{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:25:17Z","timestamp":1792783517286,"version":"4.5.0"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Manipal Academy of Higher Education, Manipal","id":[{"id":"https:\/\/ror.org\/02xzytt36","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Granulomatous amoebic encephalitis (GAE) is the conventional label for central nervous system (CNS) infection caused principally by\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      spp. and\n                      <jats:italic>Balamuthia mandrillaris<\/jats:italic>\n                      , but contemporary disease encompasses meningitic, focal, vascular, brainstem, and spinal phenotypes that extend beyond the classical description. This narrative review examines the changing epidemiology, clinical spectrum, diagnosis, and management of non-flagellated amoebic CNS infection in India.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We narratively synthesised published Indian case reports, case series, molecular studies, surveillance investigations, and relevant environmental and epidemiological evidence on CNS infections caused by\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      ,\n                      <jats:italic>Balamuthia<\/jats:italic>\n                      ,\n                      <jats:italic>Vermamoeba<\/jats:italic>\n                      , and\n                      <jats:italic>Sappinia<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Historically, disease in India was recognised mainly through sporadic reports of\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      GAE, with occasional confirmed\n                      <jats:italic>Balamuthia<\/jats:italic>\n                      infection. More recent reports from several regions, particularly Karnataka and West Bengal, together with systematic surveillance in Kerala, suggest a substantial expansion in recognised disease. Contemporary Indian experience increasingly includes apparently immunocompetent patients and a broader neurological spectrum, including chronic meningitis mimicking CNS tuberculosis, focal abscess, parkinsonism, myelopathy, and rhombencephalomyelitis; relapse after apparent recovery has also been documented. Water-related exposures and use of nonchlorinated domestic water have emerged as potentially important epidemiological associations. Molecular studies confirm that\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      is the dominant contemporary organism, whereas\n                      <jats:italic>Balamuthia<\/jats:italic>\n                      remains rare; reported\n                      <jats:italic>Vermamoeba<\/jats:italic>\n                      infections warrant cautious interpretation, and no Indian\n                      <jats:italic>Sappinia<\/jats:italic>\n                      CNS infection was identified. Treatment remains empirical, multidrug, and poorly standardised.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The recent Indian experience probably reflects substantial diagnostic discovery superimposed on a possible true increase in environmentally acquired\n                      <jats:italic>Acanthamoeba<\/jats:italic>\n                      CNS infection. Organism-specific surveillance, improved molecular diagnosis, and prospective treatment data are needed to define the true burden, transmission pathways, and optimal management of these infections.