Acanthamoeba Infections


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a) an acanthamoeba cyst is shown. b) an acanthamoeba trophozoite micrograph is shown. c) a photo of an eye with a fluorescent cornea is shown.
(a) An Acanthamoeba cyst. (b) An Acanthamoeba trophozoite (c) The eye of a patient with Acanthamoeba keratitis. The fluorescent color, which is due to sodium fluorescein application, highlights significant damage to the cornea and vascularization of the surrounding conjunctiva. (credit a: modification of work by Centers for Disease Control and Prevention; credit b, c: modification of work by Jacob Lorenzo-Morales, Naveed A Kahn and Julia Walochnik)

OpenStax Microbiology

Acanthamoeba is a genus of free-living protozoan amoebae that are common in soils and unchlorinated bodies of fresh water. (This is one reason why some swimming pools are treated with chlorine.) The genus contains a few parasitic species, some of which can cause infections of the eyes, skin, and nervous system. Such infections can sometimes travel and affect other body systems. Skin infections may manifest as abscesses, ulcers, and nodules. When acanthamoebae infect the eye, causing inflammation of the cornea, the condition is called Acanthamoeba keratitisFigure 21.34 illustrates the Acanthamoeba life cycle and various modes of infection.

While Acanthamoeba keratitis is initially mild, it can lead to severe corneal damage, vision impairment, or even blindness if left untreated. Similar to eye infections involving P. aeruginosa, Acanthamoeba poses a much greater risk to wearers of contact lenses because the amoeba can thrive in the space between contact lenses and the cornea. Prevention through proper contact lens care is important. Lenses should always be properly disinfected prior to use, and should never be worn while swimming or using a hot tub.

Acanthamoeba can also enter the body through other pathways, including skin wounds and the respiratory tract. It usually does not cause disease except in immunocompromised individuals; however, in rare cases, the infection can spread to the nervous system, resulting in a usually fatal condition called granulomatous amoebic encephalitis (GAE). Disseminated infections, lesions, and Acanthamoeba keratitis can be diagnosed by observing symptoms and examining patient samples under the microscope to view the parasite. Skin biopsies may be used.

Acanthamoeba keratitis is difficult to treat, and prompt treatment is necessary to prevent the condition from progressing. The condition generally requires three to four weeks of intensive treatment to resolve. Common treatments include topical antiseptics (e.g., polyhexamethylene biguanide, chlorhexidine, or both), sometimes with painkillers or corticosteroids (although the latter are controversial because they suppress the immune system, which can worsen the infection). Azoles are sometimes prescribed as well. Advanced cases of keratitis may require a corneal transplant to prevent blindness.

Live cycle of Acanthamoeba. In the water the cyst becomes a trophozoite. This then undergoies mitosis to form more trophozoites. Trophozoites can also become cysts. The amebae (cysts and trophozoites) can enter humans in various ways. Amoebae can enter through the eye, resulting in severe keratitis of the eye. Whn amoebae enter through nasal passages and infect the lower respiratory tract, it can result in granulomatous amebic encephalitis (GAE) and/or disseminated disease in individuals with compromised immune systems. Amoebae entering through ulcerated or broken skin can cause granulomatous amebic encephalitis (GAE), disseminated disease, or skin lesions in individuals with compromised immune systems.
Acanthamoeba spp. are waterborne parasites very common in unchlorinated aqueous environments. As shown in this life cycle, Acanthamoeba cysts and trophozoites are both capable of entering the body through various routes, causing infections of the eye, skin, and central nervous system. (credit: modification of work by Centers for Disease Control and Prevention)


Parker, N., Schneegurt, M., Thi Tu, A.-H., Forster, B. M., & Lister, P. (n.d.). Microbiology. Houston, Texas: OpenStax. Access for free at: