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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 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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Yamanouchi K, Arima H, Sakamoto Y, Kanto K, Itoh K, Tsujiguchi T. Isolation and habitat analysis of Balamuthia mandrillaris from soil. Parasitol Res 2024; 123:163. [PMID: 38499865 DOI: 10.1007/s00436-024-08182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024]
Abstract
Balamuthia mandrillaris is a free-living amoeba that causes meningoencephalitis in mammals. Over 200 cases of infection were reported worldwide, with a fatality rate of over 95%. A clear route of infection was unknown for a long time until a girl died of granulomatous amoebic encephalitis (GAE) in California, USA, in 2003 due to infection with B. mandrillaris detected in a potted plant. Since then, epidemiological studies were conducted worldwide to detect B. mandrillaris in soil and other environmental samples. We previously reported the isolation of B. mandrillaris from the soil in Japan; however, the existing B. mandrillaris culture method with BM3 medium and COS-7 cells was unsuccessful. Therefore, in this study, we aimed to conduct soil analysis to determine the growth conditions of B. mandrillaris. B. mandrillaris-positive soils were defined as soils from which B. mandrillaris was isolated and environmental DNA was PCR-positive. Soils inhabited by B. mandrillaris were alkaline, with high electrical conductivity and characteristics of nutrient-rich soils of loam and clay loam. The results of this study suggest a possible reason for the high prevalence of GAE caused by B. mandrillaris among individuals employed in agriculture-related occupations.
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Affiliation(s)
- Kanako Yamanouchi
- Department of Bioscience and Laboratory Medicine, Graduate School of Health Sciences, Hirosaki University, 66-1 Hon-Cho, Hirosaki, 036-8564, Japan.
| | - Hiroaki Arima
- Department of International Health and Medical Anthropology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Yamato Sakamoto
- Department of Bioscience and Laboratory Medicine, Graduate School of Health Sciences, Hirosaki University, 66-1 Hon-Cho, Hirosaki, 036-8564, Japan
| | - Kazuki Kanto
- Department of Bioscience and Laboratory Medicine, Graduate School of Health Sciences, Hirosaki University, 66-1 Hon-Cho, Hirosaki, 036-8564, Japan
| | - Katsuhiro Itoh
- Education Center for Disaster and Radiation Emergency Medicine, Hirosaki University, 66-1 Hon-Cho, Hirosaki, 036-8564, Japan
| | - Takakiyo Tsujiguchi
- Education Center for Disaster and Radiation Emergency Medicine, Hirosaki University, 66-1 Hon-Cho, Hirosaki, 036-8564, Japan
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Aykur M, Dagci H. Molecular identification of Acanthamoeba spp., Balamuthia mandrillaris and Naegleria fowleri in soil samples using quantitative real-time PCR assay in Turkey; Hidden danger in the soil! Acta Trop 2023:106956. [PMID: 37244403 DOI: 10.1016/j.actatropica.2023.106956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri are pathogenic free-living amoeba (FLA) and are commonly found in the environment, particularly soil. This pathogenic FLA causes central nervous system-affecting granulomatous amebic encephalitis (GAE) or primary amebic meningoencephalitis (PAM) and can also cause keratitis and skin infections. In the present study, we aimed to determine the quantitative concentration of Acanthamoeba spp., B. mandrillaris, and N. fowleri in soil samples collected from places where human contact is high by using a qPCR assay in Izmir, Turkey. A total of 45.71% (n=16) of Acanthamoeba spp., 20% (n=7) of B. mandrillaris, and 17.4% (n=6) of N. fowleri were detected in five different soil sources by the qPCR assay. The quantitative concentration of Acanthamoeba spp., B. mandrillaris, and N. fowleri in various soil sources was calculated at 10 × 105 - 6 × 102, 47 × 104 to 39 × 103, and 9 × 103 - 8 × 102 plasmid copies/gr, respectively. While the highest quantitative concentration of Acanthamoeba spp. and B. mandrillaris was determined in garden soil samples, N. fowleri was detected in potting soil samples. Three different genotypes T2 (18.75%), T4 (56.25%), and T5 (25%) were identified from Acanthamoeba-positive soil samples. Acanthamoeba T4 genotype was the most frequently detected genotype from soil samples and is also the most common genotype to cause infection in humans and animals. To the best of our knowledge, the present study is the first study to identify genotype T5 in soil samples from Turkey. In conclusion, people and especially children should be aware of the hidden danger in the garden and potting soil samples that come into contact most frequently. Public health awareness should be raised about human infections that may be encountered due to contact with the soil. Public health specialists should raise awareness about this hidden danger in soil.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Tokat Gaziosmanpasa University Medical School, Tokat, Turkey; Department of Parasitology, Ege University Medical School, İzmir, Turkey.