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02986-6","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:59:42Z","timestamp":1791017982000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond granulomatous amoebic encephalitis: changing epidemiology and an expanding spectrum of non-flagellated amoebic CNS infection in India"],"prefix":"10.1007","author":[{"given":"Nitin","family":"Gupta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aravind","family":"Reghukumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirlangi Praveen","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"2986_CR1","doi-asserted-by":"publisher","first-page":"101384","DOI":"10.1016\/j.lanmic.2026.101384","volume":"7","author":"PK Tirlangi","year":"2026","unstructured":"Tirlangi PK, Grobusch MP, Gupta N. Amoebic CNS disease: when terminology obscures biology. Lancet Microbe. 2026;7:101384. https:\/\/doi.org\/10.1016\/j.lanmic.2026.101384.","journal-title":"Lancet Microbe"},{"key":"2986_CR2","doi-asserted-by":"publisher","first-page":"ofag289","DOI":"10.1093\/ofid\/ofag289","volume":"13","author":"N Gupta","year":"2026","unstructured":"Gupta N, Singh S, Salian K, Singh S, Das Adhikari S, Gupta M, et al. Clinical profile, epidemiology, and outcomes of granulomatous amebic encephalitis: a systematic review. Open Forum Infect Dis. 2026;13:ofag289. https:\/\/doi.org\/10.1093\/ofid\/ofag289.","journal-title":"Open Forum Infect Dis"},{"key":"2986_CR3","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1128\/jcm.21.4.666-667.1985","volume":"21","author":"MK Lalitha","year":"1985","unstructured":"Lalitha MK, Anandi V, Srivastava A, Thomas K, Cherian AM, Chandi SM. Isolation of Acanthamoeba culbertsoni from a patient with meningitis. J Clin Microbiol. 1985;21:666\u20137. https:\/\/doi.org\/10.1128\/jcm.21.4.666-667.1985.","journal-title":"J Clin Microbiol"},{"key":"2986_CR4","first-page":"484","volume":"50","author":"A Hamide","year":"2002","unstructured":"Hamide A, Sarkar E, Kumar N, Das AK, Narayan SK, Parija SC. Acanthamoeba meningoencephalitis: a case report. Neurol India. 2002;50:484\u20136.","journal-title":"Neurol India"},{"key":"2986_CR5","first-page":"1219","volume":"30","author":"PP Sharma","year":"1993","unstructured":"Sharma PP, Gupta P, Murali MV, Ramachandran VG. Primary amebic meningoencephalitis caused by Acanthamoeba: successfully treated with cotrimoxazole. Indian Pediatr. 1993;30:1219\u201322.","journal-title":"Indian Pediatr"},{"key":"2986_CR6","doi-asserted-by":"publisher","first-page":"984","DOI":"10.3201\/eid1206.060087","volume":"12","author":"CG Shirwadkar","year":"2006","unstructured":"Shirwadkar CG, Samant R, Sankhe M, Deshpande R, Yagi S, Schuster FL, et al. Acanthamoeba encephalitis in patient with systemic lupus, India. Emerg Infect Dis. 2006;12:984\u20136. https:\/\/doi.org\/10.3201\/eid1206.060087.","journal-title":"Emerg Infect Dis"},{"key":"2986_CR7","doi-asserted-by":"publisher","first-page":"182","DOI":"10.4103\/0255-0857.40539","volume":"26","author":"V Kaushal","year":"2008","unstructured":"Kaushal V, Chhina DK, Kumar R, Pannu HS, Dhooria HP, Chhina RS. Acanthamoeba encephalitis. Indian J Med Microbiol. 2008;26:182\u20134. https:\/\/doi.org\/10.4103\/0255-0857.40539.","journal-title":"Indian J Med Microbiol"},{"key":"2986_CR8","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s12098-009-0205-z","volume":"76","author":"A Saxena","year":"2009","unstructured":"Saxena A, Mittal S, Burman P, Garg P. Acanthamoeba meningitis with successful outcome. Indian J Pediatr. 2009;76:1063\u20134. https:\/\/doi.org\/10.1007\/s12098-009-0205-z.","journal-title":"Indian J Pediatr"},{"key":"2986_CR9","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1111\/j.1440-1789.2010.01151.x","volume":"31","author":"R Reddy","year":"2011","unstructured":"Reddy R, Vijayasaradhi M, Uppin MS, Challa S, Jabeen A, Borghain R. Acanthamoeba meningoencephalitis in an immunocompetent patient: an autopsy case report. Neuropathology. 