Acanthamoeba spp. un agente oportunista en infecciones humanas
Resumen
Las amebas de vida libre (AVL) se encuentran ampliamente distribuidas en la naturaleza, siendo Acanthamoeba spp. el género más aislado del suelo, aire, aguas tratadas para consumo, agua de mar, lagos y aguas termales. El presente trabajo aborda las características de Acanthamoeba spp., su biología, las patologías que afectan a humanos; además, el diagnóstico microbiológico y molecular, que es una herramienta que ha venido mejorándose con el avance de la tecnología. La clave es la identificación de la ameba, para lograr una buena intervención clínica y terapéutica. Finalmente exponemos las combinaciones terapéuticas exitosas en los escasos reportes clínicos existentes.
Citas
Margulis L. Una revolución en la evolución.
Poder para los protoctistas. Pp. 110-
Colección Honoris Causa. Universitat de València. Valencia, 2003.
Amoebae on the Web. Web-site dedicated
to systematics and identification of
naked lobose amoebae. Disponible
en: <http://amoeba.ifmo.ru/>.
The Amoebae. Disponible en:
www.bms.ed.ac.uk/research/others/
smaciver/amoebae.htm>.
Martínez AJ. Free-Living Amebas: Natural History, Prevention, Diagnosis,
Pathology, and Treatment of Disease.
CRC Press, Boca Raton, FL 1985.
Marciano-Cabral F, Cabral G. Acanthamoeba spp. As agents of disease in humans. Clin Microbiol Rev. 2003; 16:
–307.
Schuster FL, Visvesvara GS. Free-living amoebae as opportunistic and
non-opportunistic pathogens of humans and animals. Int J Parasitol.
; 34: 1001–1027.
Khan NA. Acanthamoeba: biology and
increasing importance in human
health. FEMS Microbiol Rev. 2006;
: 564–595.
Martínez AJ. Free-Living Amebas: Naegleria, Acanthamoeba and Balamuthia
In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX):
University of Texas Medical Branch
at Galveston; 1996. Chapter 81.
Khan NA. Acanthamoeba and the bloodbrain barrier: the breakthrough. J Med
Microbiol. 2008; 57(Pt 9): 1051–7.
Visvesvara G S. Classification of Acanthamoeba. Rev Infect Dis 1991; 13
Suppl 5: S369–72.
Castellani A. An amoeba found in culture of a year: preliminay note. J Trop
Med Hyg. June 2, 1930, p 160; second note: July 1, 1930, p 188; third
note: August 1, 1930, p 221.
Douglas M. Notes on the classification
of the amoeba found by Castellani on
culture of yeast-like fungus. J Trop
Med Hyg, 1930; 33: 258–59.
Culbertson CG, Smith JW, Minner JR
et al. Acanthamoeba: observations on
animal pathogenicity. Science. 1958;
: 1506.
Jahnes W G, Fulmer H M, Li CP.
Free-living amoeba as contaminants
in monkey kidney tissue cultures
(23515). Proceed Soc Exp Biol Med
; 96: 484–8.
Culbertson CG, Smith JW, Cohen HK,
Minner JR. Experimental infection of
mice and monkeys by Acanthamoeba.
Am J Pathol 1959; 35: 185–97.
Page FC. Re-definition of the genus
Acanthamoeba with description of
three species. J. Protozool. 1967; 14:
–724.
Visvesvara GS, Maguire JH. Pathogenic
and opportunistic free-living amebas:
Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea. In: RL Guerrant, DH
Walker, PF Weller (Eds.), Tropical
Infectious Diseases: Principles, Pathogens & Practice. Vol. 2. Churchill
Livingstone (Elsevier), Philadelphia,
, pp. 1114–1125.
Adl SM, Simpson AGB, Farmer MA, et
al. The new higher level classification
of eukaryotes with emphasis on the
taxonomy of protists. J Eukaryot Microbiol 2005; 52: 399–451.
Visvesvara GS, Roy SL, Maguire JH.
Pathogenic and Opportunistic
FreeLiving Amebae. Acanthamoeba
spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia pedata.
Chapter 101. In: Richard L. Guerrant,
David H. Walker, and Peter F. Weller,
Edited. Tropical Infectious Diseases:
Principles, Pathogens and Practice,
ed Hardcover. 2011. Pp. 707–713.
Visvesvara GS. Pathogenic and Opportunistic Free-living Amoebae: Agents of Human and Animal Disease. Chapter 50.
