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Szymanski KA, Kuwabara MS, Friedman N, Pfeifer CM. A devastating case of a Balamuthia mandrillaris pediatric brain infection. Radiol Case Rep 2024; 19:3648-3652. [PMID: 38983286 PMCID: PMC11228650 DOI: 10.1016/j.radcr.2024.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/30/2024] [Accepted: 05/20/2024] [Indexed: 07/11/2024] Open
Abstract
Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the right frontal and left frontoparietal lobes. Rapid progression was seen on further imaging over the length of the patient's hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired three weeks after onset of symptoms and one week after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Because of the fatal nature of this infection, we propose (1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and (2) the threshold to treat empirically should be low due to the fatal nature of the infection.
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Affiliation(s)
- Kathryn A. Szymanski
- Creighton University School of Medicine, 3100 N Central Ave, Phoenix, AZ 85012, USA
| | - Michael S. Kuwabara
- Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA
| | - Neil Friedman
- Department of Neurology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA
| | - Cory M. Pfeifer
- Department of Radiology, Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA
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Qin B, Jia L, Chen J, Liu W. Balamuthia Amebic Encephalitis Cured and Discharged. J Craniofac Surg 2024:00001665-990000000-01451. [PMID: 38651906 DOI: 10.1097/scs.0000000000010123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/10/2024] [Indexed: 04/25/2024] Open
Abstract
Intracerebral granulomatous infectious encephalitis caused by Baboon Balamuthia amoeba is a rare form of infectious granulomatous amoebic encephalitis. There are very limited case reports of cured discharges. The authors report a 59-year-old male patient who met the diagnostic criteria for granulomatous infection caused by Baboon Balamuthia amoeba. After treatment, the patient's condition improved, and he was discharged from the hospital. The authors reviewed the data of this patient, analyzed relevant imaging information, and summarized our experience to enhance understanding of this condition.
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Affiliation(s)
- Benda Qin
- Affiliated Hospital of Shandong Second Medical University, Weifang, China
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3
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Qin L, Xiang Y, Wu Z, Zhang H, Wu X, Chen Q. Metagenomic next-generation sequencing for diagnosis of fatal Balamuthia amoebic encephalitis. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 119:105570. [PMID: 38382768 DOI: 10.1016/j.meegid.2024.105570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Balamuthia amoebic encephalitis (BAE), caused by Balamuthia mandrillaris, is a rare and life-threatening infectious disease with no specific and effective treatments available. The diagnosis of BAE at an early stage is difficult because of the non-specific clinical manifestations and neuroimaging. CASE DESCRIPTION A 52-year-old male patient, who had no previous history of skin lesions, presented to the emergency department with an acute headache, walking difficulties, and disturbance of consciousness. The patient underwent a series of examinations, including regular cerebrospinal fluid (CSF) studies and magnetic resonance imaging, and tuberculous meningoencephalitis was suspected. Despite being treated with anti-TB drugs, no clinical improvement was observed in the patient. Following corticosteroid therapy, the patient developed a rapid deterioration in consciousness with dilated pupils. Metagenomic next-generation sequencing (mNGS) revealed an unexpected central nervous system (CNS) amoebic infection, and the patient died soon after the confirmed diagnosis. CONCLUSION This study highlights the application of mNGS for the diagnosis of patients with suspected encephalitis or meningitis, especially those caused by rare opportunistic infections.
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Affiliation(s)
- Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziwei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaomei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qihua Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Ngo A, McGehrin K, Di Loreto C, Arora R, LaBuzetta JN. Clinical Reasoning: A 67-Year-Old Man With Multiple Intracranial Lesions. Neurology 2023; 101:e845-e851. [PMID: 37156616 PMCID: PMC10449443 DOI: 10.1212/wnl.0000000000207386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/21/2023] [Indexed: 05/10/2023] Open
Abstract
A wide variety of diseases present with intracranial lesions. In this case report, a 67-year-old man initially presented to an outside hospital with nausea, headache, and ataxia and was found to have multiple intracranial lesions. Diagnostic workup was ultimately unrevealing, and his condition improved after a course of steroids and antibiotics. Unfortunately, symptoms returned 3 months later. MRI of the brain revealed progression of his intracranial lesions. This case highlights a diagnostic approach and general management strategy for patients presenting with undifferentiated intracranial pathology. A final diagnosis is ultimately reached and raises further discussion.
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Affiliation(s)
- Angeline Ngo
- From the Department of Neurosciences (A.N., K.M., J.N.L.), University of California San Diego; Office of the Coroner Ada County (C.D.L.), Boise, ID; and Department of Neurology (R.A.), Keck School of Medicine of USC, Los Angeles, CA.
| | - Kevin McGehrin
- From the Department of Neurosciences (A.N., K.M., J.N.L.), University of California San Diego; Office of the Coroner Ada County (C.D.L.), Boise, ID; and Department of Neurology (R.A.), Keck School of Medicine of USC, Los Angeles, CA
| | - Christina Di Loreto
- From the Department of Neurosciences (A.N., K.M., J.N.L.), University of California San Diego; Office of the Coroner Ada County (C.D.L.), Boise, ID; and Department of Neurology (R.A.), Keck School of Medicine of USC, Los Angeles, CA
| | - Rajan Arora
- From the Department of Neurosciences (A.N., K.M., J.N.L.), University of California San Diego; Office of the Coroner Ada County (C.D.L.), Boise, ID; and Department of Neurology (R.A.), Keck School of Medicine of USC, Los Angeles, CA
| | - Jamie Nicole LaBuzetta
- From the Department of Neurosciences (A.N., K.M., J.N.L.), University of California San Diego; Office of the Coroner Ada County (C.D.L.), Boise, ID; and Department of Neurology (R.A.), Keck School of Medicine of USC, Los Angeles, CA
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5
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Law CTY, Nivesvivat T, Xiong Q, Kulkeaw K, Shi L, Ruenchit P, Suwanpakdee D, Suwanpakdee P, Tongkrajang N, Sarasombath PT, Tsui SKW. Mitochondrial genome diversity of Balamuthia mandrillaris revealed by a fatal case of granulomatous amoebic encephalitis. Front Microbiol 2023; 14:1162963. [PMID: 37213512 PMCID: PMC10196457 DOI: 10.3389/fmicb.2023.1162963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Balamuthia (B.) mandrillaris is a free-living amoeba that can cause rare yet fatal granulomatous amoebic encephalitis (GAE). However, efficacious treatment for GAE is currently unavailable, especially when genomic studies on B. mandrillaris are limited. Methods In this study, B. mandrillaris strain KM-20 was isolated from the brain tissue of a GAE patient, and its mitochondrial genome was de novo assembled using high-coverage Nanopore long reads and Illumina short reads. Results and Discussion Phylogenetic and comparative analyses revealed a range of diversification in the mitochondrial genome of KM-20 and nine other B. mandrillaris strains. According to the mitochondrial genome alignment, one of the most variable regions was observed in the ribosomal protein S3 (rps3), which was caused by an array of novel protein tandem repeats. The repeating units in the rps3 protein tandem region present significant copy number variations (CNVs) among B. mandrillaris strains and suggest KM-20 as the most divergent strain for its highly variable sequence and highest copy number in rps3. Moreover, mitochondrial heteroplasmy was observed in strain V039, and two genotypes of rps3 are caused by the CNVs in the tandem repeats. Taken together, the copy number and sequence variations of the protein tandem repeats enable rps3 to be a perfect target for clinical genotyping assay for B. mandrillaris. The mitochondrial genome diversity of B. mandrillaris paves the way to investigate the phylogeny and diversification of pathogenic amoebae.
