Acanthamoebiasis and Balamuthiasis

Acanthamoebiasis and Balamuthiasis are uncommon infections of the brain and meninges that are seen primarily in severely immunocompromised individuals caused by the amoebae acanthomoeba and balamuthia mandrillaris. However, individuals with normal immune system can also get these infections after swimming and inhaling this parasite through the nasal passages.

Acanthomoeba in addition can also cause eye infections in contact lens wearers from contaminated lens cleaning and wetting solutions.

Where does it occur?

The parasites occur worldwide, and are primarily seen in warm fresh water, like late summer ponds/pools and thermal springs and rarely in hot tubs, spas and improperly maintained swimming pools.

How is it transmitted?

The amoebae invade the skin or mucous lining of the nose and then spread to the brain and meninges through the blood stream. Eye infections are transmitted through direct contact from lenses that are contaminated from cleaning and wetting solutions.

Is it contagious from person to person?

No

What is the risk for travelers?

The risk is low, only a few hundred cases of brain infection and a few thousand cases of eye infection have been reported worldwide.

How soon after exposure will I develop symptoms?

Skin lesions can develop in 1-2 weeks but brain and meningeal infection may not develop till weeks or months later. Eye infections usually develop in 2-4 weeks.

What are the signs and symptoms?

The skin lesions can look like sores, small lumps or abscesses. Brain and meningeal involvement can occur months later developing slowly with findings of weakness on one side of the body, difficulty walking, visual changes, fever, headache, stiff neck and changes in consciousness leading to death if untreated.

Are there any lab tests to diagnose the illness?

Diagnosis is made by demonstrating the amoebae on stains of the spinal fluid, scrapings of skin lesions or aspirated fluid from the eye

Is there any treatment?

Medications like pentamidine are effective for brain infection. For eye infections use of eye drops like miconazole,propamidine, isethionate, etc are effective along with debridement.

What preventive measures can be taken?

Avoid swimming or diving into fresh water lakes, ponds, springs especially if there has been known cases of illness in the area. Avoid swimming with contact lenses and follow closely the lens cleaning guidelines from the manufacturer and your ophthalmologist. Do not clean contact lenses with non sterile or home made solutions.

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