Diagnostic review of Derrick's case of generalized amoebiasis (? Iodamoeba butschlii)

Abstract

In 1943, the late E. H. Derrick performed an autopsy in Brisbane on a case of generalized amoebiasis (stomach, small intestine, caecum, ascending and transverse colon, gastric and mesenteric lymph nodes, lungs, brain) in a Japanese prisoner-of-war who had been captured at Buna in New Guinea. The causative amoeba was obviously not Entamoeba histolytica and, because of its ‘limax’ type of nucleus, was thought to be Iodamoeba butschlii or an amoeba closely resembling it. Iodamoeba butschlii is considered to be non-pathogenic. Furthermore, the amoebae and pathology in sections of brain in human primary meningo-encephalitis due to Naegleria fowleri (and transferred infection in mice) appeared identical with those in Derrick's case. On these counts it was decided to attempt immunofluorescent diagnosis on the material which was available. Sections cut from original paraffin blocked material (brain) were subjected to immunofluorescence by W. P. Stamm in London in 1975 with antisera prepared from species of Naegleria, Hartmannella, and Acanthamoeba. Tabled 1 Antiserum Titre Ami HB1 (N. fowleri) 1:32 Anti N. gruberi 0 Anti HN3 (H. rhysodes) 0 Anti Ryan (H. rhysodes) 0 Anti A1 (A. culbertsoni) 0 Anti Entamoeba histolytica 0 Open table in a new tab Sections of lung and colon gave the same titre (1:32) to anti HB1 (N. fowleri) antiserum in 1976. Although there is immunofluorescent antigenic overlap between strains of Hartmannellae (Hartmannella and Acanthamoeba), there is virtually no such overlap between the Naegleriae and Hartmannellae or between nonpathogenic (e.g., N. gruberi) and pathogenic (e.g. N. fowleri) strains of Naegleria. In view of the age of the material tested (33 years), it is considered that the titre obtained to anti HB1 (N. fowleri) is significant. Accordingly, it is submitted that the diagnosis in this case should now be one of generalized amoebiasis due to N. fowleri or a similar pathogenic species. In 1943, the late E. H. Derrick performed an autopsy in Brisbane on a case of generalized amoebiasis (stomach, small intestine, caecum, ascending and transverse colon, gastric and mesenteric lymph nodes, lungs, brain) in a Japanese prisoner-of-war who had been captured at Buna in New Guinea. The causative amoeba was obviously not Entamoeba histolytica and, because of its ‘limax’ type of nucleus, was thought to be Iodamoeba butschlii or an amoeba closely resembling it. Iodamoeba butschlii is considered to be non-pathogenic. Furthermore, the amoebae and pathology in sections of brain in human primary meningo-encephalitis due to Naegleria fowleri (and transferred infection in mice) appeared identical with those in Derrick's case. On these counts it was decided to attempt immunofluorescent diagnosis on the material which was available. Sections cut from original paraffin blocked material (brain) were subjected to immunofluorescence by W. P. Stamm in London in 1975 with antisera prepared from species of Naegleria, Hartmannella, and Acanthamoeba. Sections of lung and colon gave the same titre (1:32) to anti HB1 (N. fowleri) antiserum in 1976. Although there is immunofluorescent antigenic overlap between strains of Hartmannellae (Hartmannella and Acanthamoeba), there is virtually no such overlap between the Naegleriae and Hartmannellae or between nonpathogenic (e.g., N. gruberi) and pathogenic (e.g. N. fowleri) strains of Naegleria. In view of the age of the material tested (33 years), it is considered that the titre obtained to anti HB1 (N. fowleri) is significant. Accordingly, it is submitted that the diagnosis in this case should now be one of generalized amoebiasis due to N. fowleri or a similar pathogenic species.