Pussard M, Pons R. Morphologies de la
paroi kystique et taxonomie du genre
Acanthamoeba (Protozoa, Amoebida).
Protistologica 1977; 13: 557–610.
Page FC. A New Key to Freshwater and
Soil Gymnamoebae. Freshwater Biological Association, Cumbria, 1988.
p.
Cerva L, Serbus C, Skocil V. Isolation of
limax amoebae from the nasal mucosa of man. Folia Parasitol. (Praha).
; 20, 97–103.
Badenoch PR, Grimmond TR, Cadwgan
J, Deayton SE, Essery MSL, Hill BD.
Nasal Carriage of Free-Living Amoebae. Microbial Ecology in Health and
Disease. 1988; 1 (3), 209–211.
Cabello-Vílchez AM, Martín-Navarro
CM, López-Arencibia A, Reyes-Batlle M, González AC, Guerra H,
Gotuzzo E, Valladares B, Piñero JE,
Lorenzo-Morales J. Genotyping of
potentially pathogenic Acanthamoeba strains isolated from nasal swabs
of healthy individuals in Peru. Acta
Trop. 2013; 130C: 7–10.
Dunand VA, Hammer SM, Rossi R, et
al. Parasitic sinusitis and otitis in patients infected with human immunodeficiency virus: report of five cases
and review. Clin Infect Dis 1997; 25:
–72.
Dickson JM, Zetler PJ, Walker B, Javer
AR. Acanthamoeba rhinosinusitis. J
Otolaryngol Head Neck Surg. 2009;
(3): E87–90.
Nachega JB, Rombaux P, Weynand B,
Thomas G, Zech F. Successful treatment of Acanthamoeba rhinosinusitis in a patient with AIDS. AIDS
Patient Care STDS. 2005 Oct; 19
(10): 621–5.
Rivera MA, Padhya TA. Acanthamoeba:
a rare primary cause of rhinosinusitis.
Laryngoscope 2002; 112: 1201–3.
Teknos TN, Poulin MD, Laruentano
AM. Acanthamoeba rhinosinusitis:
characterization, diagnosis, and
treatment. Am J Rhinol 2001; 14:
–91.
Kim SY, Syms MJ, Holtel MR, et al.
Acanthamoeba sinusitis with subsequent dissemination in an AIDS patient. Ear Nose Throat J 2000; 79:
–4.
Gonzalez MM, Gould E, Dickinson G,
Martinez AJ, Visvesvara G, Cleary
TJ, Hensley GT. 1986. Acquired immunodeficiency sindrome associated
with Acanthamoeba infection and other opportunistic organisms. Arch.
Pathol. Lab. Med. 110: 749–751.
Helton J, Loveless M, White CR Jr. Cutaneous Acanthamoeba infection associated with leukocytoclastic vasculitis in
an AID Spatient. Am. J. Dermatopathol. 1993; 15: 146–149.
Murakawa GJ, McCalmont T, Altman J,
Telang GM, Hoffman MD, Kantor
GR, Berger TG. Disseminated acanthamebiasis in patients with AIDS.
A report of five cases and a review of
the literature. Arch. Dermatol. 1995;
: 1291–1296.
Duluol AM, Teilhac MF, Poirot JL. Cutaneous lesions due to Acanthamoeba sp.
in patients with AIDS. J. Eukaryot.
Microbiol. 1996; 43: 130–131.
Chandrasekar, PH, Nandi PS, Fairfax
MR, Crane LR. Cutaneous infections due to Acanthamoeba in patients
with acquired immunodeficiency
syndrome. Arch. Intern. Med. 1997;
: 569–572.
Bonilla, HF, Whitehurst A, Kauffman
CA. Acanthamoeba sinusitis and disseminated infection in a patient with
AIDS. Infect. Med. 1999; 16: 397–
Casper T, Basset D, Leclercq C, Fabre J,
Peyron-Raison N, Reynes J. Disseminated acanthamoeba infection in a
patient with AIDS: response to 5-fluorocytosine therapy. Clin. Infect. Dis.
; 29: 944–945.
Friedland LR, Raphael SA, Deutsch ES,
et al. Disseminated Acanthamoeba infection in a child with symptomatic
human immunodeficiency virus infection. Pediatr Infect Dis J 1992; 11:
–407.
Cugino L, Butcher J, Hoppes WL, Doyle
M, Bogden C. Acanthamoeba sinusitis
in a patient with AIDS. Clin Infect
Dis 1995; 21: 795.