2011;31:183\u20137. https:\/\/doi.org\/10.1111\/j.1440-1789.2010.01151.x.","journal-title":"Neuropathology"},{"key":"2986_CR10","doi-asserted-by":"publisher","first-page":"88","DOI":"10.4103\/2229-5070.175130","volume":"6","author":"S Das","year":"2016","unstructured":"Das S, Saha R, Rani M, Goyal R, Shah D, Asish JK. Central nervous system infection due to Acanthamoeba: a case series. Trop Parasitol. 2016;6:88\u201391. https:\/\/doi.org\/10.4103\/2229-5070.175130.","journal-title":"Trop Parasitol"},{"key":"2986_CR11","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1186\/s13071-016-1729-5","volume":"9","author":"HS Behera","year":"2016","unstructured":"Behera HS, Satpathy G, Tripathi M. Isolation and genotyping of Acanthamoeba spp. from Acanthamoeba meningitis\/meningoencephalitis patients in India. Parasit Vectors. 2016;9:442. https:\/\/doi.org\/10.1186\/s13071-016-1729-5.","journal-title":"Parasit Vectors"},{"key":"2986_CR12","doi-asserted-by":"publisher","first-page":"456","DOI":"10.4103\/ijmr.IJMR_1564_17","volume":"148","author":"K Megha","year":"2018","unstructured":"Megha K, Sehgal R, Khurana S. Genotyping of Acanthamoeba spp. isolated from patients with granulomatous amoebic encephalitis. Indian J Med Res. 2018;148:456\u20139. https:\/\/doi.org\/10.4103\/ijmr.IJMR_1564_17.","journal-title":"Indian J Med Res"},{"key":"2986_CR13","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.3390\/pathogens11121509","volume":"11","author":"S Khurana","year":"2022","unstructured":"Khurana S, Sharma C, Radotra BD, Mewara A, Tanwar P, Datta P, Sehgal R. Molecular diagnosis of encephalitis\/meningoencephalitis caused by free-living amoebae from a tertiary center in India. Pathogens. 2022;11:1509. https:\/\/doi.org\/10.3390\/pathogens11121509.","journal-title":"Pathogens"},{"key":"2986_CR14","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.4103\/jfmpc.jfmpc_1010_19","volume":"9","author":"S Das","year":"2020","unstructured":"Das S, Gunasekaran K, Ajjampur SSR, Abraham D, George T, Janeela MA, et al. Acanthamoeba encephalitis in immunocompetent hosts: a report of two cases. J Family Med Prim Care. 2020;9:1240\u20133. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1010_19.","journal-title":"J Family Med Prim Care"},{"key":"2986_CR15","doi-asserted-by":"publisher","first-page":"265","DOI":"10.47665\/tb.39.2.017","volume":"39","author":"R Raju","year":"2022","unstructured":"Raju R, Khurana S, Mahadevan A, John DV. Central nervous system infections caused by pathogenic free-living amoebae: an Indian perspective. Trop Biomed. 2022;39:265\u201380. https:\/\/doi.org\/10.47665\/tb.39.2.017.","journal-title":"Trop Biomed"},{"key":"2986_CR16","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1136\/jnnp.2007.142547","volume":"8","author":"K Prasad","year":"2008","unstructured":"Prasad K, Bhatia R, Srivastava MV, Pardasani V, Garg A, Rishi A. Fatal subacute necrotising brainstem encephalitis in a young man due to a rare parasitic (Balamuthia) infection. Pract Neurol. 2008;8:112\u20137. https:\/\/doi.org\/10.1136\/jnnp.2007.142547.","journal-title":"Pract Neurol"},{"key":"2986_CR17","doi-asserted-by":"publisher","first-page":"S123","DOI":"10.4103\/0255-0857.150921","volume":"33","author":"S Khurana","year":"2015","unstructured":"Khurana S, Hallur V, Goyal MK, Sehgal R, Radotra BD. Emergence of Balamuthia mandrillaris meningoencephalitis in India. Indian J Med Microbiol. 