Amoebic brain abscess: Difference between revisions
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[[File:Brain MRI 131749 rgbca-.png|thumb|Amoebic brain abscess caused by ''[[Entamoeba histolytica]]'']] |
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An '''amoebic brain abscess''' is a [[brain abscess]] caused by [[amoeba]]s. It is particularly serious in patients with [[immunodeficiency]].<ref name="Medline1">{{cite web|title=Brain abscess|url=https://medlineplus.gov/ency/article/000783.htm|website=MedlinePlus Medical Encyclopedia|access-date=2016-03-31|language=en|date=7 December 2014}}</ref> It is very rare; the first case was reported in 1849.<ref name="Shah 1994" /> |
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An '''amoebic brain abscess''' is a [[brain abscess]] generally caused by the anaerobic parasitic protist ''[[Entamoeba histolytica]]''<ref>{{Cite journal|last=Shah|first=A A|last2=Shaikh|first2=H|last3=Karim|first3=M|date=1994-02-01|title=Amoebic brain abscess: a rare but serious complication of Entamoeba histolytica infection.|url=https://jnnp.bmj.com/lookup/doi/10.1136/jnnp.57.2.240-a|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=57|issue=2|pages=240–241|doi=10.1136/jnnp.57.2.240-a|issn=0022-3050}}</ref>. It is extremely rare; the first case being reported in 1849.<ref name="Shah 1994">{{cite journal|last1=Shah|first1=AA|last2=Shaikh|first2=H|last3=Karim|first3=M|date=February 1994|title=Amoebic brain abscess: a rare but serious complication of ''Entamoeba histolytica'' infection.|journal=Journal of Neurology, Neurosurgery, and Psychiatry|volume=57|issue=2|pages=240–1|doi=10.1136/jnnp.57.2.240-a|pmc=1072466|pmid=8126521}}</ref> Brain abscesses resulting from ''[[Entamoeba histolytica]]'' certainly proves to be a source of diagnostic hindrance as there has been an inadequacy in papers reporting complete recovery, even after administration of appropriate treatment. |
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== Signs and Symptoms == |
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It may be caused by ''[[Entamoeba histolytica]]''.<ref name="Shah 1994">{{cite journal|last1=Shah|first1=AA|last2=Shaikh|first2=H|last3=Karim|first3=M|title=Amoebic brain abscess: a rare but serious complication of ''Entamoeba histolytica'' infection.|journal=Journal of Neurology, Neurosurgery, and Psychiatry|date=February 1994|volume=57|issue=2|pages=240–1|doi=10.1136/jnnp.57.2.240-a|pmid=8126521|pmc=1072466}}</ref> |
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The onset of symptoms is very abrupt and the disease progression is very rapid.<ref>{{Cite journal|last=Tamer|first=Gülden S.|last2=Öncel|first2=Selim|last3=Gökbulut|first3=Sevil|last4=Arisoy|first4=Emin S.|date=2015-03|title=A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child|url=https://smj.org.sa/lookup/doi/10.15537/smj.2015.3.10178|journal=Saudi Medical Journal|language=en|volume=36|issue=3|pages=356–358|doi=10.15537/smj.2015.3.10178|issn=0379-5284|pmc=PMC4381022|pmid=25737180}}</ref> Hence, treating the disease is of utmost importance as failing to do so, could result in imminent death. Signs and symptoms may range from but not limited to:<ref>{{Cite journal|last=Tamer|first=Gülden S.|last2=Öncel|first2=Selim|last3=Gökbulut|first3=Sevil|last4=Arisoy|first4=Emin S.|date=2015-03|title=A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child|url=https://smj.org.sa/lookup/doi/10.15537/smj.2015.3.10178|journal=Saudi Medical Journal|language=en|volume=36|issue=3|pages=356–358|doi=10.15537/smj.2015.3.10178|issn=0379-5284|pmc=PMC4381022|pmid=25737180}}</ref> |
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- Prolonged [[Headache|headaches]] |
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- Progressive [[Drowsiness]] |
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- Diminished upper limb movement |
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- [[Trouble swallowing]] |
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- [[Breathing difficulties]] |
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- [[Low-grade fever|Low grade fever]] |
