Amoebic brain abscess

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Amoebic brain abscess
Brain MRI 131749 rgbca-.png
Amoebic brain abscess caused by Entamoeba histolytica
Specialty Infectious diseases   OOjs UI icon edit-ltr-progressive.svg
Symptoms Prolonged headaches, progressive Drowsiness, diminished upper limb movement, trouble swallowing, breathing difficulties, low-grade fever, and intestinal symptoms. [1]
Causes Entamoeba histolytica
Diagnostic method PCR based analysis of the CSF.
Treatment Metronidazole.

Amoebic brain abscess is an affliction caused by the anaerobic parasitic protist Entamoeba histolytica . It is extremely rare; the first case being reported in 1849. [2] Brain abscesses resulting from Entamoeba histolytica are difficult to diagnose and very few case reports suggest complete recovery even after the administration of appropriate treatment regimen. [1]

Contents

Signs and symptoms

The onset of symptoms is very abrupt and the disease progression is very rapid. [1] Hence finding the root cause of the symptoms is very important as failing to do so, could result in imminent death. Signs and symptoms include: [1]

The CT images for the abscesses caused by Entamoeba histolytica are completely indistinguishable from the abscesses caused by any other organisms or causative agents. However, the brain abscesses are often observed in the frontal lobe or the basal ganglial regions. [1]

Immunopathogenesis of Entamoeba histolytica

Once the trophozoites undergo excystation in the terminal ileum region, they colonize the large bowel, remaining on the surface of the mucus layer and feeding on bacteria and food particles. However, in response to an unknown stimuli, trophozoites often move through the mucus layer and once they come in contact with the epithelial cell layer, they are able to start the pathological process. E. histolytica has a lectin that binds to galactose and N-Acetylgalactosamine sugars on the surface of the epithelial cells. The lectin is normally used to bind bacteria for ingestion. The parasite has several enzymes such as pore forming proteins, lipases, and cysteine proteases, which are normally used to digest bacteria in food vacuoles. However, these enzymes can cause lysis of the epithelial cells by inducing cellular necrosis and apoptosis when the trophozoites come in contact with them and bind via the lectin. This allows for penetration into the intestinal wall and blood vessels, sometimes leading to the liver and other organs like the brain. Meanwhile, the trophozoites begin to ingest the dead cells which triggers a massive immune response in the epithelial cell layer. [3] [4]

The damage to the epithelial cell layer attracts immune cells, which in turn can be lysed by the trophozoite. This results in the release of the immune cells' own lytic enzymes into the surrounding tissue thus ultimately leading to excessive tissue destruction. This destruction manifests itself in the form of an 'ulcer', typically described as flask-shaped because of its appearance in transverse section. This tissue decimation can also involve blood vessels leading to bloody diarrhea or amebic dysentery. [3]

Occasionally, when the trophozoites enter the bloodstream, they are generally transported to the liver via the portal system. In the liver a similar pathological sequence ensues, leading to amebic liver abscesses. The trophozoites can also end up in other organs, as a result of liver abscess rupture or fistulas. In extremely rare cases, when the trophozoites travel to the brain surpassing the blood-brain barrier, they can cause amoebic brain abscess. [3]

Diagnosis

PCR can be used to diagnose the parasite Entamoeba histolytica Thermal cycler for PCR.jpg
PCR can be used to diagnose the parasite Entamoeba histolytica
The parasite Entamoeba histolytica that generally attributes to Amoebic Brain Abscesses Entamoeba histolytica.jpg
The parasite Entamoeba histolytica that generally attributes to Amoebic Brain Abscesses

The diagnosis of Entamoeba histolytica in the brain abscesses is difficult for several reasons. Firstly, the aerobic and anaerobic cultures generally provide negative results. [5] [2]

In addition, the CT results are often inconclusive and even the parasitologic stool examinations and abdominal ultrasonography often yield normal results. However, direct examination of the abscess capsule may exhibit necrotic material, foamy histiocytes, rare eosinophills and ingested erythrocytes. [1] Spheric structures may insinuate the presence of Entamoeba histolytica trophozoites with Masson's trichrome stain . Additionally, PCR based analysis of the CSF can be used to positively identify the parasite in the system . [6]

Treatment

Metronidazole is the first choice of drug for the treatment of the abscesses caused by Entamoeba histolytica . In addition, luminal amebicides such as Paramomycin must be administered after completion of Metronidazole treatment. This ensures complete eradication of the parasitic protist from the system. [7]

