<Emphasis Type="Italic">Acanthamoeba</Emphasis> T4 and T15 genotypes associated with keratitis infections in Italy

Thus far there is little data available concerning Acanthamoeba associated amoebic keratitis (AK) from Italy. In order to understand the incidence of Acanthamoeba in patients with ocular infections and to characterize the isolates at the molecular level, ocular specimens and contact lenses or lens case solutions from 140 patients were analysed by culture and by an 18S rRNA (Rns) gene-based PCR method. Nineteen (13.6%) patients showed Acanthamoeba culture positive samples. Eleven out of the 14 genetically characterized isolates were assigned to the T4 genotype. Three isolates, two of them from patients with keratitis responding to specific anti-Acanthamoeba therapy, were identified as belonging to the T15 genotype. This finding represents the first association between the T15 genotype and human amoebic keratitis. PCR amplification of the 18S ribosomal DNA proved to be a sensitive method, potentially able to detect Acanthamoeba without the need of long culture incubation, and thus considerably useful for clinical applications.     

Plant extracts as natural amoebicidal agents

Strains of Acanthamoeba sp. constitute a factor contributing to the occurrence of chronic granulomatous amoebic encephalitis, keratitis, pneumonia, as well as inflammations of other organs. Treatment of these diseases is very difficult and not always effective. A majority of these infections have been fatal. The aim of our study was to examine the amoebicidal or amoebistatic activity of plant extracts from Rubus chamaemorus, Pueraria lobata, Solidago virgaurea and Solidago graminifolia. For the purpose of isolation of pharmacologically active substances, we used the aboveground parts of plants, together with flowers, roots and leaves. It was established that extracts from S. virgauera, P. lobata and R. chamaemorus displayed chemotherapeutic properties in vitro in concentrations of approximately 0.01–0.05 mg extract/mL, i.e. in concentrations of 0.350 μg/mL expressed in ellagic acid for R. chamaemorus and 0.053 μg/mL expressed in puerarin for P. lobata. Therapeutic index values is 3.5–20. As a result of in vivo experiments, it was found out that, following therapy using the extracts, animals infected with Acanthamoeba sp. survived for an extended period (2.5–3 times longer). It was determined that plant extracts may be used both externally and internally in the case of a combined therapy for acanthamoebiasis. The tested extracts are not toxic for animals.     

Isolation of <Emphasis Type="BoldItalic">Acanthamoeba</Emphasis> species in surface waters of Gilan province-north of Iran

We analyzed water samples to determine the prevalence of free-living Acanthamoeba in water sources from Gilan, greater area, Iran. A total of 27 surface water samples were collected from environmental sources, including natural (rivers, lakes, springs, and lagoon) and freshwater source. The samples were filtrated and transferred to non-nutrient agar plates seeded with Escherichia coli and incubated for 2 to 7 days at 30°C or 42°C. The plates were examined by microscopy to morphologically identify Acanthamoeba species. Following DNA extraction, PCR was used to confirm the microscopically identification. A total of 19 out of 27 samples (70.3%) were positive for Acanthamoeba species based on the morphological criteria, and 14 (73.7%) were confirmed by PCR method. The high frequency of Acanthamoeba spp. in different environmental water sources of Gilan is an alert for the public health related to water sources in Iran.     

Experiments to produce cysts in cultures of Histomonas meleagridis—the agent of histomonosis in poultry

Experiments were done with cultured trophozoite stages of different clonal strains (Histomonas meleagridis/Turkey/Austria/2922-C6/04 and H. meleagridis/Chicken/Hungary/5009-C2/05) of H. meleagridis in order to induce a cyst formation as it is known in other intestinal parasites. It was shown that the best multiplication of H. meleagridis occurred at 40°C in a full medium 199, when fetal calf serum and rice starch had been added. Under these conditions, numerous amoebic stages (8–12 μm in diameter) without and a few with flagellum were seen showing regular reproduction rates. When the conditions of culture were experimentally changed—and thus became worse—by decreasing the temperature, by deprivation of the medium from fetal calf serum and/or rice starch, and by changing the osmolarity, the pH, or the MgCl₂ concentration, many of the amoebic stages (containing starch granules) were destroyed, and several had obtained a spherical shape. If the culture conditions became even worse, smaller spherical stages occurred, which had only diameters of 4–7 μm and which appeared more condensed. Both spherical stages did not contain starch granules. All the previously seen stages disappeared constantly. Since a similar decrease of the optimal living conditions also occurs when intestinal or cloacal feces are deposited outside from the bird’s body, the results obtained here may underline the interpretation that some of the formerly amoebic stages are able to become large spherical stages and later small spherical stages. The large spherical stage would be some type of precysts while the smaller ones would represent true cysts.     

