Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea

Benjamin Gelman, Vsevolod Popov, Gregory Chaljub, Remi Nader, Shariq J. Rauf, Haring W. Nauta, Govinda S. Visvesvara

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Here we present the neuropathological, ultrastructural, and radiological features of Sappinia diploidea, a newly recognized human pathogen. The patient was a 38-year-old man with visual disturbances, headache, and a seizure. Brain images showed a solitary mass in the posterior left temporal lobe. The mass was composed of necrotizing hemorrhagic inflammation that contained free-living amebae. Immunofluorescence microscopy showed that the organism was not a species of ameba previously known to cause encephalitis. Trophozoites had a highly distinctive double nucleus, and transmission electron microscopy confirmed that they contained 2 nuclei closely apposed along a flattened surface. The 2 nuclei were attached to each other by distinctive connecting perpendicular filaments. This and several other unique structural features led to the diagnosis of S. diploidea encephalitis. The patient was treated postoperatively with a sequential regimen of anti-amebic drugs (azithromycin, pentamidine, itraconazole, and flucytosine) and is alive after 5 years. Guidelines to recognize future cases of S. diploidea encephalitis are as follows. 1) It presented as a tumor-like cerebral mass without an abscess wall. 2) It had central necrotic and hemorrhagic inflammation that contained acute and chronic inflammatory cells without granulomas or eosinophils. 3) It contained trophozoites (40-70 μm diameter) that contained a distinctive double nucleus. 4) Cyst forms in the host were not excluded or definitely evident. 5) Trophozoites engulfed host blood cells and were stained brightly with Giemsa and periodic acid-Schiff. 6) Trophozoites often were present in viable brain parenchyma on the periphery of the mass without inflammatory response. 7) The prognosis after surgical excision and medical treatment was favorable in this instance.

Original languageEnglish (US)
Pages (from-to)990-998
Number of pages9
JournalJournal of Neuropathology and Experimental Neurology
Volume62
Issue number10
StatePublished - Oct 1 2003

Fingerprint

Trophozoites
Encephalitis
Amoeba
Inflammation
Pentamidine
Flucytosine
Azithromycin
Periodic Acid
Itraconazole
Brain
Temporal Lobe
Granuloma
Transmission Electron Microscopy
Fluorescence Microscopy
Eosinophils
Abscess
Headache
Cysts
Blood Cells
Seizures

Keywords

  • Amebic encephalitis
  • Electron microscopy
  • Inflammation
  • Parasite
  • Trophozoite

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Neuroscience(all)

Cite this

Gelman, B., Popov, V., Chaljub, G., Nader, R., Rauf, S. J., Nauta, H. W., & Visvesvara, G. S. (2003). Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea. Journal of Neuropathology and Experimental Neurology, 62(10), 990-998.

Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea. / Gelman, Benjamin; Popov, Vsevolod; Chaljub, Gregory; Nader, Remi; Rauf, Shariq J.; Nauta, Haring W.; Visvesvara, Govinda S.

In: Journal of Neuropathology and Experimental Neurology, Vol. 62, No. 10, 01.10.2003, p. 990-998.

Research output: Contribution to journalArticle

Gelman, B, Popov, V, Chaljub, G, Nader, R, Rauf, SJ, Nauta, HW & Visvesvara, GS 2003, 'Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea', Journal of Neuropathology and Experimental Neurology, vol. 62, no. 10, pp. 990-998.
Gelman, Benjamin ; Popov, Vsevolod ; Chaljub, Gregory ; Nader, Remi ; Rauf, Shariq J. ; Nauta, Haring W. ; Visvesvara, Govinda S. / Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea. In: Journal of Neuropathology and Experimental Neurology. 2003 ; Vol. 62, No. 10. pp. 990-998.
@article{d7bca50a97584b8cacabfa6d310aac33,
title = "Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea",
abstract = "Here we present the neuropathological, ultrastructural, and radiological features of Sappinia diploidea, a newly recognized human pathogen. The patient was a 38-year-old man with visual disturbances, headache, and a seizure. Brain images showed a solitary mass in the posterior left temporal lobe. The mass was composed of necrotizing hemorrhagic inflammation that contained free-living amebae. Immunofluorescence microscopy showed that the organism was not a species of ameba previously known to cause encephalitis. Trophozoites had a highly distinctive double nucleus, and transmission electron microscopy confirmed that they contained 2 nuclei closely apposed along a flattened surface. The 2 nuclei were attached to each other by distinctive connecting perpendicular filaments. This and several other unique structural features led to the diagnosis of S. diploidea encephalitis. The patient was treated postoperatively with a sequential regimen of anti-amebic drugs (azithromycin, pentamidine, itraconazole, and flucytosine) and is alive after 5 years. Guidelines to recognize future cases of S. diploidea encephalitis are as follows. 1) It presented as a tumor-like cerebral mass without an abscess wall. 2) It had central necrotic and hemorrhagic inflammation that contained acute and chronic inflammatory cells without granulomas or eosinophils. 3) It contained trophozoites (40-70 μm diameter) that contained a distinctive double nucleus. 4) Cyst forms in the host were not excluded or definitely evident. 5) Trophozoites engulfed host blood cells and were stained brightly with Giemsa and periodic acid-Schiff. 6) Trophozoites often were present in viable brain parenchyma on the periphery of the mass without inflammatory response. 7) The prognosis after surgical excision and medical treatment was favorable in this instance.",
keywords = "Amebic encephalitis, Electron microscopy, Inflammation, Parasite, Trophozoite",
author = "Benjamin Gelman and Vsevolod Popov and Gregory Chaljub and Remi Nader and Rauf, {Shariq J.} and Nauta, {Haring W.} and Visvesvara, {Govinda S.}",
year = "2003",
month = "10",
day = "1",
language = "English (US)",
volume = "62",
pages = "990--998",
journal = "American Journal of Psychotherapy",
issn = "0002-9564",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Neuropathological and ultrastructural features of amebic encephalitis caused by Sappinia diploidea