2015;33:S123\u20135. https:\/\/doi.org\/10.4103\/0255-0857.150921.","journal-title":"Indian J Med Microbiol"},{"key":"2986_CR18","doi-asserted-by":"publisher","first-page":"474","DOI":"10.7883\/yoken.JJID.2018.179","volume":"71","author":"B Tarai","year":"2018","unstructured":"Tarai B, Agarwal P, Krishnamoorthi S, Mewara A, Khurana S. Fatal amoebic meningoencephalitis caused by Balamuthia mandrillaris in a sarcoidosis patient. Jpn J Infect Dis. 2018;71:474\u20136. https:\/\/doi.org\/10.7883\/yoken.JJID.2018.179.","journal-title":"Jpn J Infect Dis"},{"key":"2986_CR19","doi-asserted-by":"publisher","first-page":"246","DOI":"10.4269\/ajtmh.23-0396","volume":"110","author":"SN Haldar","year":"2024","unstructured":"Haldar SN, Banerjee K, Modak D, Mondal A, Sharma C, Vasireddy T, et al. Case report: a series of three meningoencephalitis cases caused by Acanthamoeba spp. from Eastern India. Am J Trop Med Hyg. 2024;110:246\u20139. https:\/\/doi.org\/10.4269\/ajtmh.23-0396.","journal-title":"Am J Trop Med Hyg"},{"key":"2986_CR20","doi-asserted-by":"publisher","unstructured":"Gupta N, Khanna V, Sebastian A, Pothumarthy VSK, Kamath R, Singh S, et al. When tuberculosis is not the answer: Acanthamoeba meningoencephalitis mimicking chronic CNS tuberculosis. J Travel Med. 2026. https:\/\/doi.org\/10.1093\/jtm\/taag039.","DOI":"10.1093\/jtm\/taag039"},{"key":"2986_CR21","doi-asserted-by":"publisher","first-page":"578956","DOI":"10.1016\/j.jneuroim.2026.578956","volume":"417","author":"R Prakash","year":"2026","unstructured":"Prakash R, Reghukumar A, Rammohan K, Abin VL, Vijayan A, Sharmad MS, et al. Acanthamoeba rhombencephalomyelitis: novel white matter tract-based neuroinvasive pattern in a retrospective observational study from India. J Neuroimmunol. 2026;417:578956. https:\/\/doi.org\/10.1016\/j.jneuroim.2026.578956.","journal-title":"J Neuroimmunol"},{"key":"2986_CR22","doi-asserted-by":"publisher","unstructured":"Sivanandan H, Thangaraj JWV, Saritha A, Bhaskar A, Reghukumar A, Rahim AA, AME Study Group, et al. Epidemiology of and risk factors for amebic meningoencephalitis, Kerala, India, 2025. Emerg Infect Dis. 2026. https:\/\/doi.org\/10.3201\/eid3209.260492.","DOI":"10.3201\/eid3209.260492"},{"key":"2986_CR23","doi-asserted-by":"publisher","first-page":"559","DOI":"10.25259\/IJMR_2975_2025","volume":"162","author":"S Khurana","year":"2025","unstructured":"Khurana S. The outbreak of amoebic meningoencephalitis in Kerala: a wake-up call. Indian J Med Res. 2025;162:559\u201362. https:\/\/doi.org\/10.25259\/IJMR_2975_2025.","journal-title":"Indian J Med Res"},{"key":"2986_CR24","doi-asserted-by":"publisher","first-page":"114","DOI":"10.25259\/IJMR_3314_2025","volume":"164","author":"S Khurana","year":"2026","unstructured":"Khurana S, Singh S, Rathor S, Tanwar P, Moorkoth AP, Shameer VK, et al. Molecular epidemiology of Acanthamoeba in human infections and environmental reservoirs in India. Indian J Med Res. 2026;164:114\u20139. https:\/\/doi.org\/10.25259\/IJMR_3314_2025.","journal-title":"Indian J Med Res"},{"key":"2986_CR25","doi-asserted-by":"publisher","first-page":"789","DOI":"10.4103\/aian.aian_621_23","volume":"26","author":"A Shobhana","year":"2023","unstructured":"Shobhana A, Saha B, Datta A, Trivedi S, Jha S, Bhowmik S, et al. Something amiss: Acanthamoeba meningoencephalitis: report of two cases from Kolkata, India. Ann Indian Acad Neurol. 