FREE-LIVING AMOEBA

GENERAL CHARACTERISTICS Pathogenesis

IP: 3-7 days accompanied by the prodromal symptoms of headache
Naegleria fowleri and Acanthamoeba castellani
and fever
 Free-living
 Can survive without a host but becomes opportunistic when
Frank meningitis with onset of nausea and vomiting, stiff neck,
they come into contact with humans
confusion, and coma
 Widely distributed in soil and water
Death in 3-6 days
Intestinal vs. Free-living Amoeba

Features Intestinal amoeba Free-living amoeba Forms

Habitat Intestine Soil and Water
Form Characteristics
Pathogenicity Pathogenic Opportunistic
Amoeboid -15-30um
(diseases in colon, (affect CNS, cornea, (trophozoite) -rounded/elongated
liver, and other and skin) -INFECTIVE STAGE
extra-intestinal -single nucleus
sites) -feed and divide by binary
Flagellated forms Absent May be present fission
-can be transformed into
flagellate and cyst form
-found in CSF and tissue
Naegleria fowleri Flagellate -Elongated/pear-shaped
-anterior nucleus
 Disease – Primary amoebic meningoencephalitis
-2 free flagella
 Free-living brain-eating amoeba -found in water 27-37oC
 Typically found in warm fresh water (thermo tolerant -NON FEEDING AND NON
amoeba) DIVIDING
-Maybe isolated from CSF
 Worldwide distribution
-Can be transformed to
 It exist in trophozoite and cyst forms and in a transient ameboid form
flagellate stage Cyst -7-15um
 Common history – all patients have had a history of -Rounded with single nucleus
swimming in freshwater lakes, ponds, or swimming pools a -Thick double cyst wall
-found in soil
few days before the onset of symptoms -NEVER in tissue

Life cycle
 Trophozoites live in warm water at about 42oC
 When the water dries up, trophozoites become cyst
 If the water becomes cooler (27-37oC), it will become
inactive, flagellated form N. fowleri trophozoite forms are seen in CSF but not seen in stool.
 Portal of entry – nasal cavity -> olfactory epithelium (sup. However, E. histolytica may also infect the brain. If so, go back to
nasal concha) -> olfactory nerves -> cribriform plate -> brain history. Bloody stool? Swimming?

Diagnosis
 History of swimming in pools or natural warm water
 Clinical picture
 Autopsy or lumbar tap
 Hemorrhagic inflammation
 Necrosis of brain tissue
 Amoeboid (trophozoite) form is the only form
detected in brain tissue
 CSF - purulent but NO bacteria, increased
pressure, PMN cells, increased protein, presence
of RBCs

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Treatment Forms
 NO SATISFACTORY TREATMENT
Trophozoite Cyst
 Hospitalization -10-40um -15-20um
 Pallative treatment -variable in shape -polygonal, spherical, or star-
 Amphotericin B -with slender spine-like projections shaped
 Drug of choice of plasma membrane -double wall, outer smooth
(acanthopodia) irregular ectocyst and inner rough
 Act on amoebic plasma membrane
-Contractile vacuole polyhedral endocyst with many
 IV or intrathecal -nucleus with large central pores (ostioles)
 Miconazole, Rifampin, or Sulfisoxazole karyosome -Ostioles – where the trophozoite
 Should always be given with Amphotericin B will emerge after it will excyst

Prevention
 Treat swimming pools with chlorine – troph and cysts are
prone to destruction by chlorine
 Swim with head above the water
 Public education

Acanthamoeba castellani
 Found in dust, soil, and river ponds
 Forms: Trophozoites and Cysts
 both infective
 both stages may exist in the environment and
tissues
 Water with the same component with contact lens
solutions best support Acanthamoeba growth
 Affect CNS, eye, skin, and lungs
Life Cycle
Diseases
1. Granulomatous amoebic encephalitis
 Affects immunocompromised
 Course is sub-acute or chronic (from weeks to years)
 Reaches brain through blood supply from lungs or skin
abrasions
 Forms focal granuloma at deeper brain tissues
 Headache, seizures, stiff neck, nausea and vomiting
 Tissue contains trophozoite, cysts, and multinucleate
giant cells

2. Amoebic keratitis
 Acanthamoeba that infects the lung and skin tissue may
spread hematogenously and infect the brain –
Granulomatous amoebic encephalitis
 If it infects the eyes, the infection is localized – amoebic
keratitis
 Trophozoites replicate by mitosis
 Direct contact of cornea with contaminated water or
contact lens
 Chronic, progressive ulcerative keratitis
 Vision is affected
 Neutrophils infiltration
 Trophozoite and cyst are present in corneal tissue
 Ring-like infiltrate/ Halo
 Unique from other causative agents of keratitis

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3. Chronic granulomatous skin ulcers

Laboratory Diagnosis
 Autopsy or Lumbar tap
 Brain tissue and CSF – (+) Troph and cyst
 CSF elevated protein
 Normal or decreased glucose
 Corneal scraping (direct saline wet mount)
 CT multiple brain focal lesions

Treatment
 NO EFFECTIVE THERAPY
 Sulfamethazine
 However, most cases are only diagnosed at
autopsy
 In keratitis, drug is effective (Ketoconazole) with topical
application (Miconazole) followed by keratoplasty

Prevention
 Health education
 Avoid swimming in stagnant water
 Use of proper contact lends fluid

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