Free-living amebae are ubiquitous in the environment and occasionally invade and parasitize host tissues causing illness in humans. Despite possibly frequent exposure to these organisms, infection is rare and why some people, healthy or not, end up with illness and others do not is still unclear. Human infections are rare; when illness does occur, it is often fatal. Only two papers have examined data from the literature and cases reported to the Centers for Disease Control and Prevention, and both were published over twenty years ago. The purpose of this study is to better document the epidemiology of Balamuthia and non-keratitis Acanthamoeba, give insight into trends of these infections over time, and contribute to the scientific and medical community by producing the only comprehensive review of all Balamuthia and non-keratitis Acanthamoeba cases in the United States from 1955 through 2009. This study also examines cases that have survived in an attempt to determine if there is evidence for the effectiveness of a particular treatment regimen. Only a small number of patients have survived these infections, so any evidence for a successful course of treatment could be crucial for future cases.

Free-living pathogenic amoebae Acanthamoeba spp. and Balamuthia mandrillaris are causative agents of important diseases of human: rarely occurring but highly fatal granulomatous amoebic encephalitis (both) and keratitis (Acanthamoeba). One of the reasons for the problematic therapy is differentiation into highly resistant cysts often found in affected tissues. In our study we have found that correct encystation in Acanthamoeba requires apart from others, the presence of functioning Golgi apparatus transporting the cyst wall material to the cell surface; glycogen phosphorylase degrading glycogen into glucose which seems to be further used for cellulose synthesis and two non-constitutive cellulose synthases. Acanthamoeba cellulose synthases seem not to be inhibited by known herbicides. In the cyst wall of acanthamoebae we detected cellulose, -mannan, and -1, 3-1, 4-linked glucan [lichenin or mixed-linkage glucan (MLG)]. Cellulose is present in the inner (endocyst) and the outer (exocyst) layers of the cyst wall, whereas-mannan and MLG are found in the endocyst. In a protozoan organism, MLG was detected for the first time. The MLG of Acanthamoeba has a similar composition to that found in barley with high amount of cellobiosyl and cellotriosyl followed by cellotetraosyl units. In contrast, with...