RESUMO
Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.
Assuntos
Acanthamoeba/patogenicidade , Amebíase/terapia , Antimaláricos/uso terapêutico , Abscesso Encefálico/terapia , Transplante de Fígado , Rifampina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Acanthamoeba/imunologia , Adulto , Amebíase/diagnóstico , Amebíase/patologia , Animais , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/patologia , Terapia Combinada , Quimioterapia Combinada , Lobo Frontal/patologia , Lobo Frontal/cirurgia , Humanos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/imunologia , Transplante de Fígado/imunologia , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Infecções Oportunistas/terapia , Resultado do TratamentoRESUMO
BACKGROUND: In Hong Kong, chronic hepatitis B (CHB) is endemic with a prevalence rate of 8.8%. Data, however, on chronic hepatitis C infection and other nonviral causes of chronic liver disease (CLD) are limited. AIM: To investigate the spectrum of CLDs in Hong Kong. METHODS: Records of all patients attending the Hepatology Clinic of Queen Mary Hospital, Hong Kong, in 2004 were reviewed to identify those with CLDs and their underlying causes. RESULTS: A total of 6106 patients were found to have CLD. CHB accounted for 89.4% of the cases, followed by chronic hepatitis C infection (5.1%). Nonviral causes accounted for the remaining 5.5% [alcoholic liver disease (ALD) (1.7%), nonalcoholic fatty liver disease (1.5%), primary biliary cirrhosis (PBC) (1.3%)]. Patients with CHB and Wilson's disease were significantly younger than patients with other causes (P<0.002). More than 90% of patients with autoimmune hepatitis and PBC were women. The prevalence of CHB infection was lower in patients with PBC than the general population. Among patients with ALD, the prevalence rate was higher for chronic hepatitis C but similar for CHB, as compared with the general population. CONCLUSIONS: Despite universal HBV vaccination since 1988, CHB remains the commonest cause of CLD in Hong Kong. PBC and nonalcoholic fatty liver disease were not rare in the Chinese population, being important causes of nonviral liver disease. The prevalence of chronic viral infection among patients with PBC or ALD confirmed the findings of other published literatures.
