Disseminated infections with free-living amebas in patients with HIV infection

lesions in 1 week. Noncompliance with oral medications during October 1995 was associated with the appearance of new skin lesions. A new multidrug regimen was started in December 1995 with the combination of itraconazole (400 mg/d orally) and pentamidine (150 mg/d for 5 days and then 300 mg/d for 6 days intramuscularly). No improvement was observed. The initial therapeutic regimen (5fluorocytosine plus itraconazole) was administered again. Following this therapy, the course of the acanthamoeba infection altered with improvement and worsening. A granular lesion was also noted on the wall of the right nasal fossa (biopsy was refused). Parasitological examination revealed free-living amebas in purulent discharge from the left maxillary sinus in February 1996. The patient died of inanition in July 1996 after 1 year of acanthamoeba infection without clinical or radiological signs of CNS involvement; autopsy was not performed. Disseminated infections with free-living amebas in patients with HIV infection are infrequent. As of 1 October 1996, 103 cases of disseminated acanthamoeba infection had been reported worldwide [1]. Of these 103 cases, 72 were from the United States alone (including .50 cases in patients with AIDS). This infection is usually associated with a poor prognosis. Our report documents a prolonged clinical course of cutaneous and sinus infections due to Acanthamoeba in a patient with AIDS. The successive therapeutic regimens demonstrate the transient efficacy of 5-fluorocytosine. Pentamidine (in association with itraconazole) did not show efficacy against the skin lesions. Previous reports showed variability in the activity of 5-fluorocytosine, pentamidine, and itraconazole against different Acanthamoeba strains [2–6]. Furthermore, acquired resistance of Acanthamoeba to 5-fluorocytosine was suggested by different in vitro studies and other case reports [7–8]. 5-Fluorocytosine should be included in chemotherapy for disseminated infections due to free-living amebas in combination with other antiamebic agents.