to the leading edge of the wing growing most slowly. Most primarities were shed between 1 February and 1 September. Primaries lost in late fall and early winter were not replaced until the following summer, indicating interrupted molt over the winter. In general, primary molt of the condor differs from that of smaller cathartids in being highly seasonal, highly variable in sequence, highly asymmetric between wings, and in following a roughly 2-year cycle. Molt of the condor shows many similarities to that of the White Stork (Ciconia ciconia) and to that of large accipitrid vultures.

  18. [Primary vesicoureteral reflux].

    PubMed

    Stein, R; Ziesel, C; Rubenwolf, P; Beetz, R

    2013-01-01

    The never ending discussion about the diagnostics and treatment of vesicoureteral reflux (VUR) now includes arguments for diagnostic nihilism as well as invasive diagnostics and therapy, which is reminiscent of the debate on prostate cancer in adulthood. The common goal of all currently competing diagnostic strategies and approaches is the prevention of renal scars by the most effective and least burdensome approach. There is a difference between acquired pyelonephritic scars with VUR (acquired reflux nephropathy) and congenital reflux nephropathy (primary dysplasia) which cannot be influenced by any therapy.The VUR can be verified by conventional radiological voiding cystourethrography (VCUG), by urosonography, radionuclide cystography or even by magnetic resonance imaging (MRI). The guidelines of the European Association of Urology/European Society for Paediatric Urology (EAU/ESPU) recommend radiological screening for VUR after the first febrile urinary tract infection. Significant risk factors in patients with VUR are recurrent urinary tract infections (UTI) and parenchymal scarring and the patients should undergo patient and risk-adapted therapy. Infants with dilating reflux have a higher risk of renal scarring than those without dilatation of the renal pelvis. Bladder dysfunction or dysfunctional elimination syndrome represents a well-known but previously neglected risk factor in combination with VUR and should be treated prior to any surgical intervention as far as is possible.Certainly not every patient with VUR needs therapy. The current treatment strategies take into account age and gender, the presence of dysplastic or pyelonephritic renal scars, the clinical symptoms, bladder dysfunction and frequency and severity of recurrent UTI as criteria for the therapy decision. The use of an antibacterial prophylaxis as well as the duration is controversially discussed. Endoscopic therapy can be a good alternative to antibacterial prophylaxis or a surveillance

  19. Primary Gastrointestinal Lymphoma

    PubMed Central

    Chen, Yinting; Chen, Yanzhu; Chen, Shaojie; Wu, Lili; Xu, Lishu; Lian, Guoda; Yang, Kege; Li, Yaqing; Zeng, Linjuan; Huang, Kaihong

    2015-01-01

    Abstract Primary gastrointestinal lymphoma (PGIL) is a rare malignant tumor without standard diagnosis and treatment methods. This study is aimed to systematically analyze its clinical characteristics and draw out an appropriate flow chart of diagnosis and treatment process for PGIL in China. This study retrospectively analyzed the clinicopathological characteristics, diagnostic approaches, prognostic factors, and therapeutic modalities in 415 cases of PGIL in Chinese province of Guangdong. A systematic review was conducted in 118 studies containing 5075 patients to further identify clinical manifestations and mortalities of therapeutic modalities. The most common clinical presentations were abdominal pain and bloody stools. Endoscopic biopsy was an important diagnostic means, and usually more than once to make a definite diagnosis. Retrospective multicenter clinical study showed that younger onset age (<60 years), female, one region involved, one lesion, early stage, International Prognostic Index (IPI ≤1), normal lactate dehydrogenase (LDH), normal albumin, and nonemergency operation were significant prognostic factors for B-cell lymphoma; non-B symptom, tumor restricted to gastric or ileocecal region, one lesion, performance status (PS ≤1), normal LDH, and nonsurgery alone were significant prognostic factors for T-cell lymphoma. Site of origin and IPI were independent prognostic factors for B-cell lymphoma; PS was the independent prognostic factor for T-cell lymphoma. And T-cell lymphoma had worse overall survival (OS) and progression-free survival (PFS) than B-cell lymphoma. Among different therapeutic modalities, chemotherapy alone or combined with surgery showed better OS and PFS than surgery alone for diffuse large B-cell lymphoma (DLBCL) of stage I/II E and T-cell lymphoma. For DLBCL of stage III E/IV and mucosa-associated lymphoid tissue lymphoma, OS and PFS did not differ among different therapeutic groups. In meta-analysis, surgery plus chemotherapy

