The Epidemiology and Clinical Features of Non-Keratitis Acanthamoeba Infections in the United States, 1956–2020. (12th January 2023)

• Record Type: Journal Article
• Authors: Haston, Julia C; O'Laughlin, Kevin; Matteson, Kelsey; Roy, Shantanu; Qvarnstrom, Yvonne; Ali, Ibne K M; Cope, Jennifer R
• Is Part Of: Open forum infectious diseases. Volume 10:Number 1(2023)
• Publication Date: 2023-01-12
• Subjects: Acanthamoeba -- encephalitis -- free-living ameba -- immunocompromised; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac682
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Acanthamoeba is a free-living ameba that can cause severe disease affecting the central nervous system, skin, sinuses, and other organs, particularly in immunocompromised individuals. These rare but severe infections are often fatal, yet incompletely described. Methods: Cases included were either reported to the Centers for Disease Control and Prevention (CDC) Free-Living Ameba program or published in scientific literature. Characteristics of all patients in the United States with laboratory-confirmed non-keratitis Acanthamoeba infections were described using descriptive statistics, and associations with survival were determined using χ 2 and Fisher exact tests. Results: Of 173 patients identified, 71% were male and the median age was 44 years (range, 0–87 years). Of these, 26 (15%) survived. Most patients (88%) had at least 1 immunocompromising condition, most commonly human immunodeficiency virus (39%), cancer (28%), and solid organ or hematopoietic stem cell transplant (28%). Granulomatous amebic encephalitis (GAE) was the most common disease presentation (71%). Skin (46%), sinuses (29%), lungs (13%), and bone (6%) were also involved. Nearly half of patients (47%) had involvement of >1 organ system. Survival was less frequent among those with GAE (3%, P < .001) compared with cutaneous disease, rhinosinusitis, or multiorgan disease not including GAE. Of 7 who received the currently recommended treatment regimen, 5 (71%) survived. Conclusions: Non-keratitis Acanthamoeba infections occur primarily in immunocompromised individuals and are usually fatal. Survival may be associated with disease presentation and treatment. Providers who care for at-risk patients should be aware of the various disease manifestations to improve early recognition and treatment. Abstract : Acanthamoeba can cause rare but often fatal infections of the central nervous system, skin, sinuses, and other organ systems, especially among immunocompromised people. Recognizing the various disease manifestations and risk factors may improve early diagnosis and patient outcomes.