2023;26:789\u201392. https:\/\/doi.org\/10.4103\/aian.aian_621_23.","journal-title":"Ann Indian Acad Neurol"},{"key":"2986_CR26","doi-asserted-by":"publisher","first-page":"90","DOI":"10.5005\/jp-journals-10070-8086","volume":"12","author":"SKT Islam","year":"2025","unstructured":"Islam SKT, Siddhanta S, Mandal A, Ghosh S, Mandal M, Chatterjee SK. Acanthamoeba meningoencephalitis: an emerging catastrophe: a case series from a tertiary care hospital in Kolkata, Eastern India. Bengal Physician J. 2025;12:90\u20135. https:\/\/doi.org\/10.5005\/jp-journals-10070-8086.","journal-title":"Bengal Physician J"},{"issue":"Suppl 2","key":"2986_CR27","doi-asserted-by":"publisher","first-page":"S19","DOI":"10.1002\/mdc3.70031","volume":"12","author":"J Ganguly","year":"2025","unstructured":"Ganguly J, Shobhana A, Mukherjee S, Singh N, Kundu A, Basu P, Kumar H. Acanthamoeba encephalitis presenting as rapidly developing parkinsonism-a wolf in sheep\u2019s clothing. Mov Disord Clin Pract. 2025;12(Suppl 2):S19\u201321. https:\/\/doi.org\/10.1002\/mdc3.70031.","journal-title":"Mov Disord Clin Pract"},{"issue":"5","key":"2986_CR28","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1093\/qjmed\/hcaf048","volume":"118","author":"N Gupta","year":"2025","unstructured":"Gupta N, Pothumarthy VSK, Khanna V, Khurana S, Varma M, Kumar TP. Motile trophozoites in granulomatous amoebic encephalitis. QJM. 2025;118(5):374\u20135. https:\/\/doi.org\/10.1093\/qjmed\/hcaf048.","journal-title":"QJM"},{"key":"2986_CR29","doi-asserted-by":"publisher","first-page":"e103922","DOI":"10.7759\/cureus.103922","volume":"18","author":"P Sankar","year":"2026","unstructured":"Sankar P, Moorkoth AP, Khurana S, Mohan A, Vadekkandyil S, Shameem AM, et al. Microbiological profile of meningoencephalitis due to pathogenic free-living amoebae: a case series from Kerala, India. Cureus. 2026;18:e103922. https:\/\/doi.org\/10.7759\/cureus.103922.","journal-title":"Cureus"},{"key":"2986_CR30","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/s12288-017-0826-8","volume":"34","author":"RV Nampoothiri","year":"2018","unstructured":"Nampoothiri RV, Malhotra P, Jain A, Batra N, Gupta K, Saj F, et al. An unusual cause of central nervous system infection during acute myeloid leukemia induction chemotherapy: Acanthamoeba brain abscess. Indian J Hematol Blood Transfus. 2018;34:153\u20135. https:\/\/doi.org\/10.1007\/s12288-017-0826-8.","journal-title":"Indian J Hematol Blood Transfus"},{"key":"2986_CR31","doi-asserted-by":"publisher","first-page":"583139","DOI":"10.4061\/2011\/583139","volume":"2011","author":"V Lakshmi","year":"2011","unstructured":"Lakshmi V, Umabala P, Anuradha K, Padmaja K, Padmasree C, Rajesh A, Purohit AK. Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review. Interdiscip Perspect Infect Dis. 2011;2011:583139. https:\/\/doi.org\/10.4061\/2011\/583139.","journal-title":"Interdiscip Perspect Infect Dis"},{"key":"2986_CR32","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s10072-026-08889-6","volume":"47","author":"R Prakash","year":"2026","unstructured":"Prakash R, Reghukumar A, Rammohan K, Johnson J, Nath SR, Narayanankutty S, et al. Acanthamoeba myelopathy mimicking tropical spastic paraparesis in immunocompetent hosts: a case series. Neurol Sci. 2026;47:307. https:\/\/doi.org\/10.1007\/s10072-026-08889-6.","journal-title":"Neurol Sci"},{"key":"2986_CR33","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1136\/pn-2025-004674","volume":"26","author":"S Chowdhury","year":"2026","unstructured":"Chowdhury S, Priyanka Y, Agarwal A, Garg D, Garg A, Jangir H, Srivastava AK. Relapsing granulomatous amoebic encephalitis. Pract Neurol. 