Clustering of Acanthamoeba isolates from human eye infections by means of mitochondrial DNA digestion patterns

A total of 90 Acanthamoeba isolates from human eye infections from 15 countries were clustered into distinct genotypes according to their mtDNA restriction fragment patterns. Closely related digestion phenotypes (sequence difference 0.1–1.5%) were integrated into a single genotype, whereas phenotypes with greater than 4.76% difference were considered distinct. Approximately 80% of the human isolates studied fell into 7 of 22 genotypes, indicating that virulence may be associated with specific clusters of cladistic groups of Acanthamoeba. This technique is useful for large-scale surveying of this particular pathogen. Received: 16 July 1998 / Accepted: 15 August 1998     

Efficacy of miltefosine for topical treatment of Acanthamoeba keratitis in Syrian hamsters

Acanthamoeba keratitis is a painful corneal infection and difficult to treat because no sufficiently efficient drug has yet been available. The aim of the study therefore was to assess the therapeutic potential of miltefosine on Acanthamoeba keratitis-infected hamster eyes. The cornea of hamsters were infected with Acanthamoeba hatchetti, a human corneal isolate. On the fifth day, all the cornea were microscopically examined in order to determine the degree of infections (G, from 0 to 3). Four groups were then prepared: miltefosine (160 μM); 0.1% propamidine isetionate plus 0.02% polyhexnide; infected control (0.05% ethanol in PBS) and a non-infected control (0.05% ethanol in PBS) groups. The treatment was continued for 28 days. After the treatment, the cornea were excised and used for Acanthamoeba culture to investigate the presence of Acanthamoeba growth. Miltefosine treatment yielded much higher cure scores than propamidine isetionate plus polyhexanide. On the last day of treatment, 85% of the miltefosine-treated eyes were graded as G0; no changes were observed in the uninfected control group eyes; G3 eyes showed only a partial improvement. Furthermore, no Acanthamoeba cells could be recovered from the miltefosine-treated eye samples. Miltefosine appeared to hold necessary therapeutic properties for the treatment of Acanthamoeba keratitis.     

Validation of real-time PCR for laboratory diagnosis of Acanthamoeba keratitis

Confirmation of Acanthamoeba keratitis by laboratory diagnosis is the first step in the treatment of this vision-threatening disease. Two real-time PCR TaqMan protocols (the Rivière and Qvarnstrom assays) were developed for the detection of genus-specific Acanthamoeba DNA but lacked clinical validation. We have adapted these assays for the Cepheid SmartCycler II system (i) by determining their real-time PCR limits of detection and amplification efficiencies, (ii) by determining their ability to detect trophozoites and cysts, and (iii) by testing a battery of positive and negative samples. We also examined the inhibitory effects of a number of commonly used topical ophthalmic drugs on real-time PCR. The results of the real-time PCR limit of detection and amplification efficiency of the Rivière and Qvarnstrom assays were 11.3 DNA copies/10 μl and 94% and 43.8 DNA copies/10 μl and 92%, respectively. Our extraction protocol enabled us to detect 0.7 Acanthamoeba cysts/10 μl and 2.3 Acanthamoeba trophozoites/10 μl by both real-time PCR assays. The overall agreement between the assays was 97.0%. The clinical sensitivity and specificity of both real-time PCR assays based on culture were 100% (7 of 7) and 100% (37 of 37), respectively. Polyhexamethylene biguanide was the only topical drug that demonstrated PCR inhibition, with a minimal inhibitory dilution of 1/640 and an amplification efficiency of 72.7%. Four clinical samples were Acanthamoeba culture negative and real-time PCR positive. Our results indicate that both real-time PCR assays could be used to diagnose Acanthamoeba keratitis. Polyhexamethylene biguanide can inhibit PCR, and we suggest that specimen collection occur prior to topical treatment to avoid possible false-negative results.     