| | - Hande Dagci
- Department of Parasitology, Ege University Medical School, İzmir, Turkey
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Fan X, Chen T, Yang H, Gao Y, Chen Y. Encephalomyelomeningitis Caused by Balamuthia mandrillaris: A Case Report and Literature Review. Infect Drug Resist 2023; 16:727-733. [PMID: 36756612 PMCID: PMC9901442 DOI: 10.2147/idr.s400692] [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: 12/16/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023] Open
Abstract
Central nervous system infection by Balamuthia mandrillaris is a rare and severe condition, which has a fatality rate of approximately 95% and often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Here, we report a case of encephalomyelomeningitis caused by B. mandrillaris in a male who presented with transient coma, nausea, and vomiting when working in a garbage dump. Initial magnetic resonance imaging (MRI) of the brain showed normal signals. Despite receiving steroids as well as antibacterial and antiviral treatment, he developed urinary and fecal dysfunction, inability to walk, and deterioration of consciousness. Both brain and spinal cord MRI revealed abnormal findings, and next-generation sequencing of the cerebrospinal fluid showed the presence of B. mandrillaris. A combination of fluconazole and albendazole was administered; however, the patient deteriorated gradually and died 30 days after the onset. We suggest the unbiased metagenomic sequencing of the affected tissues/CSF in patients with CNS infections that are difficult to diagnose or treat, and multiple tests at different stages of the disease may be required.
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Affiliation(s)
- XueMei Fan
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - TianWen Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Yang
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yue Gao
- Department of General Practice, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Yue Gao, Tel +86 13706511908; +86 531-56006851, Email
| | - Yan Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Correspondence: Yan Chen, Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261, Huan Sha Road, Shangcheng District, Hangzhou, People’s Republic of China, Tel +86 15397086693; +86 531-56006952, Email
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Aykur M, Dirim Erdogan D, Selvi Gunel N, Guler A, Biray Avci C, Celebisoy N, Gunduz C, Dagci H. Genotyping and Molecular Identification of Acanthamoeba Genotype T4 and Naegleria fowleri from Cerebrospinal Fluid Samples of Patients in Turkey: Is it the Pathogens of Unknown Causes of Death? Acta Parasitol 2022; 67:1372-1383. [PMID: 35864411 DOI: 10.1007/s11686-022-00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey. METHOD A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses. RESULTS The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing. CONCLUSION This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey. .,Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpaşa University, PO Box 60030, Tokat, Turkey.
| | - Derya Dirim Erdogan
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nur Selvi Gunel
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Ayse Guler
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cigir Biray Avci
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cumhur Gunduz
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
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7
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Tao K, Wang T, Zhang L, Yang XC, Zhai ZF. Fatal Balamuthia mandrillaris infection with red plaques on the nasal dorsum as the first presentation. An Bras Dermatol 2022; 97:498-500. [PMID: 35691739 PMCID: PMC9263639 DOI: 10.1016/j.abd.2021.12.001] [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: 08/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022] Open
Abstract
Balamuthia mandrillaris infection is a rare infectious disease around the world, with high rates of morbidity and mortality. Its early and correct diagnosis is a big challenge for us, and without it the delay in starting effective treatment can lead to the development of encephalitis. This is a report of a case of Balamuthia mandrillaris infection in a Chinese boy, with red plaques on the nasal dorsum as the first presentation, who finally developed into fatal encephalitis. The authors have reviewed the related literature and share the special skin features in order to favor the early diagnosis of the disease and increase the chances of survival.