  20. Getting Practical with Primary Teachers

    ERIC Educational Resources Information Center

    Chetwood, Janet; Smith, Melanie; Chapman, Georgina

    2011-01-01

    The Getting Practical--Improving Practical Work in Science programme offers professional development for primary teachers across England. During the 2009/2010 academic year, 237 primary teachers attended a Getting Practical training course, giving themselves the opportunity to reflect upon their own teaching practices and consider ways to make…

  1. Learning outside the Primary Classroom

    ERIC Educational Resources Information Center

    Sedgwick, Fred

    2012-01-01

    In "Learning Outside the Primary Classroom," the educationalist and writer Fred Sedgwick explores in a practical way the many opportunities for intense learning that children and teachers can find outside the confines of the usual learning environment, the classroom. This original work is based on tried and tested methods from UK primary schools.…

  2. [Primary cilia and hedgehog signaling].

    PubMed

    Fujii, Katsunori

    2015-07-01

    The primary cilium is an immotile organelle protruding from the cell surface in almost all vertebrate cells. Many molecules inside the primary cilia coordinately play a pivotal role, so genetic defects of these components result in diverse congenital malformations of the brain, eye, liver, kidney, and skeleton. Hedgehog signaling is a highly conserved pathway regulating morphogenesis in early development and tumorigenesis postnatally. Recently, advanced molecular biology has revealed that components of hedgehog signaling such as PTCH1, SMO, and GLI specifically translocate within the primary cilium upon the ligand binding of the hedgehog protein, and transduce the biological growth signal from the cell surface to the nucleus. Haploinsufficiency of the components in the primary cilium would inhibit the hedgehog pathway, resulting in developmental anomalies like ventral neural tube defects. Since the hedgehog-dependent pathway is critical for vertebrate development, it is crucial to elucidate the functional roles of hedgehog-related proteins in the primary cilium. PMID:26353446

  3. Primary Planets and Elementary Moons: Activities for Primary Students.

    ERIC Educational Resources Information Center

    Winrich, Ralph A.; Samuel, Mary

    This booklet was designed to supplement existing classroom studies on the subject of the solar system at the primary level. Science and mathematics activities for studying moons, planets, and space craft are presented. (PR)

  4. Primary structure -- An important concept to distinguish primary stresses

    SciTech Connect

    Lu Mingwan |; Li Jianguo

    1996-12-01

    A new Chinese design code JB 4732-95, Steel Pressure Vessels -- Design by Analysis, was issued in March 1995. In this paper the authors discuss some concepts and ideas which formed in the introduction and application of the design by analysis approach in China. They are: multi-possibility of stress decomposition, self-limiting stress, classification of constraints, and finally an important concept to distinguish primary stress -- primary structures.

  5. Primary Mediastinal Classical Hodgkin Lymphoma.

    PubMed

    Piña-Oviedo, Sergio; Moran, Cesar A

    2016-09-01

    Primary mediastinal Classical Hodgkin lymphoma (CHL) is rare. Nodular sclerosis CHL (NS-CHL) is the most common subtype involving the anterior mediastinum and/or mediastinal lymph nodes. Primary thymic CHL is exceedingly rare. The disease typically affects young women and is asymptomatic in 30% to 50% of patients. Common symptoms include fatigue, chest pain, dyspnea and cough, but vary depending on the location and size of the tumor. B-symptoms develop in 30% of cases. By imaging, primary mediastinal CHL presents as mediastinal widening/mediastinal mass that does not invade adjacent organs but may compress vital structures as bulky disease. Histopathology is the gold standard for diagnosis. Primary mediastinal NS-CHL consists of nodules of polymorphous inflammatory cells surrounded by broad fibrous bands extending from a thickened lymph node capsule. The cellular nodules contain variable numbers of large Hodgkin/Reed-Sternberg cells, required for diagnosis. Primary thymic CHL may exhibit prominent cystic changes. The histopathologic recognition of NS-CHL can be challenging in cases with prominent fibrosis, scant cellularity, artifactual cell distortion, or an exuberant granulomatous reaction. The differential diagnosis includes primary mediastinal non-HLs, mediastinal germ cell tumors, thymoma, and metastatic carcinoma or melanoma to the mediastinum. Distinction from primary mediastinal non-HLs is crucial for adequate therapeutic decisions. Approximately 95% of patients with primary mediastinal CHL will be alive and free of disease at 10 years after treatment with short courses of combined chemoradiotherapy. In this review, we discuss the history, classification, epidemiology, clinicoradiologic features, histopathology, immunohistochemistry, differential diagnosis, and treatment of primary mediastinal CHL. PMID:27441757