Activity of tea tree oil and nerolidol alone or in combination against Pediculus capitis (head lice) and its eggs

Acanthamoeba castellanii causes amoebic keratitis which is a painful sight-threatening disease of the eyes. Its eradication is difficult because the amoebas encyst making it highly resistant to anti-amoebic drugs, but several medicinal plants have proven to be more effective than the usual therapy. This study aimed to evaluate the in vitro amoebicidal activity of ethanol extracts of Arachis hypogaea L. (peanut), Curcuma longa L. (turmeric), and Pancratium maritimum L. (sea daffodil) on A. castellanii cysts. Acanthamoeba were isolated from keratitic patients, cultivated on 1.5% non-nutrient agar, and then incubated with different concentrations of plant extracts which were further evaluated for their cysticidal activity. The results showed that all extracts had significant inhibitory effect on the multiplication of Acanthamoeba cysts as compared to the drug control (chlorhexidine) and non-treated control, and the inhibition was time and dose dependent. The ethanol extract of A. hypogaea had a remarkable cysticidal effect with minimal inhibitory concentration (MIC) of 100 mg/ml in all incubation periods, while the concentrations of 10 and 1 mg/ml were able to completely inhibit growth after 48 and 72 h, respectively. The concentrations 0.1 and 0.01 mg/ml failed to completely inhibit the cyst growth, but showed growth reduction by 64.4–82.6% in all incubation periods. C. longa had a MIC of 1 g and 100 mg/ml after 48 and 72 h, respectively, while the concentrations 10, 1, and 0.1 mg/ml caused growth reduction by 60–90.3% in all incubation periods. P. maritimum had a MIC of 200 mg/ml after 72 h, while the 20-, 2-, 0.2-, and 0.02-mg/ml concentrations showed growth reduction by 34–94.3% in all incubation periods. All extracts seemed to be more effective than chlorhexidine which caused only growth reduction by 55.3–80.2% in all incubation periods and failed to completely inhibit the cyst growth. In conclusion, ethanol extracts of A. hypogaea, C. longa, and P. maritimum could be considered a new natural agent against the Acanthamoeba cyst.     

PCR diagnosis of infections with different species of Opisthorchiidae using a rapid clean-up procedure for stool samples and specific primers

Infections with the opisthorchiid liver flukes Clonorchis sinensis, Opisthorchis viverrini, and Opisthorchis felineus cause serious health problems in endemic areas of Southeast Asia and countries of the former Soviet Union. Chronic infections—even with low worm burdens—may lead to the development of fatal cholangiocarcinoma and related symptoms. A more sensitive diagnosis is needed since the tiny eggs of the worms are often not seen in microscopic examinations of stool samples, especially in patients with low infections. This communication reports a rapid cleanup procedure for human stool samples, which enables reliable identification of DNA by polymerase chain reaction from few eggs of opisthorchiid flukes in fecal samples.     

Optimization of <Emphasis Type="Italic">Toxoplasma gondii</Emphasis> DNA extraction from amniotic fluid using NucliSENS easyMAG and comparison with QIAamp DNA minikit

Antenatal diagnosis of congenital toxoplasmosis relies on PCR in amniotic fluid. Because parasitic load is often low, DNA extraction must be optimized. Manual methods remain widespread although automated methods appear more effective. This study aimed at optimizing an automated method and at comparing it with a widespread manual method: QIAamp DNA minikit. To optimize NucliSens easyMAG, we evaluated the addition of proteinase K pre-treatment and the increase of the amount of silica particles used for the extraction. The optimized method was then compared to QIAamp DNA minikit on samples containing less than 25 tachyzoites/ml. NucliSens easyMAG DNA yield was improved after proteinase K pre-treatment (p < 0.01), but not with a higher silica particle input. The optimized method yielded more positive PCRs than the manual method, especially for samples containing 5 tachyzoites/ml or less (71% vs 26%, p < 10^-4). The DNA amount in samples found positive by PCR was higher after optimized automated extraction than after manual extraction (p < 10^-4). Proteinase K pre-treatment should be added to extract DNA from amniotic fluid using NucliSens easyMAG. Using this optimized automated method rather than manual methods would improve the sensitivity of Toxoplasma PCR and simplify the daily workflow.     