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Affiliation(s)
- Kang Tao
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ting Wang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lian Zhang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xi-Chuan Yang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhi-Fang Zhai
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, 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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Balamuthia mandrillaris infection: report of 1st autochthonous, fatal case in Italy. Eur J Clin Microbiol Infect Dis 2022; 41:685-687. [DOI: 10.1007/s10096-022-04404-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
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10
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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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Bhosale NK, Parija SC. Balamuthia mandrillaris: An opportunistic, free-living ameba - An updated review. Trop Parasitol 2021; 11:78-88. [PMID: 34765527 PMCID: PMC8579774 DOI: 10.4103/tp.tp_36_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023] Open
Abstract
Balamuthia mandrillaris is an opportunistic, free-living ameba that is pathogenic to humans. It has a worldwide distribution but is mainly detected in warmer regions. Balamuthia infections are rare but have been reported in both immunocompetent and immunocompromised individuals of all ages. B. mandrillaris can enter through wounds on the skin or the nose and cause cutaneous lesions and the usually fatal Balamuthia amebic encephalitis (BAE). Infection usually spreads from the lungs or through nerve fibers, and attacks the central nervous system, forming granulomatous lesions and necrosis in the brain. Balamuthia infection is usually chronic, and patients initially present with nonspecific symptoms, including headache, nausea, myalgia, and low-grade fever. As the disease progresses, the patient becomes paralyzed and comatose, often leading to death. Lack of knowledge of predisposing factors, specific treatment, and standardized detection tools have resulted in a nearly cent percent fatality rate. Although only about 200 cases have been reported worldwide since its characterization in the 1990s, the number of reported cases has increased over the years. BAE is an emerging disease and a major health concern. Few patients have survived Balamuthia infections with antimicrobial treatment that has largely been empirical. Early diagnosis is the key and requires familiarity with the disease and a high degree of suspicion on the part of the diagnostician. There are currently no specific treatment and prevention recommendations. This review highlights our current understanding of B. mandrillaris in terms of its pathogenicity, genomics, and novel diagnostic and therapeutic approaches against BAE infections.
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Affiliation(s)
- Namrata K Bhosale
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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12
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Sarink MJ, van der Meijs NL, Denzer K, Koenderman L, Tielens AGM, van Hellemond JJ. Three encephalitis-causing amoebae and their distinct interactions with the host. Trends Parasitol 2021; 38:230-245. [PMID: 34758928 DOI: 10.1016/j.pt.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 01/21/2023]
Abstract
Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba spp. can cause devastating brain infections in humans which almost always result in death. The symptoms of the three infections overlap, but brain inflammation and the course of the disease differ, depending on the amoeba that is responsible. Understanding the differences between these amoebae can result in the development of strategies to prevent and treat these infections. Recently, numerous scientific advancements have been made in the understanding of pathogenicity mechanisms in general, and the basic biology, epidemiology, and the human immune response towards these amoebae in particular. In this review, we combine this knowledge and aim to identify which factors can explain the differences between the lethal brain infections caused by N. fowleri, B. mandrillaris, and Acanthamoeba spp.
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Affiliation(s)
- Maarten J Sarink
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Nadia L van der Meijs
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Kristin Denzer
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aloysius G M Tielens
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Jaap J van Hellemond
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
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Safavi M, Mehrtash V, Habibi Z, Mohammadpour M, Haghi Ashtiani MT, Sotoudeh Anvari M, Zaresharifi N, Shafizadeh M, Jafarzadeh B. Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl. Am J Trop Med Hyg 2021; 104:1836-1840. [PMID: 33720845 PMCID: PMC8103465 DOI: 10.4269/ajtmh.20-1257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.