  6. Minimum-Risk Path Finding by an Adaptive Amoebal Network

    NASA Astrophysics Data System (ADS)

    Nakagaki, Toshiyuki; Iima, Makoto; Ueda, Tetsuo; Nishiura, Yasumasa; Saigusa, Tetsu; Tero, Atsushi; Kobayashi, Ryo; Showalter, Kenneth

    2007-08-01

    When two food sources are presented to the slime mold Physarum in the dark, a thick tube for absorbing nutrients is formed that connects the food sources through the shortest route. When the light-avoiding organism is partially illuminated, however, the tube connecting the food sources follows a different route. Defining risk as the experimentally measurable rate of light-avoiding movement, the minimum-risk path is exhibited by the organism, determined by integrating along the path. A model for an adaptive-tube network is presented that is in good agreement with the experimental observations.

  7. Problems of Primary Education Today

    ERIC Educational Resources Information Center

    Dubova, M. V.

    2014-01-01

    Primary education in Russia has failed to adapt to the needs of post-Soviet society, and is still based on rote learning and memorization instead of learning through discovery and learning to use and apply what is learned.

  8. Molariform mesiodens in primary dentition.

    PubMed

    Mangalekar, Sachin B; Ahmed, Tajammul; Zakirulla, M; Shivappa, Halawar Sangmesh; Bheemappa, F B; Yavagal, Chandrashekar

    2013-01-01

    Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment. PMID:23606994

  9. Structures in the primary spectrum

    NASA Astrophysics Data System (ADS)

    Kempa, J.; Knurenko, S. P.; Malecki, R.

    2009-12-01

    Structures in the energy spectrum of primary cosmic rays at the 'knee' region and for energies higher than 1 EeV are obtained through studying extensive air showers (EAS). The main problem of the research is the fact that we work in the ranges of highly fluctuating parameters used to obtain the primary energy spectrum. In this paper the log-normal distribution for the error function has been used in convolution with the power spectrum to explain the Yakutsk experimental data. Similar results have been obtained for the gamma distribution as the error function. Using the power law primary spectrum in the energy region around 10 19 eV we will argue that the primary Yakutsk spectrum is overestimated. In the best case this overestimation is not less than 42%.

  10. Esthetic restoration of primary incisors.

    PubMed

    Carranza, F; García-Godoy, F

    1999-04-01

    A simple and esthetic technique for restoring cariously involved primary maxillary incisors is described. The technique includes mini-pins, a preformed celluloid crown and resin-based composite. PMID:10477982

  11. JWST Primary Mirror Installation Complete

    NASA Video Gallery

    Completing the assembly of the primary mirror, which took place at NASA’s Goddard Space Flight Center in Greenbelt, Maryland, is a significant milestone and the culmination of over a decade of desi...

  12. Primary care psychiatry in Italy.

    PubMed

    Berardi, Domenico; Ferrannini, Luigi; Menchetti, Marco; Vaggi, Marco

    2014-06-01

    In Italy, the importance of integrating primary care and mental health has only recently been grasped. Several reasons may explain this delay: a) until 2005, primary care physicians worked individually instead of in group practices, without any functional network or structured contacts with colleagues; b) community mental health centers with multiprofessional teams were well structured and widespread in several regions but focused on people with severe and persistent mental disorders; and c) specific national government health policies were lacking. Only two regions have implemented explicit policies on this issue. The "G. Leggieri" program started by the Emilia-Romagna region health government in 1999 aims to coordinate unsolicited bottom-up cooperation initiatives developing since the 1980s. In Liguria, a regional work group was established in 2010 to boost the strategic role of collaborative programs between primary care and mental health services. This article describes the most innovative experiences relating to primary care psychiatry in Italy.