Sison JP, Kemper CA, Loveless M,
McShane D, Visvesvara GS, Deresinski SC. Disseminated Acanthamoeba infection in patients with AIDS:
Case reports and review. Clin Infect
Dis 1995; 20: 1207–1216.
Landres B. Acanthamoeba Sinusitis in a
Patient with Acquired Immunodeficiency Syndrome. Proceedings of
UCLA Healthcare-Summer 2000;
: (2): 4-7.
Carter WW, Gompf SG, Toney JF, et al.
Disseminated Acanthamoeba sinusitis
in a patient with AIDS: A posible role
for early antiretroviral therapy. AIDS
Read 2004; 14: 41–49.
Galarza C, Ramos W, Gutierrez EL,
Ronceros G, Teran M, Uribe M,
Navincopa M, Ortega-Loayza AG.
Cutaneous acanthamebiasis infection in immunocompetent and
immunocompromised patients. Int J
Dermatol. 2009; 48(12): 1324–9.
Slater CA, Sickel JZ, Visvesvara GS,
Pabico RC, Gaspari A. Brief report:
successful treatment of disseminated
Acanthamoeba infection in an immunocompromised patient. N. Engl. J.
Med.1994; 331: 85–87.
Van Hamme C, Dumont M, Delos M,
Lachapelle JM. Acanthamibiase cutanee chez un transplante pulmonaire.
Ann. Dermatol. Venereol. 2001; 128:
–1240.
Panjwani N, Zhao Z, Baum J, Hazlett
LD, Yang Z. Acanthamoebae bind to
rabbit corneal epithelium in vitro.
Invest Ophthalmol Vis Sci 1997; 38:
–64.
Siddiqui R, Emes R, Elsheikha H, Khan
NA. Area 51: How do Acanthamoeba
invade the central nervous system?
Trends Parasitol 2011; 27: 185–9.
Garate M, Marchant J, Cubillos I, Cao
Z, Khan NA, Panjwani N. In vitro
pathogenicity of Acanthamoeba is associated with the expression of the mannose-binding protein. Invest Ophthalmol Vis Sci 2006; 47: 1056–62.
Garate M, Cao Z, Bateman E, Panjwani
N. Cloning and characterization of
a novel mannose-binding protein of
Acanthamoeba. J Biol Chem 2004;
: 29849–56.
Siddiqui R, Khan NA. Biology and
pathogenesis of Acanthamoeba. Parasit Vectors. 2012; 5: 6.
Hong YC, Lee WM, Kong HH, Jeong
HJ, Chung DI: Molecular cloning
and characterization of a cDNA encoding a laminin-binding protein
(AhLBP) from Acanthamoeba healyi.
Exp Parasitol 2004, 106: 95–102.
Rocha-Azevedo BD, Jamerson M, Cabral
GA, Marciano-Cabral F: Acanthamoeba culbertsoni: Analysis of amoebic
adhesion and invasion on extracellular matrix components collagen I and
laminin-1. Exp Parasitol 2009, 126:
–84.
Yang Z, Cao Z, Panjwani N. Pathogenesis of Acanthamoeba keratitis: carbohydrate-mediated host-parasite interactions. Infect Immun. 1997; 65(2):
–45.
Khan NA, Paget TA. Molecular tools for
speciation and epidemiological studies of Acanthamoeba. Curr Microbiol.
; 44(6): 444–9.
Khan NA, Jarroll EL, Panjwani N, Cao
Z, Paget TA. Proteases as markers
for differentiation of pathogenic
and nonpathogenic species of Acanthamoeba. J Clin Microbiol. 2000;
(8): 2858–61.
Alfieri SC, Correia CE, Motegi SA &
Pral EM. Proteinase activities in total extracts and in medium conditioned by Acanthamoeba polyphaga
trophozoites. J Parasitol 2000; 86:
–227.
Na BK, Kim JC, Song CY.
Characterization and pathogenetic
role of proteinase from Acanthamoeba castellanii. Microb Pathog. 2001;
(1): 39–48.
Alsam S, Sissons J, Jayasekera S, Khan
NA. Extracellular proteases of Acanthamoeba castellanii (encephalitis
isolate belonging to T1 genotype)
contribute to increased permeability
in an in vitro model of the human
blood–brain barrier. J. Infect. 2005;
, 150–156.
Sissons J, Alsam S, Goldsworthy G, Lightfoot M, Jarroll EL, Khan NA. Identification and properties of proteases
from an Acanthamoeba isolate capable
of producing granulomatous encephalitis. BMC Microbiol. 2006; 6, 42.
