Acanthamoeba may lead to granulomatous amebic encephalitis (GAE) withhigh mortality rates generally in patients with immunosupression and/orchronic disease. Here, we present a rare GAE case, who was a previouslyhealthy child. A Georgian 9 year old boy presented with focal seizure onhis left arm and confusion. Since computed tomography (CT) demonstratedhypodense lesion on right occipital lobe, brain biopsy was performed.Histopathological examination of the biopsy material revealed Acanthamoebacysts and trophozoites together with granulomatous inflammation. The patient,who had no clinical and laboratory findings consistent with immunedeficiency,was diagnosed as GAE. He was treated with a combination drug therapy.Even if it is very rare, amebic meningoencephalitis may also be seen inimmunocompetent children, as in our case. Definitive diagnosis is made bymicrobiological and histopathological examination of brain biopsy material
___
1. Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-livingamoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea. FEMS Immunol Med Microbiol 2007; 50 : 1-26.
2. McNeil C, Singh U. Acanthamoeba species. In: Long SS, Pıckering LK, Prober GC, eds. Principles and Practice of Pediatric Infectious Diseases, fourth ed. Philadelphia: Churchill Livingstone, 2012: 1295-1298.
3. Stockman LJ, Wright CJ, Visvesvara GS, Fields BS, Beach MJ. Prevalence of Acanthamoeba spp. and other free-living amoebae in household water, Ohio, USA 1990–1992. Parasitol Res 2011; 108: 621-627.
4. Ferrante A.Free-living amoebae: Pathogenicity and immunity. Parasite Immunol 1991; 13: 31-47.
5. Steinberg JP, Galindo RL, Kraus ES, Ghanem KG. Disseminated acanthamebiasis in a renal transplant recipient with osteomyelitis and cutaneous lesions: Case report and literature review. Clin Infect Dis 2002; 35: e43-e49.
6. Sison J, Kemper CA, Loveless M, McShane D, Visvesvara GS, Deresinski SC. Disseminated acanthamoeba infection in patients with AIDS: Case reports and review. Clin Infect Dis 1995; 20: 1207-1216.
7. Zamora A, Henderson H, Swiatlo E. Acanthamoeba encephalitis: A case report and review of therapy. Surg Neurol Int 2014; 5: 68.
8. Binesh F, Karimi M, Navabii H. Unexpected postmortem diagnosis of acanthamoeba meningoencephalitis in an immunocompetent child. BMJ Case Rep 2011; 2011. pii: bcr0320113954.
9. Sarica FB, Tufan K, Cekinmez M, Erdoğan B, Altinörs MN. A rare but fatal case of granulomatous amebic encephalitis with brain abscess: The first case reported from Turkey. Turk Neurosurg 2009; 19: 256-259.
10. Marciano-Cabral F, Cabral G. Acanthamoeba spp. as agents of disease in humans. Clin Microbiol Rev 2003; 16: 273-307.
11. Saxena A, Mittal S, Burman P, Garg P. Acanthameba meningitis with successful outcome. Indian J Pediatr 2009; 76: 1063-1064.
12. Singhal T, Bajpai A, Kalra V, et al. Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials. Pediatr Infect Dis J 2001; 20: 623-627.
13. Webster D, Umar I, Kolyvas G, et al. Case Report: Treatment of granulomatous amoebic encephalitis with voriconazole and miltefosine in an immunocompetent soldier. Am J Trop Med Hyg 2012; 87: 715-718