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Affiliation(s)
- Cherie Tsz-Yiu Law
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thirapa Nivesvivat
- Infectious Disease Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Qing Xiong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kasem Kulkeaw
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ling Shi
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Pichet Ruenchit
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Detchvijitr Suwanpakdee
- Infectious Disease Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Piradee Suwanpakdee
- Neurology Division, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nongnat Tongkrajang
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patsharaporn T. Sarasombath
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Patsharaporn T. Sarasombath, ;
| | - Stephen Kwok-Wing Tsui
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Stephen Kwok-Wing Tsui,
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6
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Akbar N, Kaman WE, Sarink M, Nazmi K, Bikker FJ, Khan NA, Siddiqui R. Novel Antiamoebic Tyrocidine-Derived Peptide against Brain-Eating Amoebae. ACS OMEGA 2022; 7:28797-28805. [PMID: 36033708 PMCID: PMC9404165 DOI: 10.1021/acsomega.2c01614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Acanthamoeba castellanii (A. castellanii) can cause Acanthamoeba keratitis, a sight-threatening infection, as well as a fatal brain infection termed granulomatous amoebic encephalitis, mostly in immunocompromised individuals. In contrast, Naegleria fowleri (N. fowleri) causes a deadly infection involving the central nervous system, recognized as primary amoebic encephalitis, mainly in individuals partaking in recreational water activities or those with nasal exposure to contaminated water. Worryingly, mortality rates due to these infections are more than 90%, suggesting the need to find alternative therapies. In this study, antiamoebic activity of a peptide based on the structure of the antibiotic tyrocidine was evaluated against A. castellanii and N. fowleri. The tyrocidine-derived peptide displayed significant amoebicidal efficacy against A. castellanii and N. fowleri. At 250 μg/mL, the peptide drastically reduced amoebae viability up to 13% and 21% after 2 h of incubation against N. fowleri and A. castellanii., whereas, after 24 h of incubation, the peptide showed 86% and 94% amoebicidal activity against A. castellanii and N. fowleri. Furthermore, amoebae pretreated with 100 μg/mL peptide inhibited 35% and 53% A. castellanii and N. fowleri, while, at 250 μg/mL, 84% and 94% A. castellanii and N. fowleri failed to adhere to human cells. Amoeba-mediated cell cytopathogenicity assays revealed 31% and 42% inhibition at 100 μg/mL, while at 250 μg/mL 75% and 86% A. castellanii and N. fowleri were inhibited. Assays revealed inhibition of encystation in both A. castellanii (58% and 93%) and N. fowleri (73% and 97%) at concentrations of 100 and 250 μg/mL respectively. Importantly, tyrocidine-derived peptide depicted minimal cytotoxicity to human cells and, thus, may be a potential candidate in the rational development of a treatment regimen against free-living amoebae infections. Future studies are necessary to elucidate the in vivo effects of tyrocidine-derived peptide against these and other pathogenic amoebae of importance.
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Affiliation(s)
- Noor Akbar
- College
of Arts and Sciences, American University
of Sharjah, University
City, Sharjah 26666, United Arab Emirates
| | - Wendy E. Kaman
- Department
of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Maarten Sarink
- Erasmus MC, University Medical Center
Rotterdam, Department
of Medical Microbiology and Infectious Diseases, Wytemaweg 80, 3015
CE Rotterdam, The Netherlands
| | - Kamran Nazmi
- Department
of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Floris J. Bikker
- Department
of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
| | - Naveed Ahmed Khan
- Department
of Clinical Sciences, College of Medicine, University of Sharjah, University
City, Sharjah 27272, Unites Arab Emirates
| | - Ruqaiyyah Siddiqui
- College
of Arts and Sciences, American University
of Sharjah, University
City, Sharjah 26666, United Arab Emirates
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Antiamoebic Properties of Laboratory and Clinically Used Drugs against Naegleria fowleri and Balamuthia mandrillaris. Antibiotics (Basel) 2022; 11:antibiotics11060749. [PMID: 35740156 PMCID: PMC9220410 DOI: 10.3390/antibiotics11060749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/26/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Naegleria fowleri and Balamuthia mandrillaris are pathogenic free-living amoebae that infect the central nervous system with over 95% mortality rates. Although several compounds have shown promise in vitro but associated side effects and/or prolonged approval processes for clinical applications have led to limited success. To overcome this, drug repurposing of marketed compounds with known mechanism of action is considered a viable approach that has potential to expedite discovery and application of anti-amoebic compounds. In fact, many of the drugs currently employed in the treatment of N. fowleri and B. mandrillaris, such as amphotericin B, fluconazole, rifampin and miltefosine, are repurposed drugs. Here, we evaluated a range of clinical and laboratory compounds including metformin, quinclorac, indaziflam, inositol, nateglinide, 2,6-DNBT, trans-cinnamic acid, terbuthylazine, acarbose, glimepiride, vildagliptin, cellulase, thaxtomin A, repaglinide and dimethyl peptidase (IV) inhibitor against N. fowleri and B. mandrillaris. Anti-amoebic assays revealed that indaziflam, nateglinide, 2,6-DNBT, terbuthylazine, acarbose and glimepiride exhibited potent amoebicidal properties against both N. fowleri and B. mandrillaris. Notably, all compounds tested showed minimal human (HaCaT) cell cytotoxicity as determined by lactate dehydrogenase release. Prospective research using animal models is warranted to determine the potential of these repurposed compounds, as well as the need for investigating the intranasal route of delivery to treat these devastating infections.
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8
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Zhang Z, Liang J, Wei R, Feng X, Wang L, Wang L, Zhao P, Yu H, Gu Y, Yao Z. Facial Balamuthia mandrillaris infection with neurological involvement in an immunocompetent child. THE LANCET. INFECTIOUS DISEASES 2022; 22:e93-e100. [PMID: 34838200 DOI: 10.1016/s1473-3099(21)00334-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Cutaneous infection by Balamuthia mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement. It often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Patients can be either immunocompetent or immunocompromised. It is probably transmitted via inhalation or inoculation through broken skin, and then spreads to the brain and other organs through haematogenous spread. It is important for clinicians to be aware of this disease because rapid diagnosis and subsequent therapy has, in some cases, been associated with survival. In this Grand Round, we report the case of a 7-year-old boy who presented with large, chronic plaques on his face. Several biopsies showed non-specific granulomatous inflammation. The patient deteriorated rapidly and died within 1 month of displaying abnormal symptoms in the CNS. Immunohistochemical staining of skin tissue identified B mandrillaris as the infectious agent. The diagnosis was confirmed with PCR, which detected B mandrillaris DNA in formalin-fixed skin tissue sections. B mandrillaris infection should be considered in the differential diagnosis of patients with chronic granulomatous lesions. We also reviewed the epidemiology, B mandrillaris in nature and in the laboratory, clinical manifestations, histopathology, diagnosis, and treatment of infection.
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Affiliation(s)
- Zhen Zhang
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianying Liang
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruoqu Wei
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaobo Feng
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Liuhui Wang
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Piaoping Zhao
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Yu
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Gu
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Hu J, Zhang Y, Yu Y, Yu H, Guo S, Shi D, He J, Hu C, Yang J, Fang X, Xiao Y. Encephalomyelitis Caused by Balamuthia mandrillaris in a Woman With Breast Cancer: A Case Report and Review of the Literature. Front Immunol 2022; 12:768065. [PMID: 35069540 PMCID: PMC8766823 DOI: 10.3389/fimmu.2021.768065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Balamuthia mandrillaris is one cause of a rare and severe brain infection called granulomatous amoebic encephalitis (GAE), which has a mortality rate of >90%. Diagnosis of Balamuthia GAE is difficult because symptoms are non-specific. Here, we report a case of Balamuthia amoebic encephalomyelitis (encephalitis and myelitis) in a woman with breast cancer. She sustained trauma near a garbage dump 2 years ago and subsequently developed a skin lesion with a Mycobacterium abscessus infection. She experienced dizziness, lethargy, nausea and vomiting, inability to walk, and deterioration of consciousness. Next-generation sequencing of cerebrospinal fluid (CSF) samples revealed B. mandrillaris, and MRI of both brain and spinal cord showed abnormal signals. T-cell receptor (TCR) sequencing of the CSF identified the Top1 TCR. A combination of amphotericin B, flucytosine, fluconazole, sulfamethoxazole, trimethoprim, clarithromycin, pentamidine, and miltefosine was administrated, but she deteriorated gradually and died on day 27 post-admission.
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Affiliation(s)
- Juan Hu
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiqi Zhang
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongwei Yu
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huili Yu
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Siruo Guo
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ding Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianqin He
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chi Hu
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiqi Yang
- Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueling Fang
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Ai J, Zhang H, Yu S, Li J, Chen S, Zhang W, Mao R. A case of fatal amoebic encephalitis caused by Balamuthia mandrillaris, China. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 97:105190. [PMID: 34954104 DOI: 10.1016/j.meegid.2021.105190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
We reported a case of B.mandrillaris amoebic encephalitis in mainland China. Metagenomics next-generation sequencing helped initial diagnosis and then polymerase chain reaction of the B.mandrillaris in the infected nasal skin tissues reported positive and amoeba cysts were found in the tissue under microscopic observation.
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Affiliation(s)
- Jingwen Ai
- Huashan Hospital of Fudan University, Shanghai, China
| | - Hanyue Zhang
- Huashan Hospital of Fudan University, Shanghai, China.
| | - Shenglei Yu
- Huashan Hospital of Fudan University, Shanghai, China
| | - Jian Li
- Huashan Hospital of Fudan University, Shanghai, China
| | - Shu Chen
- Huashan Hospital of Fudan University, Shanghai, China.
| | - Wenhong Zhang
- Huashan Hospital of Fudan University, Shanghai, China
| | - Richeng Mao
- Huashan Hospital of Fudan University, Shanghai, China.
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11
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Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease. Front Med 2021; 15:842-866. [PMID: 34825341 DOI: 10.1007/s11684-021-0865-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 10/19/2022]
Abstract
Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which Naegleria fowleri followed by Acanthamoeba spp. and Balamuthia mandrillaris have been successively discovered. As the three dominant genera responsible for infections, Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.
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Mungroo MR, Khan NA, Maciver S, Siddiqui R. Opportunistic free-living amoebal pathogens. Pathog Glob Health 2021; 116:70-84. [PMID: 34602025 DOI: 10.1080/20477724.2021.1985892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Pathogenic free-living amoebae affecting the central nervous system are known to cause granulomatous amoebic encephalitis (GAE) or primary amoebic meningoencephalitis (PAM). Although hosts with impaired immunity are generally at a higher risk of severe disease, amoebae such as Naegleria fowleri and Balamuthia mandrillaris can instigate disease in otherwise immunocompetent individuals, whereas Acanthamoeba species mostly infect immunocompromised people. Acanthamoeba also cause a sight-threatening eye infection, mostly in contact lens wearers. Although infections due to pathogenic amoebae are considered rare, recently, these deadly amoebae were detected in water supplies in the USA. This is of particular concern, especially with global warming further exacerbating the problem. Herein, we describe the epidemiology, presentation, diagnosis, and management of free-living amoeba infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University City, Sharjah, United Arab Emirates.,Research Institute of Health and Medical Sciences, University of Sharjah, Sharjah, UAE
| | - Sutherland Maciver
- Centre for Discovery Brain Sciences, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, Sharjah, UAE
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Abstract
PURPOSE OF REVIEW This article reviews the diagnosis and treatment of infectious meningitis, including updates on newer molecular diagnostic techniques for microbiological diagnosis. RECENT FINDINGS New polymerase chain reaction (PCR)-based molecular diagnostic techniques have improved the timeliness of microbiological diagnosis in meningitis, but clinicians must be aware of the limitations of such tests. Next-generation sequencing can now be applied to CSF, allowing for diagnosis of infections not identifiable by conventional means. SUMMARY Infectious meningitis can be caused by a broad range of organisms. The clinician must be aware of the test characteristics of new molecular techniques for microbiological diagnosis as well as traditional techniques to tailor antimicrobial therapy appropriately in patients with meningitis.
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USE OF A HUMAN INDIRECT IMMUNOFLUORESCENCE ANTIBODY ASSAY FOR BALAMUTHIA MANDRILLARIS IN A GROUP OF CAPTIVE NORTHWEST BORNEAN ORANGUTANS ( PONGO PYGMAEUS PYGMAEUS). J Zoo Wildl Med 2021; 52:310-314. [PMID: 33827191 DOI: 10.1638/2019-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/21/2022] Open
Abstract
Granulomatous amoebic encephalitis caused by the free-living amoeba Balamuthia mandrillaris is a highly fatal disease that was first isolated from a mandrill (Mandrillus sphinx), and has since been diagnosed in several nonhuman primates including orangutans. Indirect immunofluorescence antibody (IFA) techniques for Balamuthia have been used in the fields of human medicine and epidemiology both for exposure assessment and screening of clinical patients for antemortem diagnosis. Stored serum samples from five captive Northwest Bornean orangutans (Pongo pygmaeus pygmaeus), including one who had died from B. mandrillaris infection, housed at a single facility were screened with a human IFA assay for B. mandrillaris. Only the single, clinically affected individual was seropositive, and the results suggest that the use of the available human B. mandrillaris IFA assay is a novel diagnostic option for detection of Balamuthia antibodies in this species. A validated screening serological test could be used in individuals exhibiting signs consistent with granulomatous amoebic encephalitis to facilitate earlier antemortem diagnosis of Balamuthia infection, which is critical if treatment is to be pursued. This pilot study presents the use of serological detection methods for B. mandrillaris screening in a nonhuman primate. Subsequent use of the B. mandrillaris IFA assay in the larger captive population should be pursued for validation of the test and to provide further information on seroprevalence and evaluation of risk factors for exposure to Balamuthia and subsequent development of disease.
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Diagnostic evaluation of fatal Balamuthia mandrillaris meningoencephalitis in a captive Bornean orangutan (Pongo pygmaeus) with identification of potential environmental source and evidence of chronic exposure. Primates 2020; 62:51-61. [PMID: 32920664 DOI: 10.1007/s10329-020-00860-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
A female Bornean orangutan (Pongo pygmaeus) aged 11 years and 6 months was examined by veterinarians after caretakers observed lethargy and facial grimacing. Within 72 h the primate had left-sided hemiparesis that worsened over the next week. An MRI revealed a focal right-sided cerebral mass suspected to be a neoplasm. Ten days after onset of clinical signs, the orangutan died. On postmortem exam, the medial right parietal lobe was replaced by a 7 × 4 × 3.5 cm focus of neuromalacia and hemorrhage that displaced the lateral ventricle and abutted the corpus callosum. Histopathology of the cerebral lesion revealed pyogranulomatous meningoencephalitis with intralesional amoeba trophozoites and rare cysts. Fresh parietal lobe was submitted to the Centers for Disease Control and Prevention lab for multiplex free-living amoebae real-time PCR and detected Balamuthia mandrillaris DNA at a high burden. Mitochondrial DNA was sequenced, and a 760-bp locus 19443F/20251R was compared to several human infections of B. mandrillaris and shown to be identical to the isolates from four human cases of encephalitis: 1998 in Australia, 1999 in California, 2000 in New York, and 2010 in Arizona. Indirect immunofluorescent antibody testing of stored serum samples indicated exposure to B. mandrillaris for at least 2 years prior to death. Within 1 week of the orangutan's death, water from the exhibit was analyzed and identified the presence of B. mandrillaris DNA, elucidating a possible source of exposure. B. mandrillaris, first reported in a mandrill in 1986, has since occurred in humans and animals and is now considered an important emerging pathogen.
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16
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Yi Z, Zhong J, Wu H, Li X, Chen Y, Chen H, Yang Y, Yu X. Balamuthia mandrillaris encephalitis in a child: case report and literature review. Diagn Microbiol Infect Dis 2020; 100:115180. [PMID: 33887622 DOI: 10.1016/j.diagmicrobio.2020.115180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
Balamuthia mandrillaris encephalitis is a rare disease with high mortality in the children. Due to the lack of specificity in clinical manifestations, laboratory tests, and neuroimaging, the diagnosis of the disease is difficult, especially the diagnosis of etiology. Currently, the evidence shows that the diagnosis of the disease depends on local brain biopsy or autopsy, and it is difficult to detect the pathogens by traditional etiological detection methods in blood and cerebrospinal fluid. We report a 9-year-old Chinese girl with B. mandrillaris encephalitis who was diagnosed with metagenomic next-generation sequencing (mNGS). The technology of mNGS can provide rapid, early etiological diagnosis without the need for a local brain biopsy, which can buy time for the early treatment of patients. We also provide a comprehensive literature review on this disease.
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Affiliation(s)
- Zhaoshi Yi
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Jianmin Zhong
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Huaping Wu
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Xiaoyan Li
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Yong Chen
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Hui Chen
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Yu Yang
- Department of Pediatric Endocrinology, Genetics and Metabolism, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Xiongying Yu
- Department of Pediatric Neurology, Jiangxi Children's Hospital&The Affiliated Children's Hospital of Nanchang University, Nanchang, China.
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18
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Mungroo M, Anwar A, Khan NA, Siddiqui R. Gold-Conjugated Curcumin as a Novel Therapeutic Agent against Brain-Eating Amoebae. ACS OMEGA 2020; 5:12467-12475. [PMID: 32548431 PMCID: PMC7271413 DOI: 10.1021/acsomega.0c01305] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
Balamuthia mandrillaris and Naegleria fowleri are free-living amoebae that cause infection of the central nervous system, granulomatous amoebic encephalitis (GAE) and primary amoebic meningoencephalitis (PAM), respectively. The fact that mortality rates for cases of GAE and PAM are more than 95% indicates the need for new therapeutic agents against those amoebae. Considering that curcumin exhibits a wide range of biological properties and has shown efficacy against Acanthamoeba castellanii, we evaluated the amoebicidal properties of curcumin against N. fowleri and B. mandrillaris. Curcumin showed significant amoebicidal activities with an AC50 of 172 and 74 μM against B. mandrillaris and N. fowleri, respectively. Moreover, these compounds were also conjugated with gold nanoparticles to further increase their amoebicidal activities. After conjugation with gold nanoparticles, amoebicidal activities of the drugs were increased by up to 56 and 37% against B. mandrillaris and N. fowleri, respectively. These findings are remarkable and suggest that clinically available curcumin and our gold-conjugated curcumin nanoparticles hold promise in the improved treatment of fatal infections caused by brain-eating amoebae and should serve as a model in the rationale development of therapeutic interventions against other infections.
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Affiliation(s)
| | - Ayaz Anwar
- Department
of Biological Sciences, Sunway University, Bandar Sunway 47500, Malaysia
| | - Naveed Ahmed Khan
- Department
of Biology, Chemistry and Environmental Sciences, College of Arts
and Sciences, American University of Sharjah, Sharjah 26666, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Department
of Biology, Chemistry and Environmental Sciences, College of Arts
and Sciences, American University of Sharjah, Sharjah 26666, United Arab Emirates
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Kalyatanda G, Rand K, Lindner MS, Hong DK, Sait Albayram M, Gregory J, Kresak J, Ibne KMA, Cope JR, Roy S, Gary JM, Reddy V, Ahmed AA. Rapid, Noninvasive Diagnosis of Balamuthia mandrillaris Encephalitis by a Plasma-Based Next-Generation Sequencing Test. Open Forum Infect Dis 2020; 7:ofaa189. [PMID: 32715017 PMCID: PMC7371414 DOI: 10.1093/ofid/ofaa189] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
Granulomatous amoebic encephalitis (GAE) caused by Balamuthia mandrillaris is a rare subacute infection with exceptionally high mortality. Diagnosis is typically made by brain biopsy or at autopsy. Detection of Balamuthia mandrillaris cell-free DNA by next-generation sequencing of plasma enabled rapid, noninvasive diagnosis in a case of amoebic encephalitis.
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Affiliation(s)
- Gautam Kalyatanda
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kenneth Rand
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | | | - Mehmet Sait Albayram
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jason Gregory
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jesse Kresak
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Karim M Ali Ibne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shantanu Roy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joy M Gary
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Varalakshmi Reddy
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida, USA
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20
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Ruqaiyyah Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
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21
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Lee DC, Fiester SE, Madeline LA, Fulcher JW, Ward ME, Schammel CMG, Hakimi RK. Acanthamoeba spp. and Balamuthia mandrillaris leading to fatal granulomatous amebic encephalitis. Forensic Sci Med Pathol 2019; 16:171-176. [PMID: 31773473 DOI: 10.1007/s12024-019-00202-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
Acanthamoeba spp. and Balamuthia mandrillaris are free-living amebae known to cause disseminated and fatal central nervous system dysfunction which manifests as granulomatous amebic encephalitis (GAE) with exceedingly rare frequency. We report two lethal cases of infection with free-living amebae: an acute case of Acanthamoeba spp. infection in an immunocompromised female and a subacute case of B. mandrillaris in a Hispanic male. The Acanthamoeba spp. infection presented with an atypical lesion in the thalamus that caused rapid deterioration of the patient while the case of B. mandrillaris had a prolonged clinical course with multifocal lesions beginning in the frontal lobe. Cerebrospinal fluid results were non-specific in both cases, however, post-mortem histology demonstrated the presence of trophozoites along a perivascular distribution of necrosis and infiltrate composed primarily of neutrophils. In addition to detailing the clinical presentations of these infrequent amebic infections, we offer insight into the difficulties surrounding their diagnoses in order to aid the clinician in accurate and timely identification.
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Affiliation(s)
- Daniel C Lee
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA
| | - Steven E Fiester
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA. .,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.
| | - Lee A Madeline
- Department of Radiology, Prisma Health - Upstate, Greenville, SC, 29605, USA
| | - James W Fulcher
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Office of the Medical Examiner, Greenville County, SC, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Michael E Ward
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Office of the Medical Examiner, Greenville County, SC, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Christine Marie-Gilligan Schammel
- Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.,Pathology Associates of Greenville, Greenville, SC, 29605, USA
| | - Ryan K Hakimi
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.,Department of Medicine, Neurology Division, Prisma Health - Upstate, Greenville, SC, 29605, USA
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22
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La Hoz RM, Morris MI. Tissue and blood protozoa including toxoplasmosis, Chagas disease, leishmaniasis, Babesia, Acanthamoeba, Balamuthia, and Naegleria in solid organ transplant recipients- Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13546. [PMID: 30900295 DOI: 10.1111/ctr.13546] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/27/2019] [Indexed: 11/29/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of tissue and blood protozoal infections in the pre- and post-transplant period. Significant new developments in the field have made it necessary to divide the previous single guideline published in 2013 into two sections, with the intestinal parasites separated from this guideline devoted to tissue and blood protozoa. The current update reflects the increased focus on donor screening and risk-based recipient monitoring for parasitic infections. Increased donor testing has led to new recommendations for recipient management of Toxoplasma gondii and Trypanosoma cruzi. Molecular diagnostics have impacted the field, with access to rapid diagnostic testing for malaria and polymerase chain reaction testing for Leishmania. Changes in Babesia treatment regimens in the immunocompromised host are outlined. The risk of donor transmission of free-living amebae infection is reviewed. Changing immigration patterns and the expansion of transplant medicine in developing countries has contributed to the recognition of parasitic infections as an important threat to transplant outcomes. Medications such as benznidazole and miltefosine are now available to US prescribers as access to treatment of tissue and blood protozoa is increasingly prioritized.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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23
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Gompf SG, Garcia C. Lethal encounters: The evolving spectrum of amoebic meningoencephalitis. IDCases 2019; 15:e00524. [PMID: 30937287 PMCID: PMC6430007 DOI: 10.1016/j.idcr.2019.e00524] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/21/2022] Open
Abstract
The free-living amoebae are thermophilic organisms that may play an increasing role among diseases of a warming world. They are uncommon, accidental, yet high consequence pathogens, with differing pathologic syndromes. New prospects for diagnosis and life-saving treatment make early disease recognition imperative. We review the three most commonly diagnosed species that infect humans: Naegleria fowleri, Acanthamoeba species, and Balamuthia mandrillaris.
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Affiliation(s)
- Sandra G. Gompf
- James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., 33612, Tampa, FL, United States
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States
| | - Cristina Garcia
- James A. Haley Veterans Hospital, 13000 Bruce B. Downs Blvd., 33612, Tampa, FL, United States
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL 33612, United States
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24
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Fatal Balamuthia mandrillaris Encephalitis. Case Rep Infect Dis 2019; 2019:9315756. [PMID: 30838148 PMCID: PMC6374803 DOI: 10.1155/2019/9315756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/01/2019] [Accepted: 01/17/2019] [Indexed: 11/18/2022] Open
Abstract
Balamuthia mandrillaris is a rare cause of granulomatous meningoencephalitis associated with high mortality. We report a 69-year-old Caucasian female who presented with a 3-day history of worsening confusion and difficulty with speech. On admission, she was disoriented and had expressive dysphasia. Motor examination revealed a right arm pronator drift. Cerebellar examination showed slowing of finger-nose testing on the left. She was HIV-negative, but the absolute CD4 count was low. Neuroimaging showed three cavitary, peripherally enhancing brain lesions, involving the right frontal lobe, the left basal ganglia, and the left cerebellar hemisphere. She underwent right frontal craniotomy with removal of tan, creamy, partially liquefied necrotic material from the brain, consistent with granulomatous amoebic encephalitis on tissue staining. Immunohistochemical studies and PCR tests confirmed infection with Balamuthia mandrillaris. She was started on pentamidine, sulfadiazine, azithromycin, fluconazole, flucytosine, and miltefosine. The postoperative course was complicated by an ischemic stroke, and she died a few weeks later.
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25
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Piper KJ, Foster H, Susanto D, Maree CL, Thornton SD, Cobbs CS. Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage. Int J Infect Dis 2018; 77:18-22. [PMID: 30243910 DOI: 10.1016/j.ijid.2018.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022] Open
Abstract
We report the case of a 69-year-old female who presented with a chronic nasal skin rash, new onset focal seizure, and a cerebral ring-enhancing lesion after a year of improper nasal irrigation. Despite aggressive and novel anti-amoebic treatment, she died as a result of a Balamuthia mandrillaris brain infection.
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Affiliation(s)
- Keenan J Piper
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA.
| | - Haidn Foster
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; University of Cincinnati College of Medicine, 3235 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Daniel Susanto
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; Radia Inc., 500 17th Ave, Seattle, WA 98122, USA.
| | - Cynthia L Maree
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA.
| | - Sean D Thornton
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; CellNetix Pathology and Laboratories, 1124 Columbia St Suite 200, Seattle, WA 98104, USA.
| | - Charles S Cobbs
- Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA.
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26
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Yamanouchi K, Arima H, Sakamoto Y, Kanto K, Kasai K, Ito K, Inaba T. First report of the isolation of Balamuthia mandrillaris in the northern region of Japan. Parasitol Res 2018; 117:2895-2900. [PMID: 29961176 PMCID: PMC6105249 DOI: 10.1007/s00436-018-5980-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022]
Abstract
Balamuthia mandrillaris is a free-living amoeba that lives in soil and water near human settlements. B. mandrillaris was first isolated from a mandrill baboon that died at the San Diego Zoo Wildlife Park in California in 1986, and the first human infection was reported in 1990. Although reported B. mandrillaris infections are often not properly characterized, it appears that B. mandrillaris invades the living body from the soil and water, either via a wound or the nasal cavity. Most confirmed infections have originated in South and North America. B. mandrillaris inhabits warm climates and is recognized as a pathogen in warm areas such as desert climates and tropical climates. B. mandrillaris has been isolated from environmental samples since 2000, most of which originated from warm areas such as step climates, tropical climates, and desert climates. However, B. mandrillaris may survive in diverse environments, although fewer granulomatous amebic encephalitis patients have been reported in colder Japanese and Northern European regions. In the present study, we conducted a survey of 13 soil samples in Aomori Prefecture located at the northernmost tip of Japan Honshu and successfully isolated one strain of B. mandrillaris from soil for the first time in Japan. In addition, B. mandrillaris gene was detected from several soils. This confirms that B. mandrillaris is capable of spreading to a wider climatic region.
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Affiliation(s)
- Kanako Yamanouchi
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan.
| | - Hiroaki Arima
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
| | - Yamato Sakamoto
- Department of Medical Technology, Hirosaki University School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
| | - Kazuki Kanto
- Department of Medical Technology, Hirosaki University School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
| | - Kosuke Kasai
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
| | - Koichi Ito
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
| | - Takashi Inaba
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, 66-1 Hon-cho, Hirosaki, 036-8564, Japan
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27
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Mittal SO, Alsinaidi O. Teaching NeuroImages: Balamuthia mandrillaris amebic encephalitis. Neurology 2017; 88:e183. [DOI: 10.1212/wnl.0000000000003891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Free-Living Amoebae as Hosts for and Vectors of Intracellular Microorganisms with Public Health Significance. Viruses 2017; 9:v9040065. [PMID: 28368313 PMCID: PMC5408671 DOI: 10.3390/v9040065] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 12/14/2022] Open
Abstract
Free-living amoebae (FLA) are parasites within both humans and animals causing a wide range of symptoms and act as hosts of, and vehicles for phylogenetically diverse microorganisms, called endocytobionts. The interaction of the FLA with sympatric microorganisms leads to an exceptional diversity within FLA. Some of these bacteria, viruses, and even eukaryotes, can live and replicate intracellularly within the FLA. This relationship provides protection to the microorganisms from external interventions and a dispersal mechanism across various habitats. Among those intracellularly-replicating or -residing organisms there are obligate and facultative pathogenic microorganisms affecting the health of humans or animals and are therefore of interest to Public Health Authorities. Mimiviruses, Pandoraviruses, and Pithoviruses are examples for interesting viral endocytobionts within FLA. Future research is expected to reveal further endocytobionts within free-living amoebae and other protozoa through co-cultivation studies, genomic, transcriptomic, and proteomic analyses.
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Boucher A, Herrmann JL, Morand P, Buzelé R, Crabol Y, Stahl JP, Mailles A. Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect 2017; 47:221-235. [PMID: 28341533 DOI: 10.1016/j.medmal.2017.02.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/17/2017] [Indexed: 10/19/2022]
Abstract
We performed a literature search in the Medline database, using the PubMed website. The incidence of presumably infectious encephalitis is estimated at 1.5-7 cases/100,000 inhabitants/year, excluding epidemics. Infectious encephalitis and immune-mediated encephalitis share similar clinical signs and symptoms. The latter accounts for a significant proportion of presumably infectious encephalitis cases without any established etiological diagnosis; as shown from a prospective cohort study where 21% of cases were due to an immune cause. Several infectious agents are frequently reported in all studies: Herpes simplex virus (HSV) is the most frequent pathogen in 65% of studies, followed by Varicella-zoster virus (VZV) in several studies. Enteroviruses are also reported; being the most frequent viruses in two studies, and the 2nd or 3rd viruses in five other studies. There are important regional differences, especially in case of vector-borne transmission: Asia and the Japanese encephalitis virus, Eastern and Northern Europe/Eastern Russia and the tick-borne encephalitis virus, Northern America and Flavivirus or Alphavirus. Bacteria can also be incriminated: Mycobacterium tuberculosis and Listeria monocytogenes are the most frequent, after HSV and VZV, in a French prospective study. The epidemiology of encephalitis is constantly evolving. Epidemiological data may indicate the emergence and/or dissemination of new causative agents. The dissemination and emergence of causative agents are fostered by environmental, social, and economical changes, but prevention programs (vaccination, vector controls) help reduce the incidence of other infectious diseases and associated encephalitis (e.g., measles).
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Affiliation(s)
- A Boucher
- Maladies infectieuses, CHU de Lille, 59000 Lille, France
| | - J L Herrmann
- Microbiologie, CHU de Garches, 92380 Garches, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38700 La Tronche, France
| | - R Buzelé
- Médecine interne, centre hospitalier de Saint-Brieuc, 22027 Saint-Brieuc, France
| | - Y Crabol
- Médecine interne, centre hospitalier Vannes-Aufray, 56000 Vannes, France
| | - J P Stahl
- Maladies infectieuses, CHU Grenoble Alpes, Grenoble - "European Study Group for the Infections of the Brain (ESGIB)", 38700 La Tronche, France.
| | - A Mailles
- Direction des maladies infectieuses, santé publique France - "European Study Group for the Infections of the Brain (ESGIB)", 94410 Saint-Maurice, France
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Fillatre P, Crabol Y, Morand P, Piroth L, Honnorat J, Stahl JP, Lecuit M. Infectious encephalitis: Management without etiological diagnosis 48hours after onset. Med Mal Infect 2017; 47:236-251. [PMID: 28314470 PMCID: PMC7131623 DOI: 10.1016/j.medmal.2017.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 02/22/2017] [Indexed: 12/18/2022]
Abstract
Introduction The etiological diagnosis of infectious encephalitis is often not established 48 hours after onset. We aimed to review existing literature data before providing management guidelines. Method We performed a literature search on PubMed using filters such as “since 01/01/2000”, “human”, “adults”, “English or French”, and “clinical trial/review/guidelines”. We also used the Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”. Results With Mesh search terms “encephalitis/therapy” and “encephalitis/diagnosis”, we retrieved 223 and 258 articles, respectively. With search terms “encephalitis and corticosteroid”, we identified 38 articles, and with “encephalitis and doxycycline” without the above-mentioned filters we identified 85 articles. A total of 210 articles were included in the analysis. Discussion Etiological investigations must focus on recent travels, animal exposures, age, immunodeficiency, neurological damage characteristics, and potential extra-neurological signs. The interest of a diagnosis of encephalitis for which there is no specific treatment is also to discontinue any empirical treatments initially prescribed. Physicians must consider and search for autoimmune encephalitis.