AU - Gelman, Benjamin

AU - Popov, Vsevolod

AU - Chaljub, Gregory

AU - Nader, Remi

AU - Rauf, Shariq J.

AU - Nauta, Haring W.

AU - Visvesvara, Govinda S.

PY - 2003/10/1

Y1 - 2003/10/1

N2 - Here we present the neuropathological, ultrastructural, and radiological features of Sappinia diploidea, a newly recognized human pathogen. The patient was a 38-year-old man with visual disturbances, headache, and a seizure. Brain images showed a solitary mass in the posterior left temporal lobe. The mass was composed of necrotizing hemorrhagic inflammation that contained free-living amebae. Immunofluorescence microscopy showed that the organism was not a species of ameba previously known to cause encephalitis. Trophozoites had a highly distinctive double nucleus, and transmission electron microscopy confirmed that they contained 2 nuclei closely apposed along a flattened surface. The 2 nuclei were attached to each other by distinctive connecting perpendicular filaments. This and several other unique structural features led to the diagnosis of S. diploidea encephalitis. The patient was treated postoperatively with a sequential regimen of anti-amebic drugs (azithromycin, pentamidine, itraconazole, and flucytosine) and is alive after 5 years. Guidelines to recognize future cases of S. diploidea encephalitis are as follows. 1) It presented as a tumor-like cerebral mass without an abscess wall. 2) It had central necrotic and hemorrhagic inflammation that contained acute and chronic inflammatory cells without granulomas or eosinophils. 3) It contained trophozoites (40-70 μm diameter) that contained a distinctive double nucleus. 4) Cyst forms in the host were not excluded or definitely evident. 5) Trophozoites engulfed host blood cells and were stained brightly with Giemsa and periodic acid-Schiff. 6) Trophozoites often were present in viable brain parenchyma on the periphery of the mass without inflammatory response. 7) The prognosis after surgical excision and medical treatment was favorable in this instance.

AB - Here we present the neuropathological, ultrastructural, and radiological features of Sappinia diploidea, a newly recognized human pathogen. The patient was a 38-year-old man with visual disturbances, headache, and a seizure. Brain images showed a solitary mass in the posterior left temporal lobe. The mass was composed of necrotizing hemorrhagic inflammation that contained free-living amebae. Immunofluorescence microscopy showed that the organism was not a species of ameba previously known to cause encephalitis. Trophozoites had a highly distinctive double nucleus, and transmission electron microscopy confirmed that they contained 2 nuclei closely apposed along a flattened surface. The 2 nuclei were attached to each other by distinctive connecting perpendicular filaments. This and several other unique structural features led to the diagnosis of S. diploidea encephalitis. The patient was treated postoperatively with a sequential regimen of anti-amebic drugs (azithromycin, pentamidine, itraconazole, and flucytosine) and is alive after 5 years. Guidelines to recognize future cases of S. diploidea encephalitis are as follows. 1) It presented as a tumor-like cerebral mass without an abscess wall. 2) It had central necrotic and hemorrhagic inflammation that contained acute and chronic inflammatory cells without granulomas or eosinophils. 3) It contained trophozoites (40-70 μm diameter) that contained a distinctive double nucleus. 4) Cyst forms in the host were not excluded or definitely evident. 5) Trophozoites engulfed host blood cells and were stained brightly with Giemsa and periodic acid-Schiff. 6) Trophozoites often were present in viable brain parenchyma on the periphery of the mass without inflammatory response. 7) The prognosis after surgical excision and medical treatment was favorable in this instance.

KW - Amebic encephalitis

KW - Electron microscopy

KW - Inflammation

KW - Parasite

KW - Trophozoite

UR - http://www.scopus.com/inward/record.url?scp=0141994803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0141994803&partnerID=8YFLogxK

M3 - Article

C2 - 14575235

AN - SCOPUS:0141994803

VL - 62

SP - 990

EP - 998

JO - American Journal of Psychotherapy

JF - American Journal of Psychotherapy

SN - 0002-9564

IS - 10

ER -