Serrano-Luna JdeJ, Cervantes-Sandoval I, Calderón J, Navarro-García F,
Tsutsumi V, Shibayama M. Protease
activities of Acanthamoeba polyphaga
and Acanthamoeba castellanii. Can J
Microbiol 2006; 52: 16–23.
Dudley R, Alsam S, Khan NA. The role
of proteases in the differentiation of
Acanthamoeba castellanii. FEMS Microbiol Lett 2008; 286: 9–15.
De Souza Carvalho FR, Carrijo-Carvalho
LC, Chudzinski-Tavassi AM, Foronda
AS, de Freitas D. Serine-like proteolytic enzymes correlated with differential
pathogenicity in patients with acute
Acanthamoeba keratitis. Clin Microbiol Infect. 2011; 17 (4): 603–9.
Moon EK, Hong Y, Chung DI, Kong
HH. Cysteine protease involving
in autophagosomal degradation of
mitochondria during encystation of
Acanthamoeba. Mol Biochem Parasitol. 2012; 185(2): 121–6.
Hadas E, Mazur T. Proteolytic enzymes
of pathogenic and non-pathogenic
strains of Acanthamoeba spp. Trop
Med Parasitol. 1993; 44(3): 197–200.
Kim HK, Ha YR, Yu HS, Kong HH,
Chung DI. Purification and characterization of a 33 kDa serine protease
from Acanthamoeba lugdunensis KA/
E2 isolated from a Korean keratitis
patient. Korean J Parasitol. 2003;
(4): 189-96.
Ferreira GA, Magliano AC, Pral EM,
Alfieri SC. Elastase secretion in Acanthamoeba polyphaga. Acta Trop.
; 112(2): 156–63.
Alizadeh H, Li H, Neelam S, Niederkorn JY. Modulation of corneal and
stromal matrix metalloproteinase by
the mannose-induced Acanthamoeba cytolytic protein. Exp Eye Res.
; 87(3): 286-91.
Tripathi T, Alizadeh H. Role of protease-activated receptors 2 (PAR2) in
ocular infections and inflammation.
Receptors Clin Investig. 2014; 1(6).
pii: e2991.
Park MK, Cho MK, Kang SA, Park
HK, Kim DH, Yu HS. Acanthamoeba protease activity promotes allergic
airway inflammation via proteaseactivated receptor 2. PLoS One.
; 21: 9(3) e92726.
Iqbal J, Panjwani S, Siddiqui R, Khan
NA. Partial characterization of Acanthamoeba castellanii (T4 genotype)
DNase activity. Parasitol Res. 2015;
(2): 457–63.
Ferrante A. Immunity to Acanthamoeba.
Rev Infect Dis 1991; 13: S403–9.
Clarke DW, Niederkorn JY. The pathophysiology of Acanthamoeba keratitis.
Trends Parasitol 2006; 22: 175–80.
Alizadeh H, Apte S, El-Agha MS, et al.
Tear IgA and serum IgG antibodies against Acanthamoeba in patients
with Acanthamoeba keratitis. Cornea
; 20: 622–7.
Cerva L. Acanthamoeba culbertsoni and
Naegleria fowleri: occurrence of antibodies in man. J Hyg Epidemiol Microbiol Immunol 1989; 33:
–103.
Kenney M. Micro-Kolmer complement
fixation test in routine screening for
soil ameba infections. Health Lab Sci
; 8: 5–10.
Chappell C, Wright JA, Coletta M, et al.
Standardized methods of measuring
Acanthamoeba antibodies in sera from
healthy human subjects. Clin Diagn
Lab Immunol 2001; 8: 724–30.
Visvesvara GS, Moura H, Schuster
FL. Pathogenic and opportunistic
free-living amebae: Acanthamoeba
spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea.
FEMS Immunol Microbiol 2007; 50:
–26 Review.
Marciano-Cabral F, Cabral G. Acanthamoeba spp. as agents of disease in
humans. Clin Microbiol Rev. 2003;
(2): 273–307. Review.
Cabello-Vílchez AM, Rodríguez-Zaragoza S, Piñero J, Valladares B, Lorenzo-Morales J. Balamuthia mandrillaris in South America: an emerging
potential hidden pathogen in Peru.
Exp Parasitol. 2014; 145 Suppl: S10-
Review.
Neff RJ. Purification, axenic cultivation, and description of a soil amoeba. Acanthamoeba sp. J. Protozool. 1957; 4: 176-182.
