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Chapter 5 : Free-Living Amebae

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Abstract:

The study of parasites and symbionts of free-living amebae is relatively new, and many of the terms used to describe these relationships are listed in this chapter. Serologic evidence that some of the endosymbionts within the free-living amebae might be human pathogens has led to additional studies of these relationships. Infections of the central nervous system (CNS) caused by free-living amebae have been recognized only since the mid-1960s. One type of meningoencephalitis (PAM) is a fulminant and rapidly fatal disease that affects mainly children and young adults. The disease closely resembles bacterial meningitis but is caused by . The first isolations of the environmental strains of pathogenic were reported from water and soil in Australia and from sewage sludge samples in India. The chapter focuses on spp. It is important to remember that in patients thought to have toxoplasmosis, review of the cranial computed tomogram could not distinguish between the two etiologic agents and/or . The free-living ameba is relatively uncommon and was originally thought to be another harmless soil organism. In vitro studies indicate that is susceptible to pentamidine isethiocyanate and that patients with this infection may benefit from this treatment. Finally, the chapter talks about which is a newly recognized human pathogen, causing amebic encephalitis.

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Figures

Image of Figure 5.1
Figure 5.1

Life cycle of .

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.2
Figure 5.2

Diagram of trophozoite. (Upper row) Flagellate and cyst forms of ; (lower row) trophozoite and cyst of spp. (Illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.3
Figure 5.3

(Upper left) Scanning electronic micrograph (SEM) of (Lovell strain) ameboid cell with numerous blunt pseudopods. (Upper right) SEM of (Lovell strain) preflagellate, rounded and producing two short, blunt flagella. (Lower left) SEM of (Lovell strain) flagellate with two long, pointed flagella emerging from the anterior rostrum. (Lower right) SEM of (Lovell strain) reverting flagellate with two long, pointed flagella. (Photographs courtesy of D. T. John. Reprinted from B. L. Cable and D. T. John, Conditions for maximum enflagellation in 467–472, 1986, with permission.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.4
Figure 5.4

(Top) Three amebae of the pathogenic free-living ameba attacking and engulfing a fourth, presumably dead, ameba. The amebae are using sucker-like structures (amebostomes) in this novel form of phagocytosis. (Photograph courtesy of D. T. John. D. T. John, T. B. Cole, Jr., and F. M. Marciano-Cabral, Sucker-like structures on the pathogenic amoeba 12–14, 1984). (Middle) trophozoites; (bottom) trophozoite ingesting starch granules. (Middle and bottom images courtesy of F. M. Marciano-Cabral.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.5
Figure 5.5

organisms in brain tissue from a human with PAM.

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.6
Figure 5.6

Life cycle of , the etiologic agent of amebic keratitis.

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.7
Figure 5.7

Life cycle of and , the etiologic agents of GAE.

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.8
Figure 5.8

(Upper) trophozoites (note the spiky acanthapodia). (Lower) cysts. (Images courtesy of F. M. Marciano-Cabral.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.9
Figure 5.9

cysts and trophozoites in the subcutis of an AIDS patient (hematoxylin and eosin; magnification, ×112). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.10
Figure 5.10

trophozoite in the subcutis of an AIDS patient (hematoxylin and eosin; magnification, ×562). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.11
Figure 5.11

trophozoite in the subcutis of an AIDS patient (hematoxylin and eosin; magnification, ×2,298). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.12
Figure 5.12

cyst in the subcutis of an AIDS patient (hematoxylin and eosin; magnification, ×562). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.13
Figure 5.13

cyst in the subcutis of an AIDS patient (hematoxylin and eosin; magnification, ×2,456). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.14
Figure 5.14

infection in a 28-year-old Mexican woman who had a skin lesion for 6 months. She developed CNS symptoms including headache and nausea. (From A Pictorial Presentation of Parasites: a cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of G. H. Healy.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.15
Figure 5.15

Microscopic view of amebae in skin. Note the typical large karyosome. (From A Pictorial Presentation of Parasites: a cooperative collection prepared and/or edited by H. Zaiman. Photograph courtesy of G. H. Healy.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.16
Figure 5.16

(Left) trophozoites in wet preparation (note the “spiky” pseudopods, called acanthapodia); (right) cyst in wet preparation (note the double-wall appearance).

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.17
Figure 5.17

(A) Trophozoite and (B) cyst of (Illustration by Sharon Belkin.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.18
Figure 5.18

trophozoites in brain (hematoxylin and eosin; magnification, ×74). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.19
Figure 5.19

trophozoites in neutrophilic exudate of brain (hematoxylin and eosin; magnification, ×112). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.20
Figure 5.20

trophozoites in brain (hematoxylin and eosin; magnification, ×742). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.21
Figure 5.21

cyst with outer, wrinkled cyst wall in brain (hematoxylin and eosin; magnification, ×562). (Armed Forces Institute of Pathology photograph.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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Image of Figure 5.22
Figure 5.22

. (Upper) Trophozoite in a wet preparation (note the two nuclei in the upper portion of the organism. (Lower) Two trophozoites in brain tissue (note the trophozoite on the right has the two nuclei clearly visible). (Photographs courtesy of Govinda Visvesvara, Centers for Disease Control and Prevention.)