Diagnosis of canine Echinococcus multilocularis infections by copro-DNA tests: comparison of DNA extraction techniques and evaluation of diagnostic deworming

The use of copro-DNA detection methods for the diagnosis of canine Echinococcus multilocularis infection was evaluated with a focus on DNA extraction techniques: two commercial kits and a modified alkaline-sodium dodecyl sulfate (SDS) technique. Dog feces (0.2 g) mixed with a protoscolex or with 1 or 10 eggs of E. multilocularis were subjected to DNA detection following extraction by these methods. DNA was extracted from all protoscolex samples by all methods, but success for samples with eggs depended on extraction technique with the modified technique showing success on all samples. Following experimental infection of dogs, copro-DNA was successfully extracted from fecal samples (0.2 g) of dogs in the patent period by all methods. In the prepatent period, PCR testing of feces subsamples (0.2 g) extracted by each technique was positive at a rate of 79.6–94.4%. Extraction by the modified technique with fecal samples of over 1 g showed detection of copro-DNA in all samples in both the patent and prepatent periods, and it produced reproducible detection in the addition recovery test using feces from 72 different domestic dogs. As copro-DNA was detected for at least 1 day following deworming with administration of anthelmintic drugs in experimentally infected dogs, diagnostic deworming might be useful for clinical examination. Using the present detection method can provide quick and accurate diagnosis of canine E. multilocularis infection, which with prompt management and treatment of infected dogs can prevent pet owners from becoming infected and prevent echinococcosis from spreading into non-endemic areas.

     

Comparison of PCR,microscopic examination and culture for the early diagnosis and characterization of <Emphasis Type="Italic">Acanthamoeba</Emphasis> isolates from ocular infections

In the study presented here, PCR, microscopic examination and culture of corneal samples were compared as methods of confirming the clinical diagnosis of Acanthamoeba keratitis, a serious ocular infection that is difficult to diagnose and threatens eyesight. The three methods were applied to isolates obtained from 513 patients with clinical signs or risk factors suggesting Acanthamoeba infection. Acanthamoeba keratitis was diagnosed in 12 of these patients. Combined PCR assays were more sensitive (94%) than either microscopic examination (33%) or culture (7%). The Acanthamoeba isolates were characterized using DNA sequence analysis of the nuclear small-subunit rRNA gene, and T4 was the predominant genotype found.     

Comparison of methods of DNA extraction for real‐time PCR in a model of pleural tuberculosis

Santos A, Cremades R, Rodríguez JC, García‐Pachón E, Ruiz M, Royo G. Comparison of methods of DNA extraction for real‐time PCR in a model of pleural tuberculosis. APMIS 2010; 118: 60–5. Molecular methods have been reported to have different sensitivities in the diagnosis of pleural tuberculosis and this may in part be caused by the use of different methods of DNA extraction. Our study compares nine DNA extraction systems in an experimental model of pleural tuberculosis. An inoculum of Mycobacterium tuberculosis was added to 23 pleural liquid samples with different characteristics. DNA was subsequently extracted using nine different methods (seven manual and two automatic) for analysis with real‐time PCR. Only two methods were able to detect the presence of M. tuberculosis DNA in all the samples: extraction using columns (Qiagen) and automated extraction with the TNAI system (Roche). The automatic method is more expensive, but requires less time. Almost all the false negatives were because of the difficulty involved in extracting M. tuberculosis DNA, as in general, all the methods studied are capable of eliminating inhibitory substances that block the amplification reaction. The method of M. tuberculosis DNA extraction used affects the results of the diagnosis of pleural tuberculosis by molecular methods. DNA extraction systems that have been shown to be effective in pleural liquid should be used.     

Comparison of Three Methods of DNA Extraction in Endocervical Specimens for Chlamydia trachomatis Infection by Spectrophotometry, Agarose Gel, and PCR

Chlamydia trachomatis is the major cause of sexually transmitted disease in the world. The aim of this study was to determine the best method of DNA extraction for detecting C. trachomatis by polymerase chain reaction (PCR) in sexually active women (n = 80) attending Shahid Beheshti Hospital in Isfahan, Iran. Endocervical swabs were collected from 80 women, 22 of whom were asymptomatic and 58 symptomatic. Three different DNA extraction methods were used in this study (phenol-chlorophorm, proteinase K, and boiling). DNA yield was evaluated by spectrophotometry, agarose gel, and PCR. The internal control was assayed by β-globin primers (PCO4, GH20). The DNA cryptic plasmid was selected as the target for C. trachomatis and samples were examined by PCR using specific KL1 and KL2 primers. It was shown that DNA extraction by boiling was the most sensitive with the highest yield of DNA. Of the 80 samples, 17 (21.25%) showed positivity for C. trachomatis by PCR. The highest rate of C. trachomatis infection was found in the group aged between 35 and 45 years old and those who used withdrawal or an intrauterine device as methods of contraception. It was demonstrated that DNA extraction by boiling was the least expensive and a very rapid method that gave the highest DNA yield. The infection rate in the sexually active women, including symptomatic and asymptomatic, was 21.25%, with a presumably high prevalence compared with other studies done in this field.     