2026;26:150\u20132. https:\/\/doi.org\/10.1136\/pn-2025-004674.","journal-title":"Pract Neurol"},{"key":"2986_CR34","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1177\/00494755251327531","volume":"55","author":"G Velayudhan","year":"2025","unstructured":"Velayudhan G, Tom Thomas M, Kundoly SV, Joseph T, Aayiliath KA. Vermamoeba vermiformis causing primary amoebic meningoencephalitis: a diagnostic challenge. Trop Doct. 2025;55:128\u201330. https:\/\/doi.org\/10.1177\/00494755251327531.","journal-title":"Trop Doct"},{"key":"2986_CR35","doi-asserted-by":"publisher","first-page":"2576","DOI":"10.1093\/jac\/dks275","volume":"67","author":"TPC Dorlo","year":"2012","unstructured":"Dorlo TPC, Balasegaram M, Beijnen JH, de Vries PJ. Miltefosine: a review of its pharmacology and therapeutic efficacy in the treatment of leishmaniasis. J Antimicrob Chemother. 2012;67:2576\u201397. https:\/\/doi.org\/10.1093\/jac\/dks275.","journal-title":"J Antimicrob Chemother"},{"key":"2986_CR36","doi-asserted-by":"publisher","first-page":"4431","DOI":"10.1007\/s00436-015-4684-8","volume":"114","author":"SL Roy","year":"2015","unstructured":"Roy SL, Atkins JT, Gennuso R, Kofos D, Sriram RR, Dorlo TPC, et al. Assessment of blood-brain barrier penetration of miltefosine used to treat a fatal case of granulomatous amebic encephalitis possibly caused by an unusual Balamuthia mandrillaris strain. Parasitol Res. 2015;114:4431\u20139. https:\/\/doi.org\/10.1007\/s00436-015-4684-8.","journal-title":"Parasitol Res"},{"key":"2986_CR37","doi-asserted-by":"publisher","first-page":"e01127","DOI":"10.1128\/AAC.01127-19","volume":"64","author":"ML Monogue","year":"2020","unstructured":"Monogue ML, Watson D, Alexander JS, Cavuoti D, Doyle LM, Wang MZ, Prokesch BC. Minimal cerebrospinal fluid concentration of miltefosine despite therapeutic plasma levels during the treatment of amebic encephalitis. Antimicrob Agents Chemother. 2020;64:e01127\u201319. https:\/\/doi.org\/10.1128\/AAC.01127-19.","journal-title":"Antimicrob Agents Chemother"},{"key":"2986_CR38","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/BF00695989","volume":"31","author":"N Marschner","year":"1992","unstructured":"Marschner N, K\u00f6tting J, Eibl H, Unger C. Distribution of hexadecylphosphocholine and octadecyl-methyl-glycero-3-phosphocholine in rat tissues during steady-state treatment. Cancer Chemother Pharmacol. 1992;31:18\u201322. https:\/\/doi.org\/10.1007\/BF00695989.","journal-title":"Cancer Chemother Pharmacol"},{"key":"2986_CR39","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1016\/j.ijpddr.2017.09.002","volume":"7","author":"A Taravaud","year":"2017","unstructured":"Taravaud A, Loiseau PM, Pomel S. In vitro evaluation of antimicrobial agents on Acanthamoeba sp. and evidence of a natural resilience to amphotericin B. Int J Parasitol Drugs Drug Resist. 2017;7:328\u201336. https:\/\/doi.org\/10.1016\/j.ijpddr.2017.09.002.","journal-title":"Int J Parasitol Drugs Drug Resist"}],"container-title":["Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02986-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s15010-026-02986-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s15010-026-02986-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T21:02:24Z","timestamp":1791061344000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s15010-026-02986-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,3]]},"references-count":39,"alternative-id":["2986"],"URL":"https:\/\/doi.org\/10.1007\/s15010-026-02986-6","relation":{},"ISSN":["0300-8126","1439-0973"],"issn-type":[{"value":"0300-8126","type":"print"},{"value":"1439-0973","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,3]]},"assertion":[{"value":"30 August 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This narrative review synthesises previously published data and involved no new research with human participants or animals.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}