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- Intestinal symptoms |
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The diagnosis of Amoebic Brain Abscess itself is very difficult as the cultures often yield negative results<ref>{{Cite journal|last=Tamer|first=Gülden S.|last2=Öncel|first2=Selim|last3=Gökbulut|first3=Sevil|last4=Arisoy|first4=Emin S.|date=2015-03|title=A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child|url=https://smj.org.sa/lookup/doi/10.15537/smj.2015.3.10178|journal=Saudi Medical Journal|language=en|volume=36|issue=3|pages=356–358|doi=10.15537/smj.2015.3.10178|issn=0379-5284|pmc=PMC4381022|pmid=25737180}}</ref>. Additionally, the CT images for the abscesses caused by ''[[Entamoeba histolytica]]'' are completely indistinguishable from the abscesses caused by other organisms or causative agents. The brain abscesses may be single or multiple but they are often observed in the frontal lobe or the basal ganglial regions. |
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== Diagnosis == |
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[[File:Thermal cycler for PCR.jpg|thumb|PCR can be used to diagnose the parasite ''[[Entamoeba histolytica]]'']] |
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[[File:Entamoeba histolytica.jpg|thumb|The parasite ''[[Entamoeba histolytica]]'' that generally attributes to Amoebic Brain Abscesses]] |
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The diagnosis of ''[[Entamoeba histolytica]]'' in the brain abscesses is extremely difficult<ref>{{Cite journal|last=Wiwanitkit|first=Somsri|last2=Wiwanitkit|first2=Viroj|date=2012|title=Childhood pyogenic brain abscess: Clinical presentations In Thai reports|url=http://dx.doi.org/10.4103/1755-6783.109265|journal=Annals of Tropical Medicine and Public Health|volume=5|issue=6|pages=563|doi=10.4103/1755-6783.109265|issn=1755-6783}}</ref>; the aerobic and anaerobic cultures often providing misleading results<ref>{{Cite journal|last=Becker|first=George L.|last2=Knep|first2=Stanley|last3=Lance|first3=Kendrick P.|last4=Kaufman|first4=Lee|date=1980-02|title=Amebic Abscess of the Brain:|url=http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006123-198002000-00014|journal=Neurosurgery|language=en|volume=6|issue=2|pages=192–194|doi=10.1227/00006123-198002000-00014|issn=0148-396X}}</ref><ref>{{Cite journal|last=Shah|first=A A|last2=Shaikh|first2=H|last3=Karim|first3=M|date=1994-02-01|title=Amoebic brain abscess: a rare but serious complication of Entamoeba histolytica infection.|url=https://jnnp.bmj.com/lookup/doi/10.1136/jnnp.57.2.240-a|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=57|issue=2|pages=240–241|doi=10.1136/jnnp.57.2.240-a|issn=0022-3050|pmc=PMC1072466|pmid=8126521}}</ref>. In addition to the CT results being often inconclusive, even the parasitologic stool examinations and abdominal ultrasonography often yields normal results. However, direct examination of the abscess capsule may exhibit necrotic material, foamy [[Histiocyte|histiocytes]], rare [[Eosinophil|eosinophills]] and ingested [[Red blood cell|erythrocytes]].<ref>{{Cite journal|last=Tamer|first=Gülden S.|last2=Öncel|first2=Selim|last3=Gökbulut|first3=Sevil|last4=Arisoy|first4=Emin S.|date=2015-03|title=A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child|url=https://smj.org.sa/lookup/doi/10.15537/smj.2015.3.10178|journal=Saudi Medical Journal|language=en|volume=36|issue=3|pages=356–358|doi=10.15537/smj.2015.3.10178|issn=0379-5284|pmc=PMC4381022|pmid=25737180}}</ref>. Spheric structures may insinuate the presence of ''[[Entamoeba histolytica]] '''trophozoites''' with'' [[Masson's trichrome stain]]'''''.''''' Additionally, there has been some success with [[Polymerase chain reaction|PCR]] based parasitic identification of the [[Cerebrospinal fluid|CSF]].<ref>{{Cite journal|last=Ralston|first=Katherine S.|last2=Petri|first2=William A.|date=2011-06|title=Tissue destruction and invasion by Entamoeba histolytica|url=http://dx.doi.org/10.1016/j.pt.2011.02.006|journal=Trends in Parasitology|volume=27|issue=6|pages=254–263|doi=10.1016/j.pt.2011.02.006|issn=1471-4922}}</ref>. Combination of CT scans and PCR based identification along with the serological methods are the current diagnostic measures for detecting ''[[Entamoeba histolytica]].'' |