Diagnosis of invasive aspergillosis using bronchoalveolar lavage in haematology patients: influence of bronchoalveolar lavage human DNA content on real-time PCR performance

In order to improve invasive pulmonary aspergillosis (IPA) diagnosis, a real-time polymerase chain reaction (PCR) assay detecting Aspergillus spp. was developed. Its detection limit reached 2–20 conidia. The retrospective evaluation on 64 bronchoalveolar lavage (BAL) fluids from 57 patients at risk for IPA, including 20 probable and five proven IPA patients, revealed a 88% or 38% sensitivity in direct examination (DE)/culture-positive or culture-negative BAL, respectively, whereas galactomannan (GM) sensitivity reached 88% or 58%, respectively. Influence on the Aspergillus-PCR yield of BAL fluid volume, cellular count and DNA content (evaluated by human β-globin quantification) was assessed. Significantly higher β-globin levels were detected in Aspergillus PCR-positive (median 5,112 pg/μl) than negative (median 1,332 pg/μl) BAL fluids, suggesting that the β-globin level could reflect BAL yields and DNA extraction. Using β-globin for the interpretation of fungal PCR could improve the negative predictive value of this test.     

Field's stain – a rapid staining method for Acanthamoeba spp.

Acanthamoeba sp. is a free-living amoeba known to cause chronic central nervous system infection or eye infection in humans. Many cases remain undetected for want of a good detection system. We report for the first time a rapid staining method to facilitate the identification of Acanthamoeba sp. using the modified Field's staining technique. A. castellanii, which was used in the present experiment, is maintained in our laboratory in mycological peptone medium (Gibco). The cultures were pooled together and smears were made on glass slides for staining purposes. Different types of stains such as Field's stain, modified Field's stain, Wright's stain, Giemsa stain, Ziehl-Neelsen stain, and trichrome stain were used to determine the best stain for the identification of this amoeba. The concentration of various stains and the duration of staining were varied to provide the best color and contrast for each stain. Acanthamoeba was also obtained from the brain of experimentally infected mice and was stained with various stains as mentioned above to determine the best stain for use in identifying the presence of this parasite in experimentally infected animals. The modified Field's stain gives a very good color contrast as compared with other stains. Furthermore, it takes only 20 s to be carried out using the least number of reagents, making it suitable for both laboratory and field use. Received: 24 March 1999 / Accepted: 16 April 1999     

Acanthamoeba DNA can be directly amplified from corneal scrapings

This study evaluated the performance of direct amplification of Acanthamoeba-DNA bypassing DNA extraction in the diagnosis of Acanthamoeba keratitis in clinically suspected cases in comparison to direct microscopic examination and in vitro culture. Corneal scrapings were collected from 110 patients who were clinically suspected to have Acanthamoeba keratitis, 63 contact lens wearers (CLW), and 47 non-contact lens wearers (NCLW). Taken samples were subjected to direct microscopic examination, cultivation onto the non-nutrient agar plate surface seeded with Escherichia coli, and PCR amplification. The diagnostic performance of these methods was statistically compared. The results showed that Acanthamoeba infection was detected in 21 (19.1 %) of clinically suspected cases (110); 17 (81 %) of them were CLW and the remaining 4 (19 %) positive cases were NCLW. Regarding the used diagnostic methods, it was found that direct amplification of Acanthamoeba DNA bypassing nucleic acid extraction was superior to microscopy and culture in which 21 cases (19.1 %) were positive for Acanthamoeba by PCR compared to 19 positive cases by culture (17.3 %) and one case (0.9 %) by direct smear. The difference in detection rates between culture and direct smear was highly statistically significant (P?=?0.001). On the other hand, there was no significant difference in detection rates between culture and PCR (P?=?0.86). On using culture as the gold standard, PCR showed three false-positive samples that were negative by culture and one false-negative sample that was positive by culture. At the same time, direct smear showed 18 false-negative samples. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of PCR were 94.7, 96.7, 85.7, 98.9, and 96.4, respectively, while those of direct smear were 5.3, 100, 100, 83.5, and 83.6, respectively. In conclusion, direct amplification of Acanthamoeba-DNA bypassing DNA extraction is a reliable, specific, sensitive method in the diagnosis of Acanthamoeba keratitis in clinically suspected cases. It should set up in ophthalmological centers as an easy diagnostic tool.     