  13. Primary retroperitoneal pelvic echinococcal cyst.

    PubMed

    Kalogeris, K G; Christoforidis, L I; Milioudis, N M

    1986-06-01

    We report a case of a single primary retroperitoneal echinococcal cyst located in the pelvis. There were no other hydatid cysts in any other organ. The cyst was excised and serological tests returned to normal.

  14. Molariform Mesiodens in Primary Dentition

    PubMed Central

    Mangalekar, Sachin B.; Ahmed, Tajammul; Zakirulla, M.; Shivappa, Halawar Sangmesh; Bheemappa, F. B.; Yavagal, Chandrashekar

    2013-01-01

    Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch, and incidence of molariform mesiodens in the maxillary midline is rare in permanent dentition and extremely uncommon in primary dentition. A midline supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. This paper reports a rare case of the presence of a molariform mesiodens in the primary dentition. On clinical and radiographic examination, flaring of the primary central incisors was seen, with a molariform mesiodens consisting of multiple lobes or tubercles on the occlusal surface with the well-formed root. The treatment plan consisted of the extraction of the supernumerary tooth and regular observation of permanent central incisors for proper eruption and alignment. PMID:23606994

  15. Primary immune deficiency in bronchiectasis.

    PubMed

    Ozerovitch, Lorraine

    The primary purpose of the immune system is to protect the body from infection. Failure of the immune system can lead to repeated infections. The aim of this review is to discuss primary immune deficiency (PID) and its relationship with bronchiectasis in adults. It examines treatment options for patients with PID and provides practical details of how nurses can empower these patients to reduce their risk of respiratory infections.

  16. Primary immune deficiency in bronchiectasis.

    PubMed

    Ozerovitch, Lorraine

    The primary purpose of the immune system is to protect the body from infection. Failure of the immune system can lead to repeated infections. The aim of this review is to discuss primary immune deficiency (PID) and its relationship with bronchiectasis in adults. It examines treatment options for patients with PID and provides practical details of how nurses can empower these patients to reduce their risk of respiratory infections. PMID:27400622

  17. Transplantation for Primary Biliary Cirrhosis

    PubMed Central

    ESQUIVEL, CARLOS O.; VAN THIEL, DAVID H.; DEMETRIS, ANTHONY J.; BERNARDOS, ANGEL; IWATSUKI, SHUNZABURO; MARKUS, BERND; GORDON, ROBERT D.; MARSH, J. WALLIS; MAKOWKA, LEONARD; TZAKIS, ANDREAS G.; TODO, SATORU; GAVALER, JUDITH S.; STARZL, THOMAS E.

    2011-01-01

    Primary biliary cirrhosis is a frequent indication for liver transplantation. The purpose of this report is to present our experience with liver transplantation for primary biliary cirrhosis. Attention is given to the causes of hepatic dysfunction seen in allografts. In addition, we review the postoperative problems encountered and the quality of life at time of last follow-up in patients with transplants for primary biliary cirrhosis. A total of 97 orthotopic liver transplant procedures were performed in 76 patients with advanced primary biliary cirrhosis at the University of Pittsburgh from March 1980 through September 1985. The transplant operation was relatively easy to perform. The most common technical complications experienced were fragmentation and intramural dissection of the recipient hepatic artery, which required an arterial graft in 20% of the cases. Most of the postoperative mortality occurred in the first 6 mo after transplantation, with an essentially flat actuarial life survival curve from that time point to a projected 5-yr survival of 66%. Common causes of death included rejection and primary graft nonfunction. Thirteen of the 76 patients had some hepatic dysfunction at the time of the last follow-up, although none were jaundiced. Recurrence of primary biliary cirrhosis could not be demonstrated in any of the patients. Antimitochondrial antibody was detected in the serum of almost all of the patients studied postoperatively for it. Most important, almost all of the 52 surviving patients have been rehabilitated socially and vocationally. PMID:3280389

  18. Detection of biomarkers of pathogenic Naegleria fowleri through mass spectrometry and proteomics.

    PubMed

    Moura, Hercules; Izquierdo, Fernando; Woolfitt, Adrian R; Wagner, Glauber; Pinto, Tatiana; del Aguila, Carmen; Barr, John R

