---
title: "Acanthamoeba Encephalitis in Chronic Lymphocytic Leukemia: Case Report and CDC Database Review"
id: "cdc-emerging-infectious-diseases-journal-1-case-report-and-retrospective-review-of-acanthamoeba-encephalitis-and-chronic"
canonical_url: "https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-1-case-report-and-retrospective-review-of-acanthamoeba-encephalitis-and-chronic"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "CDC Emerging Infectious Diseases Journal"
source_url: "https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article"
published_at: "2026-08-18T04:00:00.000Z"
evidence_level: "Agency Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Acanthamoeba Encephalitis in Chronic Lymphocytic Leukemia: Case Report and CDC Database Review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/cdc-emerging-infectious-diseases-journal-1-case-report-and-retrospective-review-of-acanthamoeba-encephalitis-and-chronic
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** CDC Emerging Infectious Diseases Journal
- **Source URL:** [Original Journal Publication](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article)
- **Published At:** 2026-08-18T04:00:00.000Z
- **Evidence Rating:** Agency Feed
## Executive GIST (TL;DR)
- A 71-year-old man with chronic lymphocytic leukemia (CLL) receiving ibrutinib developed rapidly progressive encephalopathy and a left frontal brain lesion; brain biopsy and CDC testing confirmed **Acanthamoeba** infection and the patient died 23 days after symptom onset despite combination anti-amebic therapy. - The authors reviewed the CDC Free-Living Ameba (FLA) database (1956–2023) to assess the frequency and outcomes of **Acanthamoeba** infections in patients with CLL compared with other malignancies. - Among US cases in the database, 18 patients with CLL were identified (including the reported case); CLL was the most common malignancy among patients with invasive **Acanthamoeba** infections. - Mean age at diagnosis was 48 years overall and 68 years in the CLL subgroup; most CLL cases occurred in male patients (16 of 18 total CLL cases with known sex: 14 male, 2 female in the subset with known sex). - Of 17 CLL cases with available data, 8 had CNS involvement (3 with GAE alone, 5 with GAE and disseminated disease); 9 had non-CNS infections (5 cutaneous, 1 rhinosinusitis, 3 non-CNS disseminated). - Survival outcomes differed by malignancy type and site of infection: among 17 CLL cases, 8 survived, 3 died, and 6 had unknown survival; all 3 CLL deaths had granulomatous amebic encephalitis (GAE). - In contrast, among non-CLL malignancy cases with known outcome (n = 33), 31 died and 2 survived; GAE was present in 28 of 31 non-CLL deaths. - Statistical analysis found lower odds of death for **Acanthamoeba** infection in CLL versus non-CLL malignancies (OR 0.03, 95% CI 0.003–0.18; p<0.0001), attributed in part to fewer CLL cases with CNS involvement. GAE carried markedly increased odds of death (OR 68.6, 95% CI 9.0–2,075.9; p<0.0001). - The authors note potential mechanistic predisposition in CLL related to hypogammaglobulinemia, neutropenia, impaired complement, and cell-mediated immunity; ibrutinib may further impair innate immunity and has been used in several reported CLL cases with **Acanthamoeba** infection. - Limitations include incomplete clinical, diagnostic, treatment, and outcome data in the CDC FLA database and limited generalizability because the dataset includes US cases only.