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Affiliation(s)
- P Fillatre
- Service de maladies infectieuses et réanimation médicale, CHU Pontchaillou, 35000 Rennes, France
| | - Y Crabol
- Médecine interne, CHBUA site de Vannes, 56017 Vannes, France
| | - P Morand
- Virologie, CHU Grenoble Alpes, 38043 Grenoble cedex 9, France
| | - L Piroth
- Infectiologie, CHU de Dijon, 21000 Dijon, France
| | - J Honnorat
- Inserm U1028, CNRS UMR5292, équipe neuro-oncologie et neuro-inflammation (Oncoflam), centre de recherche en neurosciences (CRNL), université Lyon 1, 69500 Bron, France
| | - J P Stahl
- Service d'infectiologie, CHU de Grenoble, 38043 Grenoble cedex 9, France.
| | - M Lecuit
- Institut Pasteur, Biology of Infection Unit, CNR CCOMS Listeria, Inserm U1117, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Department of Infectious Diseases and Tropical Medicine, Necker-Enfants-Malades University Hospital, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Paris, France
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Gjeltema JL, Troan B, Muehlenbachs A, Liu L, Da Silva AJ, Qvarnstrom Y, Tobias JR, Loomis MR, De Voe RS. Amoebic meningoencephalitis and disseminated infection caused by Balamuthia mandrillaris in a Western lowland gorilla (Gorilla gorilla gorilla). J Am Vet Med Assoc 2016; 248:315-21. [PMID: 26799111 DOI: 10.2460/javma.248.3.315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 22-year-old male gorilla (Gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. CLINICAL FINDINGS Physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. A CBC and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a stress leukogram, and signs consistent with dehydration. Subsequent CSF analysis revealed lymphocytic pleocytosis and markedly increased total protein concentration. TREATMENT AND OUTCOME Despite treatment with antimicrobials, steroids, and additional supportive care measures, the gorilla's condition progressed to an obtunded mentation with grand mal seizures over the course of 10 days. Therefore, the animal was euthanized and necropsy was performed. Multifocal areas of malacia and hemorrhage were scattered throughout the brain; on histologic examination, these areas consisted of necrosis and hemorrhage associated with mixed inflammation, vascular necrosis, and intralesional amoebic trophozoites. Tan foci were also present in the kidneys and pancreas. Immunohistochemical testing positively labeled free-living amoebae within the brain, kidneys, eyes, pancreas, heart, and pulmonary capillaries. Subsequent PCR assay of CSF and frozen kidney samples identified the organism as Balamuthia mandrillaris, confirming a diagnosis of amoebic meningoencephalitis. CLINICAL RELEVANCE Infection with B mandrillaris has been reported to account for 2.8% of captive gorilla deaths in North America over the past 19 years. Clinicians working with gorillas should have a high index of suspicion for this diagnosis when evaluating and treating animals with signs of centrally localized neurologic disease.
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LATIFI AR, NIYYATI M, LORENZO-MORALES J, HAGHIGHI A, SEYYED TABAEI SJ, LASJERDI Z. Presence of Balamuthia mandrillaris in hot springs from Mazandaran province, northern Iran. Epidemiol Infect 2016; 144:2456-61. [PMID: 27086943 PMCID: PMC9150520 DOI: 10.1017/s095026881600073x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/27/2016] [Accepted: 03/26/2016] [Indexed: 11/06/2022] Open
Abstract
Balamuthia mandrillaris is an opportunistic free-living amoeba that has been reported to cause cutaneous lesions and Balamuthia amoebic encephalitis. The biology and environmental distribution of B. mandrillaris is still poorly understood and isolation of this pathogen from the environment is a rare event. Previous studies have reported that the presence of B. mandrillaris in the environment in Iran may be common. However, no clinical cases have been reported so far in this country. In the present study, a survey was conducted in order to evaluate the presence of B. mandrillaris in hot-spring samples of northern Iran. A total of 66 water samples were analysed using morphological and molecular tools. Positive samples by microscopy were confirmed by performing PCR amplification of the 16S rRNA gene of B. mandrillaris. Sequencing of the positive amplicons was also performed to confirm morphological data. Two of the 66 collected water samples were positive for B. mandrillaris after morphological and molecular identification. Interestingly, both positive hot springs had low pH values and temperatures ranging from 32 °C to 42 °C. Many locals and tourists use both hot springs due to their medicinal properties and thus contact with water bodies containing the organism increases the likelihood of infection. To the best of our knowledge, this is the first report on the isolation of B. mandrillaris from hot-spring sources related to human activity. Therefore, B. mandrillaris should be considered as a possible causative agent if cases of encephalitis are suspected following immersion in hot springs in addition to Acanthamoeba and Naegleria.
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Affiliation(s)
- A. R. LATIFI
- Research Centre for Cellular and Molecular Biology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. NIYYATI
- Research Centre for Cellular and Molecular Biology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J. LORENZO-MORALES
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Tenerife, Canary Islands, Spain
| | - A. HAGHIGHI
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S. J. SEYYED TABAEI
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z. LASJERDI
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Siddiqui R, Kulsoom H, Lalani S, Khan NA. Isolation of Balamuthia mandrillaris-specific antibody fragments from a bacteriophage antibody display library. Exp Parasitol 2016; 166:94-6. [DOI: 10.1016/j.exppara.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/13/2016] [Accepted: 04/02/2016] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW This article describes recent advances in the diagnosis and management of encephalitis in immunocompromised individuals. RECENT FINDINGS Herpes simplex virus (HSV) and varicella zoster virus (VZV) are common causes of encephalitis in immunocompromised individuals, although clinical manifestations may be atypical, and thus challenging to recognize. Recently, an increased incidence of HSV and VZV central nervous system infections has been reported in association with novel immunosuppressive and immunomodulatory treatments. The free-living ameba Balamuthia mandrillaris causes granulomatous encephalitis predominantly in immunocompromised individuals and is associated with nearly uniform fatality. In the setting of organ transplantation, the recipient's immunocompromised state along with the potential for donor-transmitted infections can result in a unique epidemiology of encephalitis, including infection by human herpes virus-6 and BK virus. Recent studies utilizing next-generation sequencing techniques have identified several pathogens, including Leptospira santarosai and a neurotropic astrovirus, as causes of encephalitis in immunocompromised individuals. SUMMARY Diagnosis and management of encephalitis is challenging in immunocompromised individuals, in part because of atypical clinical presentations and the presence of uncommon or novel infectious agents. Unbiased techniques for pathogen discovery are likely to play an increasing role in the diagnosis of central nervous system infections in immunocompromised individuals.
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Crossland NA, Ali I, Higbie C, Jackson J, Pirie G, Bauer R. Neurologic amebiasis caused by Balamuthia mandrillaris in an Indian flying fox (Pteropus giganteus). J Vet Diagn Invest 2016; 28:54-8. [PMID: 26762405 DOI: 10.1177/1040638715614346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 4-5-month-old intact male Indian flying fox (Pteropus giganteus) was presented to the Baton Rouge Zoo's veterinary hospital with an acute onset of obtundation that was diagnosed with amebic encephalitis. Histologic examination revealed numerous amebic trophozoites within necrotic foci, affecting the occipital cerebrum and surrounding the mesencephalic aqueduct. The etiologic agent, Balamuthia mandrillaris, was determined by multiplex quantitative real-time polymerase chain reaction, immunohistochemistry, and indirect fluorescent antibody test. The current report documented a case of amebic encephalitis within the order Chiroptera.