Page FC. Nackte Rhizopoda. In: Nackte
Rhizopoda und Heliozoea (Eds. Page
F.C. and Siemensma F.J.). G. Fischer Verlag, Stuttgart-New York, 1991;
pp. 1–170.
Pussard M, Pons R. Morphologies de la
paroi kystique et taxonomie du genre
Acanthamoeba (Protozoa, Amoebida). Protistologica 1977; 13: 557–
Schuster FL. Cultivation of pathogenic
and opportunistic free-living amebas.
Clin Microbiol Rev. 2002; 15(3):
–54. Review.
Stothard DR, Schroeder-Diedrich JM,
Awwad MH, Gast RJ, Ledee DR, Rodriguez-Zaragoza S, Dean CL, Fuerst
PA, Byers TJ. The evolutionary history of the genus Acanthamoeba and the
identification of eight new 18S rRNA
gene sequence types. J. Eukaryot. Microbiol. 1998; 45: 45–54.
Nuprasert W, Putaporntip C, Pariyakanok
L, Jongwutiwes S. Identification of a
novel T17 genotype of Acanthamoeba
from environmental isolates and T10
genotype causing keratitis in Thailand. Journal of Clinical Microbiology.
; 48: 4636–4640.
Qvarnstrom Y, Nerad TA, Visvesvara GS.
Characterization of a new pathogenic
Acanthamoeba Species, A. byersi n.
sp., isolated from a human with fatal
amoebic encephalitis. J Eukaryot Microbiol. 2013; 60 (6): 626–33.
Magnet A, Henriques-Gil N, Galván-Díaz AL, Izquiedo F, Fenoy S, del
Aguila C. Novel Acanthamoeba 18S
rRNA gene sequence type from an
environmental isolate. Parasitol Res.
; 113 (8): 2845–50.
Corsaro D, Walochnik J, Köhsler M, Rott
MB. Acanthamoeba misidentification
and multiple labels: redefining
genotypes T16, T19, and T20 and
proposal for Acanthamoeba micheli
sp. nov. (genotype T19). Parasitol
Res. 2015; 114 (7): 2481–90.
Schroeder JM, Booton GC, Hay J, Niszl
IA, Seal DV, Markus MB, Fuerst
PA, Byers TJ. Use of subgenic 18S
ribosomal DNA PCR and sequencing
for genus and genotype identification
of acanthamoebae from humans with
keratitis and from sewage sludge. J Clin
Microbiol. 2001; 39 (5): 1903–11.
Booton GC, Kelly DJ, Chu YW, Seal DV,
Houang E, Lam DS, Byers TJ, Fuerst
PA. 18S ribosomal DNA typing and
tracking of Acanthamoeba species isolates from corneal scrape specimens,
contact lenses, lens cases, and home
water supplies of Acanthamoeba keratitis patients in Hong Kong. J Clin
Microbiol. 2002; 40 (5): 1621–5.
Fuerst PA, Booton GC, Visvesvara GS,
Byers TJ. Genotypic identification of
non-keratitis infections caused by the
opportunistically pathogenic ameba
genus Acanthamoeba. J Eukaryot Microbiol. 2003; 50 Suppl: 512–3.
Booton GC, Visvesvara GS, Byers TJ,
Kelly DJ, Fuerst PA. Identification
and distribution of Acanthamoeba
species genotypes associated with
nonkeratitis infections. J Clin Microbiol. 2005; 43(4): 1689–93.
Yagi S, Schuster FL, Bloch K.
Demonstration of presence of Acanthamoeba mitochondrial DNA in
brain tissue and cerebrospinal fluid
by PCR in samples from a patient
who died of granulomatous amebic
encephalitis. J Clin Microbiol. 2007;
(6): 2090–1.
Walochnik J, Aichelburg A, Assadian
O, Steuer A, Visvesvara G, Vetter N,
Aspöck H. Granulomatous amoebic
encephalitis caused by Acanthamoeba amoebae of genotype T2 in a
human immunodeficiency virusnegative patient. J Clin Microbiol.
Jan; 46 (1): 338–40.
Fuerst PA, Booton GC, Visvesvara GS,
Byers TJ. Genotypic identification of
non-keratitis infections caused by the
opportunistically pathogenic ameba
genus Acanthamoeba. J Eukaryot Microbiol. 2003; 50 Suppl: 512-3.