See also

Related Research Articles

<i>Entamoeba</i> Genus of internal parasites

Entamoeba is a genus of Amoebozoa found as internal parasites or commensals of animals. In 1875, Fedor Lösch described the first proven case of amoebic dysentery in St. Petersburg, Russia. He referred to the amoeba he observed microscopically as Amoeba coli; however, it is not clear whether he was using this as a descriptive term or intended it as a formal taxonomic name. The genus Entamoeba was defined by Casagrandi and Barbagallo for the species Entamoeba coli, which is known to be a commensal organism. Lösch's organism was renamed Entamoeba histolytica by Fritz Schaudinn in 1903; he later died, in 1906, from a self-inflicted infection when studying this amoeba. For a time during the first half of the 20th century the entire genus Entamoeba was transferred to Endamoeba, a genus of amoebas infecting invertebrates about which little is known. This move was reversed by the International Commission on Zoological Nomenclature in the late 1950s, and Entamoeba has stayed 'stable' ever since.

<span class="mw-page-title-main">Dysentery</span> Inflammation of the intestine causing diarrhea with blood

Dysentery, historically known as the bloody flux, is a type of gastroenteritis that results in bloody diarrhea. Other symptoms may include fever, abdominal pain, and a feeling of incomplete defecation. Complications may include dehydration.

<span class="mw-page-title-main">Phagocytosis</span> Process by which a cell uses its plasma membrane to engulf a large particle

Phagocytosis is the process by which a cell uses its plasma membrane to engulf a large particle, giving rise to an internal compartment called the phagosome. It is one type of endocytosis. A cell that performs phagocytosis is called a phagocyte.

<i>Entamoeba histolytica</i> Anaerobic parasitic protist

Entamoeba histolytica is an anaerobic parasitic amoebozoan, part of the genus Entamoeba. Predominantly infecting humans and other primates causing amoebiasis, E. histolytica is estimated to infect about 35-50 million people worldwide. E. histolytica infection is estimated to kill more than 55,000 people each year. Previously, it was thought that 10% of the world population was infected, but these figures predate the recognition that at least 90% of these infections were due to a second species, E. dispar. Mammals such as dogs and cats can become infected transiently, but are not thought to contribute significantly to transmission.

<i>Entamoeba coli</i> Species of parasitic amoeba

Entamoeba coli is a non-pathogenic species of Entamoeba that frequently exists as a commensal parasite in the human gastrointestinal tract. E. coli is important in medicine because it can be confused during microscopic examination of stained stool specimens with the pathogenic Entamoeba histolytica. This amoeba does not move much by the use of its pseudopod, and creates a "sur place (non-progressive) movement" inside the large intestine. Usually, the amoeba is immobile, and keeps its round shape. This amoeba, in its trophozoite stage, is only visible in fresh, unfixed stool specimens. Sometimes the Entamoeba coli have parasites as well. One is the fungus Sphaerita spp. This fungus lives in the cytoplasm of the E. coli. While this differentiation is typically done by visual examination of the parasitic cysts via light microscopy, new methods using molecular biology techniques have been developed. The scientific name of the amoeba, E. coli, is often mistaken for the bacterium, Escherichia coli. Unlike the bacterium, the amoeba is mostly harmless, and does not cause as many intestinal problems as some strains of the E. coli bacterium. To make the naming of these organisms less confusing, "alternate contractions" are used to name the species for the purpose making the naming easier; for example, using Esch. coli and Ent. coli for the bacterium and amoeba, instead of using E. coli for both.

<span class="mw-page-title-main">Amoebozoa</span> Phylum of protozoans

Amoebozoa is a major taxonomic group containing about 2,400 described species of amoeboid protists, often possessing blunt, fingerlike, lobose pseudopods and tubular mitochondrial cristae. In traditional classification schemes, Amoebozoa is usually ranked as a phylum within either the kingdom Protista or the kingdom Protozoa. In the classification favored by the International Society of Protistologists, it is retained as an unranked "supergroup" within Eukaryota. Molecular genetic analysis supports Amoebozoa as a monophyletic clade. Modern studies of eukaryotic phylogenetic trees identify it as the sister group to Opisthokonta, another major clade which contains both fungi and animals as well as several other clades comprising some 300 species of unicellular eukaryotes. Amoebozoa and Opisthokonta are sometimes grouped together in a high-level taxon, variously named Unikonta, Amorphea or Opimoda.

<span class="mw-page-title-main">Naegleriasis</span> Rare and usually fatal brain infection by a protist

Naegleriasis is an almost invariably fatal infection of the brain by the free-living unicellular eukaryote Naegleria fowleri. Symptoms are meningitis-like and include headache, fever, nausea, vomiting, a stiff neck, confusion, hallucinations and seizures. Symptoms progress rapidly over around five days, and death usually results within one to two weeks of symptoms.