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Affiliation(s)
- Nicholas A Crossland
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
| | - Ibne Ali
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
| | - Christine Higbie
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
| | - Jonathan Jackson
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
| | - Gordon Pirie
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
| | - Rudy Bauer
- Departments of Pathobiological Sciences (Crossland, Bauer), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LAVeterinary Clinical Sciences (Higbie), School of Veterinary Medicine, Louisiana State University, Baton Rouge, LALouisiana Animal Disease Diagnostic Laboratory, Louisiana State University, Baton Rouge, LA (Bauer)National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Ali, Jackson)Baton Rouge Zoo, Baton Rouge, LA (Pirie)
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Siddiqui R, Khan NA. Balamuthia mandrillaris: Morphology, biology, and virulence. Trop Parasitol 2015; 5:15-22. [PMID: 25709948 PMCID: PMC4326988 DOI: 10.4103/2229-5070.149888] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/22/2015] [Indexed: 11/04/2022] Open
Abstract
Balamuthia mandrillaris is a protist pathogen that can cause encephalitis with a fatality rate of >95%. This is due to our incomplete understanding of the pathogenesis and pathophysiology of B. mandrillaris encephalitis. B. mandrillaris has two stages in its life cycle, an active trophozoite stage during which it divides mitotically. However, under unfavorable conditions, the trophozoite transforms into a dormant cyst stage. A major concern during the course of therapy is that B. mandrillaris can transform into cysts. Cysts are highly resistant to physical and chemical conditions and present a problem in successful antimicrobial chemotherapy. Several lines of evidence suggest that B. mandrillaris encephalitis develops as a result of hematogenous spread, but it is unclear how circulating amoebae enter the central nervous system and cause inflammation, blood-brain barrier disruption, and neuronal injury. Recent studies have identified several parasite-host determinants for B. mandrillaris translocation of the blood-brain barrier, and host inflammatory markers that may be associated with neuronal injury. These determinants may provide important targets for the prevention and treatment of this devastating infection. Here, we present a brief overview of the current understanding of the morphology, biology, pathogenesis, and pathophysiology of B. mandrillaris encephalitis.
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Affiliation(s)
- Ruqaiyyah Siddiqui
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Naveed Ahmed Khan
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Itoh K, Yagita K, Nozaki T, Katano H, Hasegawa H, Matsuo K, Hosokawa Y, Tando S, Fushiki S. An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan. Neuropathology 2014; 35:64-9. [PMID: 25186798 DOI: 10.1111/neup.12151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 07/31/2014] [Indexed: 12/01/2022]
Abstract
Balamuthia mandrillaris is an amoeba found in fresh water and soil that causes granulomatous amoebic encephalitis. We report herein an autopsy case of B. mandrillaris amoebic encephalitis, which was definitely diagnosed by PCR. An 81-year-old man, who had Sjögren's syndrome, manifested drowsiness 2 months before his death with progressive deterioration. Neuroimaging demonstrated foci of T2- and fluid-attenuated inversion recovery high and T1 low-intensity with irregular post-contrast ring enhancement in the cerebral hemisphere, thalamus and midbrain. Pathologically, multiple hemorrhagic and necrotic lesions were found in the cerebrum, thalamus, midbrain, pons, medulla and cerebellum, which were characterized by liquefactive necrosis, marked edema, hemorrhage and necrotizing vasculitis associated with the perivascular accumulation of amoebic trophozoites, a few cysts, and the infiltration of numerous neutrophils and microglia/macrophages. The trophozoites were ovoid or round, 10-60 μm in diameter, and they showed foamy cytoplasm and a round nucleus with small karyosome in the center. The PCR and immunohistochemistry from paraffin-embedded brain specimens revealed angioinvasive encephalitis due to B. mandrillaris. Human cases of B. mandrillaris brain infection are rare in Japan, with only a few brief reports in the literature.
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Affiliation(s)
- Kyoko Itoh
- Department of Pathology & Applied Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Jackson BR, Kucerova Z, Roy SL, Aguirre G, Weiss J, Sriram R, Yoder J, Foelber R, Baty S, Derado G, Stramer SL, Winkelman V, Visvesvara GS. Serologic survey for exposure following fatal Balamuthia mandrillaris infection. Parasitol Res 2014; 113:1305-11. [PMID: 24458652 DOI: 10.1007/s00436-014-3769-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
Abstract
Granulomatous amebic encephalitis (GAE) from Balamuthia mandrillaris, a free-living ameba, has a case fatality rate exceeding 90% among recognized cases in the USA. In August 2010, a GAE cluster occurred following transplantation of infected organs from a previously healthy landscaper in Tucson, AZ, USA, who died from a suspected stroke. As B. mandrillaris is thought to be transmitted through soil, a serologic survey of landscapers and a comparison group of blood donors in southern Arizona was performed. Three (3.6%) of 83 serum samples from landscapers and 11 (2.5%) of 441 serum samples from blood donors were seropositive (p = 0.47). On multivariable analysis, county of residence was associated with seropositivity, whereas age, sex, and ethnicity were not. Exposure to B. mandrillaris, previously unexamined in North America, appears to be far more common than GAE in Southern Arizona. Risk factors for disease progression and the ameba's geographic range should be examined.
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Affiliation(s)
- Brendan R Jackson
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30333, USA,
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Lobo SA, Patil K, Jain S, Marks S, Visvesvara GS, Tenner M, Braun A, Wang G, El Khoury MY. Diagnostic challenges in Balamuthia mandrillaris infections. Parasitol Res 2013; 112:4015-9. [DOI: 10.1007/s00436-013-3592-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
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Lorenzo-Morales J, Cabello-Vílchez AM, Martín-Navarro CM, Martínez-Carretero E, Piñero JE, Valladares B. Is Balamuthia mandrillaris a public health concern worldwide? Trends Parasitol 2013; 29:483-8. [PMID: 23988231 DOI: 10.1016/j.pt.2013.07.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 10/26/2022]
Abstract
Balamuthia mandrillaris is an opportunistic, free-living amoeba that can cause skin lesions and the typically fatal Balamuthia amoebic encephalitis (BAE) both in immunocompromised and immunocompetent individuals. Available data for BAE cases indicate that this disease is difficult to detect because knowledge of predisposing factors is lacking, causing a challenge for diagnosing BAE. The number of reported BAE cases is increasing worldwide, and this is a major concern because little is known about the pathogen, no standardized detection tools are available, and most of the treatments are almost empirical. The recently reported cases, novel diagnostics tools, and successful therapeutic approaches against BAE infections are reviewed here.
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Affiliation(s)
- Jacob Lorenzo-Morales
- University Institute of Tropical Diseases and Public Health of The Canary Islands, University of La Laguna, Avenida Astrofísico Francisco Sánchez SN, 38203 La Laguna, Tenerife, Canary Islands, Spain.
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Krasaelap A, Prechawit S, Chansaenroj J, Punyahotra P, Puthanakit T, Chomtho K, Shuangshoti S, Amornfa J, Poovorawan Y. Fatal Balamuthia amebic encephalitis in a healthy child: a case report with review of survival cases. THE KOREAN JOURNAL OF PARASITOLOGY 2013; 51:335-41. [PMID: 23864745 PMCID: PMC3712108 DOI: 10.3347/kjp.2013.51.3.335] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
Abstract
Balamuthia mandrillaris is one of the 4 amebas in fresh water and soil that cause diseases in humans. Granulomatous amebic encephalitis (GAE), caused by B. mandrillaris, is a rare but life-threatening condition. A 4-year-old, previously healthy, Thai girl presented with progressive headache and ataxia for over a month. Neuroimaging studies showed an infiltrative mass at the right cerebellar hemisphere mimicking a malignant cerebellar tumor. The pathological finding after total mass removal revealed severe necrotizing inflammation, with presence of scattered amebic trophozoites. Cerebrospinal fluid (CSF) obtained from lumbar puncture showed evidence of non-specific inflammation without identifiable organisms. A combination of pentamidine, sulfasalazine, fluconazole, and clarithromycin had been initiated promptly before PCR confirmed the diagnosis of Balamuthia amebic encephalitis (BAE). The patient showed initial improvement after the surgery and combined medical treatment, but gradually deteriorated and died of multiple organ failure within 46 days upon admission despite early diagnosis and treatment. In addition to the case, 10 survivors of BAE reported in the PubMed database were briefly reviewed in an attempt to identify the possible factors leading to survival of the patients diagnosed with this rare disease.
