Case Report: A Series of Three Meningoencephalitis Cases Caused by Acanthamoeba spp. from Eastern India

Abstract

Acanthamoeba spp. are rare etiological agents of meningoencephalitis with high mortality. We present three cases of Acanthamoeba meningoencephalitis in immunocompetent individuals from Eastern India. The first patient presented with fever and headache; the second with headache, visual disturbance, and squint; and the third presented in a drowsy state. The cases presented on March 3, 18, and 21, 2023 respectively. The first two patients had concomitant tubercular meningitis for which they received antitubercular therapy and steroid. Their cerebrospinal fluid showed slight lymphocytic pleocytosis and increased protein. The diagnosis was done by microscopy, culture, and polymerase chain reaction. They received a combination therapy comprising rifampicin, fluconazole, and trimethoprim-sulfamethoxazole. The first patient additionally received miltefosine. She responded well to therapy and survived, but the other two patients died despite intensive care. Detection of three cases within a period of 1 month from Eastern India is unusual. It is imperative to sensitize healthcare providers about Acanthamoeba meningoencephalitis to facilitate timely diagnosis and treatment of the disease.

Figure 1.

Agarose gel image for Acanthamoeba-specific polymerase chain reaction. Lane 1, negative control; lane 2–5, patient samples amplifying 450- to 500-bp band of Acanthamoeba spp.; lane 6, 100-bp molecular marker; lane 7, positive control.

Figure 2.

Bilateral sixth cranial nerve palsy.

Figure 3.

Magnetic resonance imaging scan of brain showing effaced cortical sulci with slightly prominent lateral ventricles.

Figure 4.

Cerebrospinal fluid wet mount showing Acanthamoeba trophozoites.

Figure 5.

Magnetic resonance imaging scan of brain showing bilateral meningeal enhancement with bilateral periventricular hyperintensities.