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== Treatment == |
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[[File:Metronidazole.gif|thumb|Metronidazole can effectively treat amebiasis and is used to treat Amoebic Brain Abscesses]] |
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The treatment regimen for treating Amoebic brain abscesses is very limited. '''[[Metronidazole]]''' is the first choice of treatment for eradicating ''[[Entamoeba histolytica]]'' from the abscesses.<ref>{{Cite journal|last=Chacín-Bonilla|first=Leonor|date=2020-09|title=Editorial. Avances de la ciencia y perspectivas de las personas infectadas por el VIH en Venezuela|url=http://dx.doi.org/10.22209/ic.v61n3a00|journal=Investigación Clínica|volume=61|issue=3|pages=185–187|doi=10.22209/ic.v61n3a00|issn=2477-9393}}</ref> In addition, luminal amebicides such as [[Paromomycin|Paramomycin]] must be administered after completion of [[Metronidazole]] treatment.<ref>{{Cite journal|last=Chacín-Bonilla|first=Leonor|date=2020-09|title=Editorial. Avances de la ciencia y perspectivas de las personas infectadas por el VIH en Venezuela|url=http://dx.doi.org/10.22209/ic.v61n3a00|journal=Investigación Clínica|volume=61|issue=3|pages=185–187|doi=10.22209/ic.v61n3a00|issn=2477-9393}}</ref> This ensures the complete eradication of the parasitic protist from the system. However, the disease is extremely rare and such cases have rarely been published where eradication was documented to its completion. |
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== Immunopathogeneis and associated complications<ref>{{Cite journal|last=Kantor|first=Micaella|last2=Abrantes|first2=Anarella|last3=Estevez|first3=Andrea|last4=Schiller|first4=Alan|last5=Torrent|first5=Jose|last6=Gascon|first6=Jose|last7=Hernandez|first7=Robert|last8=Ochner|first8=Christopher|date=2018-12-02|title=Entamoeba Histolytica: Updates in Clinical Manifestation, Pathogenesis, and Vaccine Development|url=https://www.hindawi.com/journals/cjgh/2018/4601420/|journal=Canadian Journal of Gastroenterology and Hepatology|language=en|volume=2018|pages=1–6|doi=10.1155/2018/4601420|issn=2291-2789|pmc=PMC6304615|pmid=30631758}}</ref><ref>{{Cite journal|last=Abdullah|first=Umme Hani|last2=Baig|first2=Mirza Zain|last3=Azeemuddin|first3=Muhammad|last4=Wasay|first4=Mohammad|last5=Yakoob|first5=Javed|last6=Beg|first6=Mohammad Asim|date=2017-11|title=Amoebic brain abscess associated with renal cell carcinoma|url=https://pericles-gcp.literatumonline.com/doi/10.1111/ncn3.12162|journal=Neurology and Clinical Neuroscience|language=en|volume=5|issue=6|pages=195–197|doi=10.1111/ncn3.12162|issn=2049-4173}}</ref> == |
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Once the trophozoites are excysted in the terminal ileum region, they colonize the large bowel, remaining on the surface of the mucus layer and feeding on bacteria and food particles. Occasionally, and in response to unknown stimuli, trophozoites move through the mucus layer where they come in contact with the epithelial cell layer and start the pathological process. ''E. histolytica'' has a [[lectin]] that binds to galactose and N-acetylgalactosamine sugars on the surface of the epithelial cells, The lectin normally is used to bind bacteria for ingestion. The parasite has several enzymes such as pore forming proteins, lipases, and cysteine proteases, which are normally used to digest bacteria in food vacuoles but which can cause lysis of the epithelial cells by inducing cellular necrosis and apoptosis when the trophozoite comes in contact with them and binds via the lectin. Enzymes released allow penetration into intestinal wall and blood vessels, sometimes on to liver and other organs. The trophozoites will then ingest these dead cells. This damage to the epithelial cell layer attracts human immune cells and these in turn can be lysed by the trophozoite, which