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
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References

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1. Abramowicz, M. (ed). 2004. Drugs for parasitic infections. Med. Lett. Drugs Ther. 46:112.
2. Alejandre-Aguilar, R.,, M. L. Calvo-Méndez,, B. Nogueda-Torres, and, F. de la Jara-Alcocer. 1998. Maintenance of Acanthamoeba culbertsoni by cryopreservation. J. Parasitol. 84:12611264.
3. Axelsson-Olsson, D.,, J. Waldenstrom,, T. Broman,, B. Olsen, and, M. Holmberg. 2005. Protozoan Acanthamoeba polyphaga as a potential reservoir for Campylobacter jejuni. Appl. Environ. Microbiol. 71:987992.
4. Beattie, T. K.,, D. V. Seal,, A. Tomlinson,, A. K. McFadyen, and, A. M. Grimason. 2003. Determination of amoebicidal activities of multipurpose contact lens solutions by using a most probable number enumeration technique. J. Clin. Microbiol. 41:29923000.
5. Beaver, P. C.,, R. C. Jung, and, E. W. Cupp. 1984. Clinical Parasitology, 9th ed. Lea & Febiger, Philadelphia, Pa.
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7. Booton, G. C.,, J. R. Carmichael,, G. S. Visvesvara,, T. J. Byers, and, P. A. Fuerst. 2003. Identification of Balamuthia mandrillaris by PCR assay using the mitochondrial 16S rRNA gene as a target. J. Clin. Microbiol. 41:453455.
8. Booton, G. C.,, G. S. Visvesvara,, T. J. Byers,, D. J. Kelly, and, P. A. Fuerst. 2005. Identification and distribution of Acanthamoeba species genotypes associated with nonkeratitis infections. J. Clin. Microbiol. 43:16891693.
9. Gelman, B. B.,, V. Popov,, G. Chaljub,, R. Nader,, S. J. Rauf,, H. W. Nauta, and, G. S. Visvesvara. 2003. Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea. J. Neuropathol. Exp. Neurol. 62:990998.
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11. Jayasekera, S.,, J. Sissons,, J. Tucker,, C. Rogers,, D. Nolder,, D. Warhurst,, S. Alsan,, J. M. White,, E. M. Higgins, and, N. A. Khan. 2004. Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis using human brain microvascular endothelial cells. J. Med. Microbiol. 53:10071012.
12. Jung, S.,, R. L. Schelper,, G. S. Visvesvara, and, H. T. Chang. 2004. Balamuthia mandrillaris meningoencephalitis in an immunocompetent patient: an unusual clinical course and a favorable outcome. Arch. Pathol. Lab. Med. 128:466468.
13. Kilvington, S.,, T. Gray,, J. Dart,, N. Morlet,, J. R. Beeching,, D. G. Frazer, and, M. Matheson. 2004. Acanthamoeba keratitis: the role of domestic tap water contamination in the United Kingdom. Investig. Ophthalmol. Vis. Sci. 45:165169.
14. Kinnear, F. B. 2003. Cytopathogenicity of Acanthamoeba, Vahlkampfia and Hartmannella: quantative and qualitative in vitro studies on keratocytes. J. Infect. 46:228237.
15. Marciano-Cabral, F.,, and G. Cabral. 2003. Acanthamoeba spp. as agents of disease in humans. Clin. Microbiol. Rev. 16:273307.
16. McBride, J.,, P. R. Ingram,, F. L. Henriquez, and, C. W. Roberts. 2005. Development of colorimetric microtiter plate assay for assessment of antimicrobials against Acanthamoeba. J. Clin. Microbiol. 43:629634.
17. Paltiel, M.,, E. Powell,, J. Lynch,, B. Baranowski, and, C. Martins. 2004. Disseminated cutaneous acanthamebiasis: a case report and review of the literature. Cutis 73:241248.
18. Pasricha, G.,, S. Sharma,, P. Garg, and, R. K. Aggarwal. 2003. Use of 18S rRNA gene-based PCR assay for diagnosis of Acanthamoeba keratitis in non-contact lens wearers in India. J. Clin. Microbiol. 41:32063211.
19. Schuster, F. L.,, T. H. Dunnebacke,, G. C. Booton,, S. Yagi,, C. K. Kohnmeier,, C. Glaser,, D. Vugia,, A. Bakardjiev,, P. Azimi,, M. Maddux-Gonzalez,, A. J. Martinez, and, G. S. Visvesvara. 2003. Environmental isolation of Balamuthia mandrillaris associated with a case of amebic encephalitis. J. Clin. Microbiol. 41:31753180.
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21. Schuster, F. L.,, and G. S. Visvesvara. 2004. Opportunistic amoebae: challenges in prophylaxis and treatment. Drug Resist. Updat. 7:4151.
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23. Thomas, V.,, T. Bouchez,, V. Nicolas,, S. Robert,, J. F. Loret, and, Y. Levi. 2004. Amoebae in domestic water systems: resistance to disinfection treatments and implication in Legionella persistence. J. Appl. Microbiol. 97:950963.

Tables

Generic image for table
Table 5.1

Free-living amebae causing disease in humans

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.2

Definitions pertaining to the relationships among free-living amebae and other organisms

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.3

Comparison of and spp.

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.4

infection: clinical manifestations of patients with AIDS

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.5

infection: examples of clinical features in specific patients with AIDS

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.6

infections, treatment, and positive patient outcomes

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5
Generic image for table
Table 5.7

Summary of information on the newly recognized pathogenic free-living ameba,

Citation: Garcia L. 2007. Free-Living Amebae, p 102-122. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch5

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