Comparison of a novel semi-nested polymerase chain reaction (PCR) with a uniplex PCR for the detection of <Emphasis Type="BoldItalic">Acanthamoeba</Emphasis> genome in corneal scrapings

A semi-nested polymerase chain reaction (snPCR) was developed to improve the sensitivity of detection of Acanthamoeba sp. genome from corneal scrapings of Acanthamoeba keratitis patients. The snPCR was developed using a laboratory designed inner forward primer targeting the 450-bp product of the 18s rRNA-gene-based PCR. The snPCR was optimized using 11 Acanthamoeba sp. culture isolates and further applied onto 35 corneal scrapings from keratitis patients. The sensitivity and specificity of the snPCR was compared against conventional methods (smear and/or culture-gold standard) and the uniplex PCR described by Schroeder et al. Eleven out of the 35 corneal scrapings were positive by the gold standard and snPCR, whereas only 3 of these 11 were positive by the uniplex PCR. The clinical sensitivity and specificity of the snPCR was 100% when compared with the gold standard. DNA sequencing was performed on first round amplicons of four culture isolates and one specimen, and all of them were identified as genus Acanthamoeba when compared with the GenBank database sequences. Application of snPCR on the 11 culture isolates yielded amplicons ranging 120–160 bp in size, indicating sequence variation among the different culture isolates. The clinical sensitivity of snPCR was higher than the conventional methods and the uniplex PCR reported earlier.     

Demonstration of Balamuthia and Acanthamoeba mitochondrial DNA in sectioned archival brain and other tissues by the polymerase chain reaction

Granulomatous amoebic encephalitis (GAE) is a usually fatal disease caused by the free-living amoebae Balamuthia mandrillaris and Acanthamoeba spp. The intent of this study was to determine if the polymerase chain reaction (PCR) could be used retrospectively to detect amoeba mitochondrial 16S rRNA gene DNA in confirmed archival tissue sections from GAE cases stored in our laboratories for 1 to 34 years. The DNA was extracted from deparaffinized sections, and appropriate primer sets for each of the two amoebae were used for amoeba DNA detection. Indirect immunofluorescent (IIF) staining of tissue sections was used as the standard for identification of amoebae against which the PCR results were compared. Sixty slides from a total of 56 cases were processed by PCR for amoeba 16S DNA. In 28 slides (47%), there was agreement between the IIF and PCR results. In 41 of the slides (52%), no amoeba DNA was detected after PCR. In one slide (1%), the PCR and IIF results did not agree. While PCR supported IIF findings in about half of the slides, there are significant limitations in amoeba DNA identifications in formalin-fixed brain tissues. Degradation of amoeba DNA caused by formalin fixation was probably a factor in limiting valid results. An erratum to this article can be found at     

Demonstration of <Emphasis Type="Italic">Balamuthia</Emphasis> and <Emphasis Type="Italic">Acanthamoeba</Emphasis> mitochondrial DNA in sectioned archival brain and other tissues by the polymerase chain reaction

Granulomatous amoebic encephalitis (GAE) is a usually fatal disease caused by the free-living amoebae Balamuthia mandrillaris and Acanthamoeba spp. The intent of this study was to determine if the polymerase chain reaction (PCR) could be used retrospectively to detect amoeba mitochondrial 16S ribosomal ribonucleic acid gene deoxyribonucleic acid (DNA) in confirmed archival tissue sections from GAE cases stored in our laboratories for 1 to 34 years. The DNA was extracted from deparaffinized sections, and appropriate primer sets for each of the two amoebae were used for DNA detection. Indirect immunofluorescent staining (IIF) of tissue sections was used as the standard for identification of amoebae against which the PCR results were compared. Sixty slides from a total of 56 cases were processed by PCR for amoeba 16S DNA. In 28 (47%) slides, there was agreement between the IIF and PCR results. In 41 of the slides (52%), no DNA was detected after PCR. In one slide (1%), the PCR and IIF results did not agree. While PCR supported IIF findings in about half of the slides, there are significant limitations in amoeba DNA identifications in formalin-fixed brain tissues. Degradation of amoeba DNA because of formalin fixation was probably a factor in limiting valid results.