Lackner P, Beer R, Broessner G, Helbok
R, Pfausler B, Brenneis C, Auer
H, Walochnik J, Schmutzhard
E. Acute granulomatous acanthamoeba encephalitis in an
immunocompetent patient. Neurocrit
Care. 2010; 12(1): 91–4.
Köhsler M, Leitner B, Blaschitz M, Michel R, Aspöck H, Walochnik J. ITS1
sequence variabilities correlate with
S rDNA sequence types in the genus Acanthamoeba (Protozoa: Amoebozoa). Parasitol Res. 2006; 98(2): 86–93.
Lehmann OJ, Green SM, Morlet N,
Kilvington S, Keys MF, Matheson
MM, Dart JK, McGill JI, Watt PJ.
Polymerase chain reaction analysis of
corneal epithelial and tear samples in
the diagnosis of Acanthamoeba keratitis. Invest Ophthalmol Vis Sci. 1998;
(7): 1261–5.
Yera H, Zamfir O, Bourcier T, Ancelle T, Batellier L, Dupouy-Camet J, Chaumeil C. Comparison of PCR, microscopic examination and culture forthe early diagnosis andcharacterization of Acanthamoeba isolates from ocular infections. Eur J Clin Microbiol Infect Dis.
; 26 (3): 2 21-4.
Yagi S, Schuster FL, Visvesvara GS.
Demonstration of Balamuthia and
Acanthamoeba mitochondrial DNA
in sectioned archival brain and other
tissues by the polymerase chain reaction. Parasitol Res. 2008 Feb; 102 (3):
–7.
Walochnik J, Aichelburg A, Assadian
O, Steuer A, Visvesvara G, Vetter N,
Aspöck H. Granulomatous amoebic
encephalitis caused by Acanthamoeba amoebae of genotype T2 in a
human immunodeficiency virusnegative patient. J Clin Microbiol.
; 46 (1): 338–40.
Yagi S, Schuster FL, Bloch K. Demonstration of presence of Acanthamoeba
mitochondrial DNA in brain tissue
and cerebrospinal fluid by PCR in
samples from a patient who died of
granulomatous amebic encephalitis. J Clin Microbiol. 2007; 45 (6):
–1.
Oliva S, Jantz M, Tiernan D, et al. Successful treatment of widely disseminated acanthamebiasis. South Med J
; 92: 55–7.
Vernon SE, Acar BC, Pham SM, et al.
Acanthamoeba infection in lung transplantation: report of a case and review
of the literature. Transpl Infect Dis
; 7: 154–7.
Walia R, Montoya JG, Visvesvara GS,
et al. A case of successful treatment
of cutaneous Acanthamoeba infection
in a lung transplant recipient. Transpl
Infect Dis 2007; 9: 51–4.
Tang-Tat Fung K, Dhillon AP, McLaughlin JE, et al. Cure of Acanthamoeba cerebral abscess in a liver
transplant patient. Liver Transpl
; 14: 308–12.
Singhal T, Bajpai A, Kalra V, et al. Successful treatment of Acanthamoeba
meningitis with combination of antimicrobials. Pediatr Infect Dis 2001;
: 623–7.
Petry F, Torzewski M, Bohl J, et al. Early
diagnosis of Acanthamoeba infection
during routine cytological examination of cerebrospinal fluid. J Clin Microbiol 2006; 44: 1903–4.
Martínez MS, Gonzalez-Mediero G,
Santiago P, et al. Granulomatous
amebic encephalitis in a patient with
AIDS: isolation of Acanthamoeba sp.
group II from brain tissue and successful treatment with sulfadiazine
and fluconazole. J Clin Microbiol
; 38: 3892–5.
Aichelburg AC, Walochnik J, Assadian
O, et al. Successful treatment of disseminated Acanthamoeba spp. infection with Miltefosine. Emerg Infect
Dis 2008; 141: 743–6.
Cabello-Vílchez AM, Martín-Navarro
CM, López-Arencibia A, Reyes-Batlle
M, Sifaoui I, Valladares B, Piñero JE,
Lorenzo-Morales J. Voriconazole as a
first-line treatment against potentially pathogenic Acanthamoeba strains
from Peru. Parasitol Res. 2014;
(2): 755–9.
Martínez DY, Seas C, Bravo F, Legua P,
Ramos C, Cabello AM, Gotuzzo E.
Successful treatment of Balamuthia
mandrillaris amoebic infection with
extensive neurological and cutaneous
involvement. Clin Infect Dis. 2010;
(2): e7–11.
Derechos de autor 2019 Revista de Investigación de la Universidad Norbert Wiener

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