Naegleria Acanthamoeba and Balamuthia

Causative agents of naegleriosis, acanthamebosis, and balamuthiosis

Free-living ameba of the genera Naegleria, Acanthamoeba, and Balamuthia have the potential to infect vertebrates and to cause diseases in humans. The morphological characteristics of these amebas include: nucleus with large karyosome, lack of chromatin granules at the nuclear membrane (see Entamoeba). Trophozoites: Naegleria fowleri (15-30 im) with wide pseudopods, produces flagellated stages in water; Acanthamoeba spp. (24-56 im) with fingerlike protrusions ("filopods"); Balamuthia mandrillaris (12-60 im) has irregularly branched pseudopods. All of these genera produce cysts.

Naegleria. The causative agent of primary amebic meningoencephalitis (PAM) is Naegleria fowleri. This species occurs worldwide in bodies of freshwater, especially warm water in swimming pools, storage containers or thermally polluted lakes and rivers, etc.

Infection of humans occurs by the nasal route with water containing trophozoites, i.e., during a swim or shower. The amebas migrate from the olfactory epithelium along the nerve tracts into the CNS and cause, after an incubation period of two to seven (rarely as long as 15) days a hyperacute to acute meningoencephalitis that usually has a lethal outcome. The infection occurs mainly in children and youths. Sporadic occurrence is reported from all continents. Treatment with amphotericin B has been successful in a small number of cases.

Acanthamoeba. Potential human pathogens in this genus include Acanthamoeba culbertsoni and several other species. These amebas occur worldwide in soil, sand, dust (also house dust), air, and water (also in tap water). The cysts can survive for several years in a dry state and disseminate with dust. Inhalation of cysts with dust is considered to be one of the main transmission routes. Acanthamebas are frequent colonizers of human nasal mucosa and have been isolated from the oral mucosa, skin lesions, and the cornea. From the portal of entry, they can spread hematogenously to the CNS and other organs.

Acanthamoeba infections in humans frequently take an asymptomatic course. Keratitis is observed occasionally, especially in contact lens wearers. Diagnosis: cultur-ing of amebas from conjunctival and contact lens rinsing liquids. Prevention: use only sterile lens rinsing liquid. In rare cases of generalized infection, Acanthamoeba can cause granulomatous amebic encephalitis (GAE) as well as granulomatous lesions in the lungs and other organs, especially in immunodeficient patients. Balamuthia mandrillaris can also cause GAE.

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