    2015-01-01

    Emerging methods based on mass spectrometry (MS) can be used in the rapid identification of microorganisms. Thus far, these practical and rapidly evolving methods have mainly been applied to characterize prokaryotes. We applied matrix-assisted laser-desorption-ionization-time-of-flight mass spectrometry MALDI-TOF MS in the analysis of whole cells of 18 N. fowleri isolates belonging to three genotypes. Fourteen originated from the cerebrospinal fluid or brain tissue of primary amoebic meningoencephalitis patients and four originated from water samples of hot springs, rivers, lakes or municipal water supplies. Whole Naegleria trophozoites grown in axenic cultures were washed and mixed with MALDI matrix. Mass spectra were acquired with a 4700 TOF-TOF instrument. MALDI-TOF MS yielded consistent patterns for all isolates examined. Using a combination of novel data processing methods for visual peak comparison, statistical analysis and proteomics database searching we were able to detect several biomarkers that can differentiate all species and isolates studied, along with common biomarkers for all N. fowleri isolates. Naegleria fowleri could be easily separated from other species within the genus Naegleria. A number of peaks detected were tentatively identified. MALDI-TOF MS fingerprinting is a rapid, reproducible, high-throughput alternative method for identifying Naegleria isolates. This method has potential for studying eukaryotic agents. PMID:25231600

  19. Bis-benzimidazole hits against Naegleria fowleri discovered with new high-throughput screens.

    PubMed

    Rice, Christopher A; Colon, Beatrice L; Alp, Mehmet; Göker, Hakan; Boykin, David W; Kyle, Dennis E

    2015-04-01

    Naegleria fowleri is a pathogenic free-living amoeba (FLA) that causes an acute fatal disease known as primary amoebic meningoencephalitis (PAM). The major problem for infections with any pathogenic FLA is a lack of effective therapeutics, since PAM has a case mortality rate approaching 99%. Clearly, new drugs that are potent and have rapid onset of action are needed to enhance the treatment regimens for PAM. Diamidines have demonstrated potency against multiple pathogens, including FLA, and are known to cross the blood-brain barrier to cure other protozoan diseases of the central nervous system. Therefore, amidino derivatives serve as an important chemotype for discovery of new drugs. In this study, we validated two new in vitro assays suitable for medium- or high-throughput drug discovery and used these for N. fowleri. We next screened over 150 amidino derivatives of multiple structural classes and identified two hit series with nM potency that are suitable for further lead optimization as new drugs for this neglected disease. These include both mono- and diamidino derivatives, with the most potent compound (DB173) having a 50% inhibitory concentration (IC50) of 177 nM. Similarly, we identified 10 additional analogues with IC50s of <1 μM, with many of these having reasonable selectivity indices. The most potent hits were >500 times more potent than pentamidine. In summary, the mono- and diamidino derivatives offer potential for lead optimization to develop new drugs to treat central nervous system infections with N. fowleri. PMID:25605363

  20. Iron-Binding Protein Degradation by Cysteine Proteases of Naegleria fowleri.

    PubMed

    Martínez-Castillo, Moisés; Ramírez-Rico, Gerardo; Serrano-Luna, Jesús; Shibayama, Mineko

    2015-01-01

    Naegleria fowleri causes acute and fulminant primary amoebic meningoencephalitis. This microorganism invades its host by penetrating the olfactory mucosa and then traveling up the mesaxonal spaces and crossing the cribriform plate; finally, the trophozoites invade the olfactory bulbs. During its invasion, the protozoan obtains nutrients such as proteins, lipids, carbohydrates, and cationic ions (e.g., iron, calcium, and sodium) from the host. However, the mechanism by which these ions are obtained, particularly iron, is poorly understood. In the present study, we evaluated the ability of N. fowleri to degrade iron-binding proteins, including hololactoferrin, transferrin, ferritin, and hemoglobin. Zymography assays were performed for each substrate under physiological conditions (pH 7 at 37°C) employing conditioned medium (CM) and total crude extracts (TCEs) of N. fowleri. Different degradation patterns with CM were observed for hololactoferrin, transferrin, and hemoglobin; however, CM did not cause ferritin degradation. In contrast, the TCEs degraded only hololactoferrin and transferrin. Inhibition assays revealed that cysteine proteases were involved in this process. Based on these results, we suggest that CM and TCEs of N. fowleri degrade iron-binding proteins by employing cysteine proteases, which enables the parasite to obtain iron to survive while invading the central nervous system. PMID:26090408