Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea

doi:10.1111/j.1574-695X.2007.00232.x

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Wiley InterScience

FEMS Immunology & Medical Microbiology

Volume 50 Issue 1, Pages 1 - 26

Published Online: 11 Apr 2007

Published on behalf of the Federation of European Microbiological Societies

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MINIREVIEW

Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea

Govinda S. Visvesvara ¹ , Hercules Moura ² & Frederick L. Schuster ³

¹ Division of Parasitic Diseases, National Center for Infectious Diseases, Atlanta, Georgia, USA; ² Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and ³ Viral and Rickettsial Diseases Laboratory, California Department of Health Services, Richmond, California, USA

Correspondence: Govinda S. Visvesvara, Centers for Disease Control and Prevention, Chamblee Campus, F-36, 4770 Buford Highway NE, Atlanta, Georgia 30341-3724, USA. Tel.: +770 488 4417; fax: +770 488 4253; e-mail: gsv1@cdc.gov

Editor: Willem van Leeuwen

KEYWORDS

primary amoebic meningoencephalitis • granulomatous amoebic encephalitis • amphizoic amoebae • central nervous system infection • skin infection • Acanthamoeba keratitis

ABSTRACT

Among the many genera of free-living amoebae that exist in nature, members of only four genera have an association with human disease: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri and Sappinia diploidea. Acanthamoeba spp. and B. mandrillaris are opportunistic pathogens causing infections of the central nervous system, lungs, sinuses and skin, mostly in immunocompromised humans. Balamuthia is also associated with disease in immunocompetent children, and Acanthamoeba spp. cause a sight-threatening infection, Acanthamoeba keratitis, mostly in contact-lens wearers. Of more than 30 species of Naegleria, only one species, N. fowleri, causes an acute and fulminating meningoencephalitis in immunocompetent children and young adults. In addition to human infections, Acanthamoeba, Balamuthia and Naegleria can cause central nervous system infections in animals. Because only one human case of encephalitis caused by Sappinia diploidea is known, generalizations about the organism as an agent of disease are premature. In this review we summarize what is known of these free-living amoebae, focusing on their biology, ecology, types of disease and diagnostic methods. We also discuss the clinical profiles, mechanisms of pathogenesis, pathophysiology, immunology, antimicrobial sensitivity and molecular characteristics of these amoebae.