- M Scaglia: Laboratori di Ricerca di Area Infettivologica, Università degli Studi, IRCCS Policlinico San Matteo, Pavia.
Naegleria fowleri, Acanthamoeba spp. and Balamuthia mandrillaris are free-living amoebae that occasionally may induce pathology in human beings. CNS disease due to N. fowleri, called "primary" amoebic meningoencephalitis, is acquired after exposure to polluted waters in swimming pools, rivers, and lakes. The clinical course is acute, often fulminant and characterized pathologically by necrotizing hemorrhagic meningoencephalitis, involving mainly the base of the brain, brainstem and cerebellum. In contrast, some Acanthamoeba spp. and B. mandrillaris cause opportunistic, chronic "granulomatous" encephalitis in subjects pathologically or iatrogenically immunocompromised. There are, most likely, foci of protozoa in lung and skin reaching the CNS by hematogenous route. Only Acanthamoeba spp. can also produce severe, subacute keratitis, mainly today in contact lens wearers.