## Clinical Analysis & Structured Key Points
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[EID Journal](https://wwwnc.cdc.gov/eid/) 2. [Volume 32](https://wwwnc.cdc.gov/eid/early-release) 3. [Early Release](https://wwwnc.cdc.gov/eid/early-release#issue-1345) 4. [Main Article](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) * [Facebook](https://www.facebook.com/sharer/sharer.php?u=%2Feid%2Farticle%2F32%2F9%2F26-0790_article "Share to Facebook") * [Twitter](http://twitter.com/share?url=%2Feid%2Farticle%2F32%2F9%2F26-0790_article&text= "Share to Twitter") * [LinkedIn](https://www.linkedin.com/shareArticle?url=%2Feid%2Farticle%2F32%2F9%2F26-0790_article&title= "Share to LinkedIn") * [Syndicate](https://tools.cdc.gov/medialibrary/index.aspx#/sharecontent//eid/article/32/9/26-0790_article "Embed this Page") [ Emerging Infectious Disease journal ISSN: 1080-6059 ](https://wwwnc.cdc.gov/eid/) _Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released._ #### Volume 32, Number 9—September 2026 ##### _Dispatch_ ### Case Report and Retrospective Review of _Acanthamoeba_ Encephalitis and Chronic Lymphocytic Leukemia, United States On This Page [The Study](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) * * * [Conclusions](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) * * * [Suggested Citation](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) Figures [Figure](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-f1) Tables [Table](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-t1) Downloads [Appendix ](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-app1.pdf) * * * [RIS [TXT - 2 KB] ](https://wwwnc.cdc.gov/eid/article/32/9/26-0790.ris) Article Metrics [Metric Details](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article) Related Articles [_C. hominivorax_ Screwworm, Mexico, 2025–2026](https://wwwnc.cdc.gov/eid/article/32/10/26-1235_article) * * * [Wastewater Surveillance in the United States](https://wwwnc.cdc.gov/eid/article/32/13/26-0301_article) * * * [Effort to Sustain Wastewater Surveillance](https://wwwnc.cdc.gov/eid/article/32/13/26-0221_article) * * * [More articles on Parasites](https://wwwnc.cdc.gov/eid/spotlight/parasites) Michele Persico[![Comments to Author](https://wwwnc.cdc.gov/eid/content/images/icon/email.gif)](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#comment) , Julia C. Haston, Erin Imada, Jennifer Kasten, Cederic Pimentel, and Jeffrey M. Collins Author affiliation: Emory University, Atlanta, Georgia, USA (M. Persico, C. Pimentel, J.M. Collins); Centers for Disease Control and Prevention, Atlanta (J.C. Haston, E. Imada, J. Kasten) [Suggested citation for this article](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#suggestedcitation) ### Abstract We describe a case of _Acanthamoeba_ encephalitis with chronic lymphocytic leukemia (CLL) in the United States and summarize the Free-Living Ameba database to highlight CLL as the most common underlying malignancy for _Acanthamoeba_ infections. CLL patients are more likely to have improved survival and nondisseminated cutaneous disease than those with other cancers. _Acanthamoeba_ is a free-living amoeba (FLA) transmitted via inhalation or direct contact with the eyes or skin ([_1_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r1 "1")) that can cause keratitis and granulomatous amebic encephalitis (GAE) ([_2_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r2 "2")). GAE occurs most often in immunocompromised patients; risk factors include hematologic malignancy and immunosuppressive drugs ([_2_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r2 "2")). Chronic lymphocytic leukemia (CLL), the most common leukemia ([_3_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r3 "3")), can lead to immune dysfunction from immunosuppressive treatments and hypogammaglobulinemia, as well as impairments in complement activity, cell-mediated immunity, and neutrophil function ([_4_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r4 "4")). The 5-year risk for severe infections in CLL is as high as 57% when IgG levels are low ([_5_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r5 "5")). Ibrutinib, a Bruton tyrosine-kinase inhibitor ([_6_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r6 "6")), is an immunomodulatory drug used for CLL treatment that increases the risk for invasive infections up to 11.4% during the first year of treatment through innate immune system impairment ([_7_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r7 "7")–[ _9_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r9 "9")). We report a case of _Acanthamoeba_ GAE in a patient with CLL managed with ibrutinib. Using a retrospective analysis of data from the Centers for Disease Control and Prevention (CDC) Free-Living Ameba database ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-app1.pdf)), we sought to determine the frequency of _Acanthamoeba_ infections among patients with CLL and to compare clinical characteristics with those of patients without CLL. ### The Study Figure ![Acanthamoeba immunoassay from study of Acanthamoeba