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Affiliation(s)
- A Krasaelap
- Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Abstract
The blood-brain barrier (BBB) is a structural and functional barrier that protects the central nervous system (CNS) from invasion by blood-borne pathogens including parasites. However, some intracellular and extracellular parasites can traverse the BBB during the course of infection and cause neurological disturbances and/or damage which are at times fatal. The means by which parasites cross the BBB and how the immune system controls the parasites within the brain are still unclear. In this review we present the current understanding of the processes utilized by two human neuropathogenic parasites, Trypanosoma brucei spp and Toxoplasma gondii, to go across the BBB and consequences of CNS invasion. We also describe briefly other parasites that can invade the brain and how they interact with or circumvent the BBB. The roles played by parasite-derived and host-derived molecules during parasitic and white blood cell invasion of the brain are discussed.
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Affiliation(s)
- Willias Masocha
- Department of Applied Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
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Stidd DA, Root B, Weinand ME, Anton R. Granulomatous amoebic encephalitis caused by Balamuthia mandrillaris in an immunocompetent girl. World Neurosurg 2011; 78:715.e7-12. [PMID: 22120559 DOI: 10.1016/j.wneu.2011.10.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/12/2011] [Accepted: 10/24/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Balamuthia mandrillaris is a recently recognized cause of a rare, devastating infection, granulomatous amoebic encephalitis (GAE). Presenting symptoms of GAE are nonspecific and can last for months before becoming clinically significant. Once the infection involves the central nervous system, death often results within days to weeks. A high degree of clinical suspicion is needed to correctly diagnose this infection because definitive diagnostic tests are presently limited, and even then there are only sparse data concerning effective treatment. The importance of early diagnosis is emphasized because delay likely contributes to the extremely high mortality with this infection. METHODS This study presents a previously healthy, immunocompetent 2-year-old female patient who succumbed to GAE secondary to B. mandrillaris, with the intention of raising awareness of this devastating infection. RESULTS Balamuthia amoebic encephalitis is a devastating form of amoebic encephalitis that is increasingly reported in the literature. CONCLUSIONS GAE should be considered for a patient with atypical encephalitis and single or multiple lesions with surrounding edema evident on neurodiagnostic imaging.
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Affiliation(s)
- David A Stidd
- Division of Neurosurgery, University of Arizona, Tucson, Arizona, USA.
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Doyle JS, Campbell E, Fuller A, Spelman DW, Cameron R, Malham G, Gin D, Lewin SR. Balamuthia mandrillaris brain abscess successfully treated with complete surgical excision and prolonged combination antimicrobial therapy. J Neurosurg 2011; 114:458-62. [DOI: 10.3171/2010.10.jns10677] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Amoebic encephalitis is an uncommon and usually fatal condition. This case describes successful treatment of a Balamuthia mandrillaris brain abscess using prolonged antimicrobial agents with complete excision. It illustrates the risk of dissemination from cutaneous to cerebral amoebic lesions, potential progression with corticosteroid therapy, and the prospect for curative excision.
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Affiliation(s)
| | | | | | | | | | | | | | - Sharon R. Lewin
- 1Infectious Diseases Unit and
- 6Department of Medicine, Monash University; and
- 7Burnet Institute, Melbourne, Victoria, Australia
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46
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Combs FJ, Erly WK, Valentino CM, Rance NE. Best Cases from the AFIP:Balamuthia mandrillarisAmebic Meningoencephalitis. Radiographics 2011; 31:31-5. [DOI: 10.1148/rg.311105067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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47
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Hodge PJ, Kelers K, Gasser RB, Visvesvara GS, Martig S, Long SN. Another case of canine amoebic meningoencephalitis—the challenges of reaching a rapid diagnosis. Parasitol Res 2010; 108:1069-73. [DOI: 10.1007/s00436-010-2197-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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48
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Cary LC, Maul E, Potter C, Wong P, Nelson PT, Given C, Robertson W. Balamuthia mandrillaris meningoencephalitis: survival of a pediatric patient. Pediatrics 2010; 125:e699-703. [PMID: 20123772 DOI: 10.1542/peds.2009-1797] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Balamuthia mandrillaris infections are rare and almost always fatal. This ameba is a naturally occurring soil inhabitant that can cause disease in immunocompetent hosts, with early diagnosis typically proving difficult. We recently cared for a previously healthy 2-year-old boy who was diagnosed with meningoencephalitis secondary to B mandrillaris relatively early in his presentation, which enabled us to initiate targeted antimicrobial therapy. Since discharge from the hospital the child has shown slow, steady improvement with dramatic improvements seen on follow-up brain imaging. Our observations suggest that early diagnosis and treatment may significantly reduce mortality and morbidity rates from this highly virulent organism.
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Affiliation(s)
- Larry Curtis Cary
- University of Kentucky College of Medicine, Department of Pediatrics, Pediatric Residency Program, MN118 William R. Willard Medical Education Building, 800 Rose St, Lexington, KY 40536-0298, USA.
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Salah IB, Ghigo E, Drancourt M. Free-living amoebae, a training field for macrophage resistance of mycobacteria. Clin Microbiol Infect 2009; 15:894-905. [PMID: 19845701 DOI: 10.1111/j.1469-0691.2009.03011.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mycobacterium species evolved from an environmental recent common ancestor by reductive evolution and lateral gene transfer. Strategies selected through evolution and developed by mycobacteria resulted in resistance to predation by environmental unicellular protists, including free-living amoebae. Indeed, mycobacteria are isolated from the same soil and water environments as are amoebae, and experimental models using Acanthamoeba spp. and Dictyostelium discoideum were exploited to analyse the mechanisms for intracellular survival. Most of these mechanisms have been further reproduced in macrophages for mycobacteria regarded as opportunistic and obligate pathogens. Amoebal cysts may protect intracellular mycobacteria against adverse conditions and may act as a vector for mycobacteria. The latter hypothesis warrants further environmental and clinical studies to better assess the role of free-living amoebae in the epidemiology of infections caused by mycobacteria.
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Affiliation(s)
- I B Salah
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, CNRS 6236 IRD 198, IFR 48 Faculté de Médecine, Université de la Méditerranée, Marseille, France
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Santillo MF, Heien ML, Ewing AG. Temporal analysis of protozoan lysis in a microfluidic device. LAB ON A CHIP 2009; 9:2796-802. [PMID: 19967116 PMCID: PMC4801346 DOI: 10.1039/b907942d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
A microfluidic device was fabricated and characterized for studying cell lysis of Arcella vulgaris, a nonpathogenic amoeba, over time. The device contains a series of chambers which capture cells allowing them to be subsequently exposed to a constant flow of biocidal agent. With this microfluidic system, individual cells are observed as they undergo lysis. This allows high-throughput measurements of individual lysis events, which are not possible with conventional techniques. Differences in lysis and decay times for Arcella were seen at different flow rates and concentrations of benzalkonium chloride, a biocidal detergent. The efficacy of benzalkonium chloride, chlorhexidine digluconate, phenol, sodium dodecyl sulfate, and Triton X-100 were compared, revealing information on their mechanisms of action. The presented device allows cell capture, controlled exposure to chemical biocides, and observation of lysis with single-cell resolution. Observations at the single cell level give insight into the mechanistic details of the lysis of individual Arcella cells vs. the population; decay times for individual Arcella cells were much shorter when compared to a population of 15 cells.
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Affiliation(s)
- Michael F. Santillo
- Department of Chemistry, The Pennsylvania State University, University Park, PA USA
| | - Michael L. Heien
- Department of Chemistry, The Pennsylvania State University, University Park, PA USA
| | - Andrew G. Ewing
- Department of Chemistry, The Pennsylvania State University, University Park, PA USA
- Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA USA
- Department of Chemistry, University of Gothenburg, Göteborg, Sweden
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