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While meningoencephalitis is the most common presentation of infection with these free-living amebae, pustules, ulcers, and nodules have been reported in the skin, particularly in immunocompromised patients
  • Granulomatous and suppurative inflammation
  • Ulceration and abscess formation
  • Trophozoites (8-25 microns) within infiltrate with characteristic bull's eye appearance.
  • Work-Up Considerations:

    • Biopsy of affected tissue
    • Tissue culture
    • PCR can also be performed
    • Associated with immunosuppression including HIV and organ transplantation.
    • Ophthalmology consultation for ocular examination (corneal involvement from homemade contact lens solution)
    • CT scan, including of the brain, to determine extent of disease
    • Lumbar puncture and brain biopsy in cases of granulomatous amebic encephalitis.

    Treatment:

    • Consultation with infectious disease specialist
    • Early recognition and treatment is critical
    • Medical therapy not well established
    • Few treatments have been used in disseminated cutaneous acanthamebiasis without CNS involvement, and efforts to restore the patient?s immune system as well as a multidrug regimen including 5-flucytosine and sulfadiazine may offer higher chances of survival
    • Topical chlorhexidine and surgical debridement may also be helpful adjunctive therapies.
    • CNS disease is nearly always fatal.
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