A trophozoite is the activated, feeding stage in the life cycle of certain protozoa such as malaria-causing Plasmodium falciparum and those of the Giardia group. The complementary form of the trophozoite state is the thick-walled cyst form. They are often different from the cyst stage, which is a protective, dormant form of the protozoa. Trophozoites are often found in the host's body fluids and tissues and in many cases, they are the form of the protozoan that causes disease in the host. In the protozoan, Entamoeba histolytica it invades the intestinal mucosa of its host, causing dysentery, which aid in the trophozoites traveling to the liver and leading to the production of hepatic abscesses.

<i>Balamuthia mandrillaris</i> Species of pathogenic Amoebozoa

Balamuthia mandrillaris is a free-living amoeba that causes the rare but deadly neurological condition granulomatous amoebic encephalitis (GAE). B. mandrillaris is a soil-dwelling amoeba and was first discovered in 1986 in the brain of a mandrill that died in the San Diego Wild Animal Park.

<span class="mw-page-title-main">Granulomatous amoebic encephalitis</span> Rare and usually fatal brain infection by certain amoebae

.

<span class="mw-page-title-main">Liver abscess</span> Medical condition

A liver abscess is a mass filled with pus inside the liver. Common causes are abdominal conditions such as appendicitis or diverticulitis due to haematogenous spread through the portal vein. It can also develop as a complication of a liver injury.

<span class="mw-page-title-main">Protozoan infection</span> Parasitic disease caused by a protozoan

Protozoan infections are parasitic diseases caused by organisms formerly classified in the kingdom Protozoa. These organisms are now classified in the supergroups Excavata, Amoebozoa, Harosa, and Archaeplastida. They are usually contracted by either an insect vector or by contact with an infected substance or surface.

An amebicide is an agent that is destructive to amoeba, especially parasitic amoeba that cause amoebiasis.

<span class="mw-page-title-main">Amoebiasis</span> Human disease caused by amoeba protists

Amoebiasis, or amoebic dysentery, is an infection of the intestines caused by a parasitic amoeba Entamoeba histolytica. Amoebiasis can be present with no, mild, or severe symptoms. Symptoms may include lethargy, loss of weight, colonic ulcerations, abdominal pain, diarrhea, or bloody diarrhea. Complications can include inflammation and ulceration of the colon with tissue death or perforation, which may result in peritonitis. Anemia may develop due to prolonged gastric bleeding.

<span class="mw-page-title-main">Amoebic liver abscess</span> Medical condition

A amoebic liver abscess is a type of liver abscess caused by amebiasis. It is the involvement of liver tissue by trophozoites of the organism Entamoeba histolytica and of its abscess due to necrosis.

<span class="mw-page-title-main">Dehydroemetine</span> Chemical compound

Dehydroemetine is a synthetically produced antiprotozoal agent similar to emetine in its anti-amoebic properties and structure, but it produces fewer side effects. In the United States, it is manufactured by Roche.

Entamoeba polecki is an intestinal parasite of the genus Entamoeba. E. polecki is found primarily in pigs and monkeys and is largely considered non-pathogenic in humans, although there have been some reports regarding symptomatic infections of humans. Prevalence is concentrated in New Guinea, with distribution also recorded in areas of southeast Asia, France, and the United States.

Entamoeba moshkovskii is part of the genus Entamoeba. It is found in areas with polluted water sources, and is prevalent in places such as Malaysia, India, and Bangladesh, but more recently has made its way to Turkey, Australia, and North America. This amoeba is said to rarely infect humans, but recently this has changed. It is in question as to whether it is pathogenic or not. Despite some sources stating this is a free living amoeba, various studies worldwide have shown it contains the ability to infect humans, with some cases of pathogenic potential being reported. Some of the symptoms that often occur are diarrhea, weight loss, bloody stool, and abdominal pain. The first known human infection also known as the "Laredo strain" of Entamoebic mushkovskii was in Laredo, Texas in 1991, although it was first described by a man named Tshalaia in 1941 in Moscow, Russia. It is known to affect people of all ages and genders.

Entamoeba invadens is an amoebozoa parasite of reptiles, within the genus Entamoeba. It is closely related to the human parasite Entamoeba histolytica, causing similar invasive disease in reptiles, in addition to a similar morphology and lifecycle.

<i>Naegleria fowleri</i> Species of free-living excavate form of protist

Naegleria fowleri, colloquially known as the "brain-eating amoeba", is a species of the genus Naegleria. It belongs to the phylum Percolozoa and is technically classified as an amoeboflagellate excavate, rather than a true amoeba. This free-living microorganism primarily feeds on bacteria but can become pathogenic in humans, causing an extremely rare, sudden, severe, and usually fatal brain infection known as naegleriasis or primary amoebic meningoencephalitis (PAM).

References

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