releases the immune cell's own lytic enzymes into the surrounding tissue, creating a type of chain reaction and leading to tissue destruction. This destruction manifests itself in the form of an 'ulcer' in the tissue, typically described as flask-shaped because of its appearance in transverse section. This tissue destruction can also involve blood vessels leading to bloody diarrhea, amebic dysentery. Occasionally, trophozoites enter the bloodstream where they are transported typically to the liver via the [[Hepatic portal vein|portal system]]. In the liver a similar pathological sequence ensues, leading to amebic liver abscesses. The trophozoites can also end up in other organs, sometimes via the bloodstream, sometimes via liver abscess rupture or [[Fistula|fistulas]]. Similarly, when the trophozoites travel to the brain, they can cause amoebic brain abscess. |
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Additionally, brain abscesses by ''[[Entamoeba histolytica]]'' can also lead to renal cell carcinoma.<ref>{{Cite journal|last=Abdullah|first=Umme Hani|last2=Baig|first2=Mirza Zain|last3=Azeemuddin|first3=Muhammad|last4=Wasay|first4=Mohammad|last5=Yakoob|first5=Javed|last6=Beg|first6=Mohammad Asim|date=2017-11|title=Amoebic brain abscess associated with renal cell carcinoma|url=https://pericles-gcp.literatumonline.com/doi/10.1111/ncn3.12162|journal=Neurology and Clinical Neuroscience|language=en|volume=5|issue=6|pages=195–197|doi=10.1111/ncn3.12162|issn=2049-4173}}</ref> The single case thus observed was treated with [[Metronidazole]] and performing nephrectomy had resulted in complete recovery. |
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* [[Primary amoebic meningoencephalitis]] |
* [[Primary amoebic meningoencephalitis]] |
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* [[Granulomatous amoebic encephalitis]] |
* [[Granulomatous amoebic encephalitis]] |
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Revision as of 22:05, 10 October 2021
| Amoebic brain abscess | |
|---|---|
| Specialty | Infectious diseases  |
An amoebic brain abscess is a brain abscess generally caused by the anaerobic parasitic protist Entamoeba histolytica[1]. It is extremely rare; the first case being reported in 1849.[2] Brain abscesses resulting from Entamoeba histolytica certainly proves to be a source of diagnostic hindrance as there has been an inadequacy in papers reporting complete recovery, even after administration of appropriate treatment.
Signs and Symptoms
The onset of symptoms is very abrupt and the disease progression is very rapid.[3] Hence, treating the disease is of utmost importance as failing to do so, could result in imminent death. Signs and symptoms may range from but not limited to:[4]
- Prolonged headaches
- Progressive Drowsiness
- Diminished upper limb movement
- Intestinal symptoms
The diagnosis of Amoebic Brain Abscess itself is very difficult as the cultures often yield negative results[5]. Additionally, the CT images for the abscesses caused by Entamoeba histolytica are completely indistinguishable from the abscesses caused by other organisms or causative agents. The brain abscesses may be single or multiple but they are often observed in the frontal lobe or the basal ganglial regions.
Diagnosis
The diagnosis of Entamoeba histolytica in the brain abscesses is extremely difficult[6]; the aerobic and anaerobic cultures often providing misleading results[7][8]. In addition to the CT results being often inconclusive, even the parasitologic stool examinations and abdominal ultrasonography often yields normal results. However, direct examination of the abscess capsule may exhibit necrotic material, foamy histiocytes, rare eosinophills and ingested erythrocytes.[9]. Spheric structures may insinuate the presence of Entamoeba histolytica trophozoites with Masson's trichrome stain. Additionally, there has been some success with PCR based parasitic identification of the CSF.[10]. Combination of CT scans and PCR based identification along with the serological methods are the current diagnostic measures for detecting Entamoeba histolytica.