encephalitis and chronic lymphocytic leukemia, United States. Arrow indicates free-living amebic trophozoites of small to medium size that have rare double-walled cysts and show immunoreactivity to an Acanthamoeba spp. immunoassay.](https://wwwnc.cdc.gov/eid/images/26-0790-F1-tn.jpg) [Figure](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-f1 "Figure"). _Acanthamoeba_ immunoassay from study of _Acanthamoeba_ encephalitis and chronic lymphocytic leukemia, United States. Arrow indicates free-living amebic trophozoites of small to medium size that have rare double-walled cysts... A 71-year-old man with CLL who was receiving ibrutinib sought care for fever, encephalopathy, and focal right-sided weakness. Neuroimaging showed a rapidly enlarging left frontal lesion with surrounding edema; test results for bacterial, viral, and parasitic pathogens were unremarkable ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-app1.pdf) Table). Brain biopsy demonstrated necrosis, inflammation, and rare Periodic acid-Schiff–positive organisms ([Figure](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-f1)). CDC testing confirmed _Acanthamoeba_ infection. Despite initiation of azithromycin, sulfadiazine, flucytosine, fluconazole, and miltefosine, the patient died 23 days after symptom onset. To further investigate the possible role of CLL in this patient’s course, we examined all US cases of _Acanthamoeba_ infection reported to the CDC FLA database during 1956–2023 ([Appendix](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-app1.pdf)). This activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy (see e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.). The mean age of diagnosis was 48 years for all case-patients with _Acanthamoeba_ infection and 68 years in the CLL subgroup ([Table](https://wwwnc.cdc.gov/eid/article/32/9/26-0790-t1)). Among the 16 _Acanthamoeba_ cases in CLL patients with known sex, 14 occurred in male patients and 2 in female patients, compared with 118 male patients and 173 female patients in cases without CLL. Fifty-six patients had >1 malignancy at the time of _Acanthamoeba_ diagnosis: 16 had CLL alone, 1 had CLL and non-Hodgkin lymphoma, and 30 had >1 non-CLL hematologic malignancy (5 with acute lymphoblastic leukemia, 7 with acute myeloid leukemia, 2 with chronic myeloid leukemia, and 13 with lymphoma). Twelve had >1 nonhematologic malignancy. Of 17 patients with CLL, 8 had central nervous system (CNS) involvement, including 3 with GAE alone and 5 with GAE and disseminated disease. In comparison, CNS involvement was seen among 24 of 31 with non-CLL hematologic malignancies and 11 out of 12 of those with non-hematologic malignancies. Nine of 17 CLL patients had non-CNS _Acanthamoeba_ infections: 5 with cutaneous disease, 1 with rhinosinusitis, and 3 with non-CNS disseminated disease. Of the 17 CLL cases, 8 survived, 3 died, and 6 had an unknown survival status. The 3 patients with CLL who died all had GAE, whereas 1 of 8 survivors had GAE. Among patients with a non-CLL malignancy and known survival outcome (n = 33), 2 patients survived and 31 died. Neither of the 2 non-CLL survivors had GAE; GAE was present in 28 of 31 non-CLL patients who died. _Acanthamoeba_ infection in patients with CLL was associated with lower odds for death than non-CLL malignancies (odds ratio [OR] 0.03 [95% CI 0.003–0.18]; p 4 patients have been treated with ibrutinib since it was introduced to the US market in 2012. Similar to our case, 2 other cases describe a more acute course, in which death occurred 4–14 days after the patients initially sought care at the hospital ([_13_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r13 "13"),[_14_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r14 "14")). That finding was unusual because GAE is typically considered a subacute to chronic form of encephalitis ([_2_](https://wwwnc.cdc.gov/eid/article/32/9/26-0790_article#r2 "2")). Given the small number of cases reported, it is unclear whether the more acute clinical course can be attributed to CLL or immunosuppressive treatment. Further monitoring could determine whether ibrutinib may increase the risk for _Acanthamoeba_ infection or death. Our cross-sectional analysis of US disease surveillance data had limitations. For patients with a cancer diagnosis, detailed clinical and laboratory data, as well as treatment history and survival time, were not routinely collected in the CDC FLA database. In addition, information on the method of _Acanthamoeba_ diagnosis, treatment, and time to death after diagnosis was not generally available. Last, the CDC FLA database includes _Acanthamoeba_ cases from the United States only, which limited generalizability of our results. Since 1956, a total of 18 _Acanthamoeba_ infections have been identified in patients with CLL, including the case we reported here. CLL is the most common malignancy among patients with invasive _Acanthamoeba_ infections. CLL patients with _Acanthamoeba_ infections had lower rates than patients with other malignancies, which could be attrib
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