Acanthamoeba Clinical Presentation

  • Author: Nancy F Crum-Cianflone; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Nov 28, 2011
 

History

  • Keratitis is usually associated with a history of improper cleaning of contact lenses, using homemade sodium chloride solution to clean the lenses, and swimming in fresh water or a swimming pool, especially while contact lenses are worn. Rarely, this infection develops after radial keratotomy. The incubation period is a few days. Keratitis typically begins with a foreign-body sensation followed by pain, tearing, photophobia, blepharospasm, and blurred vision. Patients may have periods of symptom remission with a waxing and waning course. Bilateral involvement has been described in up to 11% of cases.[4]
  • Granulomatous amebic encephalitis (GAE) is a subacute diffuse meningoencephalitis, usually with an insidious onset. The incubation period is unknown but is probably weeks to months. The duration of illness until death ranges from 7-120 days (average, 39 d). Patients with GAE may have concurrent sinus, lung, or skin disease. Most patients present with focal neurologic deficits; other symptoms are as follows:
    • Mental status changes (86%)
    • Seizures (66%)
    • Hemiparesis (53%)
    • Fever (53%)
    • Headache (53%)
    • Meningismus (40%)
    • Visual disturbances (26%)
    • Ataxia (20%)
    • Nausea and vomiting
    • Hallucinations
    • Personality changes
    • Photophobia
    • Sleep disturbances
  • Skin disease may predate the onset of CNS manifestations by weeks to months and may include ulcers, nodules, or subcutaneous abscesses. Disseminated disease without CNS involvement may manifest as skin lesions, sinusitis, pneumonitis, or a combination. Other unusual manifestations of Acanthamoeba infections have included osteomyelitis, adrenalitis, and vasculitis.
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Physical

  • Keratitis
    • Conjunctivitis or conjunctival hyperemia
    • Corneal ulceration
    • Lid edema
    • A characteristic corneal ring stromal infiltrate
    • Anterior uveitis of fluctuating severity
    • Increased intraocular pressures
    • Hypopyon
    • Cataract formation
  • Granulomatous amebic encephalitis
    • Altered mental status
    • Ataxia
    • Fever
    • Hemiparesis
    • Cranial nerve deficits
    • Meningismus, Babinski sign, and Kernig sign
    • Diplopia, photophobia
    • Coma
    • Concurrent skin lesions, sinus tenderness, or pulmonary rales
  • Disseminated disease without GAE may manifest as skin lesions that are typically hard erythematous nodules or skin ulcers. Other presentations of disseminated disease include pneumonitis and sinusitis.
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Causes

  • Keratitis
    • Wearing contact lenses
    • Using homemade sodium chloride solutions to clean contact lenses
    • Wearing contacts while swimming
    • Cleaning contact lenses less frequently than recommended by the manufacturer
  • Granulomatous amebic encephalitis and disseminated disease: Acanthamoeba is ubiquitous; most persons are exposed to this organism. Although rare cases have been described in immunocompetent adults and children, the main risk factors for the development of disease include immunocompromising conditions and factors associated with immunosuppression, such as the following:
    • AIDS
    • Liver disease
    • Transplantation
    • Diabetes mellitus
    • Steroid use
    • Systemic lupus erythematosus
    • Cancer that requires chemotherapy
    • Malnutrition
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Contributor Information and Disclosures
Author

Nancy F Crum-Cianflone  MD, MPH, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Naval Medical Center at San Diego

Nancy F Crum-Cianflone is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

David Hall Shepp, MD  Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Gilead Sciences Salary Management position

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard B Brown, MD, FACP  Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine

Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor William B. Harley, MD, to the development and writing of this article.

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