Treatment
The treatment regimen for treating Amoebic brain abscesses is very limited. Metronidazole is the first choice of treatment for eradicating Entamoeba histolytica from the abscesses.[11] In addition, luminal amebicides such as Paramomycin must be administered after completion of Metronidazole treatment.[12] This ensures the complete eradication of the parasitic protist from the system. However, the disease is extremely rare and such cases have rarely been published where eradication was documented to its completion.
Once the trophozoites are excysted in the terminal ileum region, they colonize the large bowel, remaining on the surface of the mucus layer and feeding on bacteria and food particles. Occasionally, and in response to unknown stimuli, trophozoites move through the mucus layer where they come in contact with the epithelial cell layer and start the pathological process. E. histolytica has a lectin that binds to galactose and N-acetylgalactosamine sugars on the surface of the epithelial cells, The lectin normally is used to bind bacteria for ingestion. The parasite has several enzymes such as pore forming proteins, lipases, and cysteine proteases, which are normally used to digest bacteria in food vacuoles but which can cause lysis of the epithelial cells by inducing cellular necrosis and apoptosis when the trophozoite comes in contact with them and binds via the lectin. Enzymes released allow penetration into intestinal wall and blood vessels, sometimes on to liver and other organs. The trophozoites will then ingest these dead cells. This damage to the epithelial cell layer attracts human immune cells and these in turn can be lysed by the trophozoite, which releases the immune cell's own lytic enzymes into the surrounding tissue, creating a type of chain reaction and leading to tissue destruction. This destruction manifests itself in the form of an 'ulcer' in the tissue, typically described as flask-shaped because of its appearance in transverse section. This tissue destruction can also involve blood vessels leading to bloody diarrhea, amebic dysentery. Occasionally, trophozoites enter the bloodstream where they are transported typically to the liver via the portal system. In the liver a similar pathological sequence ensues, leading to amebic liver abscesses. The trophozoites can also end up in other organs, sometimes via the bloodstream, sometimes via liver abscess rupture or fistulas. Similarly, when the trophozoites travel to the brain, they can cause amoebic brain abscess.
Additionally, brain abscesses by Entamoeba histolytica can also lead to renal cell carcinoma.[15] The single case thus observed was treated with Metronidazole and performing nephrectomy had resulted in complete recovery.
See also
References
- ^ Shah, A A; Shaikh, H; Karim, M (1994-02-01). "Amoebic brain abscess: a rare but serious complication of Entamoeba histolytica infection". Journal of Neurology, Neurosurgery & Psychiatry. 57 (2): 240–241. doi:10.1136/jnnp.57.2.240-a. ISSN 0022-3050.
- ^ Shah, AA; Shaikh, H; Karim, M (February 1994). "Amoebic brain abscess: a rare but serious complication of Entamoeba histolytica infection". Journal of Neurology, Neurosurgery, and Psychiatry. 57 (2): 240–1. doi:10.1136/jnnp.57.2.240-a. PMC 1072466. PMID 8126521.
- ^ Tamer, Gülden S.; Öncel, Selim; Gökbulut, Sevil; Arisoy, Emin S. (2015-03). "A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child". Saudi Medical Journal. 36 (3): 356–358. doi:10.15537/smj.2015.3.10178. ISSN 0379-5284. PMC 4381022. PMID 25737180.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Tamer, Gülden S.; Öncel, Selim; Gökbulut, Sevil; Arisoy, Emin S. (2015-03). "A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child". Saudi Medical Journal. 36 (3): 356–358. doi:10.15537/smj.2015.3.10178. ISSN 0379-5284. PMC 4381022. PMID 25737180.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Tamer, Gülden S.; Öncel, Selim; Gökbulut, Sevil; Arisoy, Emin S. (2015-03). "A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child". Saudi Medical Journal. 36 (3): 356–358. doi:10.15537/smj.2015.3.10178. ISSN 0379-5284. PMC 4381022. PMID 25737180.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Wiwanitkit, Somsri; Wiwanitkit, Viroj (2012). "Childhood pyogenic brain abscess: Clinical presentations In Thai reports". Annals of Tropical Medicine and Public Health. 5 (6): 563. doi:10.4103/1755-6783.109265. ISSN 1755-6783.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Becker, George L.; Knep, Stanley; Lance, Kendrick P.; Kaufman, Lee (1980-02). "Amebic Abscess of the Brain:". Neurosurgery. 6 (2): 192–194. doi:10.1227/00006123-198002000-00014. ISSN 0148-396X.
{{cite journal}}: Check date values in:|date=(help) - ^ Shah, A A; Shaikh, H; Karim, M (1994-02-01). "Amoebic brain abscess: a rare but serious complication of Entamoeba histolytica infection". Journal of Neurology, Neurosurgery & Psychiatry. 57 (2): 240–241. doi:10.1136/jnnp.57.2.240-a. ISSN 0022-3050. PMC 1072466. PMID 8126521.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Tamer, Gülden S.; Öncel, Selim; Gökbulut, Sevil; Arisoy, Emin S. (2015-03). "A rare case of multilocus brain abscess due to Entamoeba histolytica infection in a child". Saudi Medical Journal. 36 (3): 356–358. doi:10.15537/smj.2015.3.10178. ISSN 0379-5284. PMC 4381022. PMID 25737180.
{{cite journal}}: Check date values in:|date=(help)CS1 maint: PMC format (link) - ^ Ralston, Katherine S.; Petri, William A. (2011-06). "Tissue destruction and invasion by Entamoeba histolytica". Trends in Parasitology. 27 (6): 254–263. doi:10.1016/j.pt.2011.02.006. ISSN 1471-4922.
{{cite journal}}: Check date values in:|date=(help) - ^ Chacín-Bonilla, Leonor (2020-09). "Editorial. Avances de la ciencia y perspectivas de las personas infectadas por el VIH en Venezuela". Investigación Clínica. 61 (3): 185–187. doi:10.22209/ic.v61n3a00. ISSN 2477-9393.
{{cite journal}}: Check date values in:|date=(help) - ^ Chacín-Bonilla, Leonor (2020-09). "Editorial. Avances de la ciencia y perspectivas de las personas infectadas por el VIH en Venezuela". Investigación Clínica. 61 (3): 185–187. doi:10.22209/ic.v61n3a00. ISSN 2477-9393.
{{cite journal}}: Check date values in:|date=(help) - ^ Kantor, Micaella; Abrantes, Anarella; Estevez, Andrea; Schiller, Alan; Torrent, Jose; Gascon, Jose; Hernandez, Robert; Ochner, Christopher (2018-12-02). "Entamoeba Histolytica: Updates in Clinical Manifestation, Pathogenesis, and Vaccine Development". Canadian Journal of Gastroenterology and Hepatology. 2018: 1–6. doi:10.1155/2018/4601420. ISSN 2291-2789. PMC 6304615. PMID 30631758.
{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link) - ^ Abdullah, Umme Hani; Baig, Mirza Zain; Azeemuddin, Muhammad; Wasay, Mohammad; Yakoob, Javed; Beg, Mohammad Asim (2017-11). "Amoebic brain abscess associated with renal cell carcinoma". Neurology and Clinical Neuroscience. 5 (6): 195–197. doi:10.1111/ncn3.12162. ISSN 2049-4173.
{{cite journal}}: Check date values in:|date=(help) - ^ Abdullah, Umme Hani; Baig, Mirza Zain; Azeemuddin, Muhammad; Wasay, Mohammad; Yakoob, Javed; Beg, Mohammad Asim (2017-11). "Amoebic brain abscess associated with renal cell carcinoma". Neurology and Clinical Neuroscience. 5 (6): 195–197. doi:10.1111/ncn3.12162. ISSN 2049-4173.
{{cite journal}}: Check date values in:|date=(help)
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