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Affiliation(s)
- Moeinadin Safavi
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;,Address correspondence to Moeinadin Safavi or Vahid Mehrtash, Pathology Department, Children’s Medical Center, No. 62, Dr Gharib St., Tehran 1419733151, Iran. E-mails: or
| | - Vahid Mehrtash
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;,Address correspondence to Moeinadin Safavi or Vahid Mehrtash, Pathology Department, Children’s Medical Center, No. 62, Dr Gharib St., Tehran 1419733151, Iran. E-mails: or
| | - Zohreh Habibi
- Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Pediatric Intensive Care Division, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Sotoudeh Anvari
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Zaresharifi
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Shafizadeh
- Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Jafarzadeh
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Rice CA, Troth EV, Russell AC, Kyle DE. Discovery of Anti-Amoebic Inhibitors from Screening the MMV Pandemic Response Box on Balamuthia mandrillaris, Naegleria fowleri, and Acanthamoeba castellanii. Pathogens 2020; 9:E476. [PMID: 32560115 PMCID: PMC7344389 DOI: 10.3390/pathogens9060476] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023] Open
Abstract
Pathogenic free-living amoebae, Balamuthia mandrillaris, Naegleria fowleri, and several Acanthamoeba species are the etiological agents of severe brain diseases, with case mortality rates > 90%. A number of constraints including misdiagnosis and partially effective treatments lead to these high fatality rates. The unmet medical need is for rapidly acting, highly potent new drugs to reduce these alarming mortality rates. Herein, we report the discovery of new drugs as potential anti-amoebic agents. We used the CellTiter-Glo 2.0 high-throughput screening methods to screen the Medicines for Malaria Ventures (MMV) Pandemic Response Box in a search for new active chemical scaffolds. Initially, we screened the library as a single-point assay at 10 and 1 µM. From these data, we reconfirmed hits by conducting quantitative dose-response assays and identified 12 hits against B. mandrillaris, 29 against N. fowleri, and 14 against A. castellanii ranging from nanomolar to low micromolar potency. We further describe 11 novel molecules with activity against B. mandrillaris, 22 against N. fowleri, and 9 against A. castellanii. These structures serve as a starting point for medicinal chemistry studies and demonstrate the utility of phenotypic screening for drug discovery to treat diseases caused by free-living amoebae.
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Affiliation(s)
- Christopher A. Rice
- Department of Cellular Biology, University of Georgia, Athens, GA 30602, USA
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
| | - Emma V. Troth
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - A. Cassiopeia Russell
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
| | - Dennis E. Kyle
- Department of Cellular Biology, University of Georgia, Athens, GA 30602, USA
- Center for Tropical and Emerging Global Diseases, Athens, GA 30602, USA; (E.V.T.); (A.C.R.)
- Department of Infectious Diseases, University of Georgia, Athens, GA 30602, USA
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15
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Identification of T3 and T4 Genotypes of Acanthamoeba sp. in Dust Samples Isolated from Air Conditioning Equipment of Public Hospital of Ituiutaba-MG. Curr Microbiol 2020; 77:890-895. [PMID: 31960093 DOI: 10.1007/s00284-019-01869-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
The free-living amoebae are currently considered an emerging parasitic infection. The infection by this protozoan can generate serious infection and even cause death. Due to their amphizoic and opportunistic characters of these microorganisms, one should give more attention, not only in swimming pools but also where there are immunologically susceptible patients such as those found in intensive care units and surgical centers. Due to their difficult diagnosis often postmortem, because they are considered to be an emerging parasitic infection and their diagnosis is difficult, often performed post mortem. This study aimed to evaluate the safety of these protozoa in air conditioners by taking samples of dust from both the surgical center and the intensive therapy unit. We analyzed 48 dust samples that were collected from six air conditioners equipment located in the Intensive Care Unit (ICU) and Surgical Center (SC) of a public hospital. We found 10.4% of the samples collected in the SC, and 75% of the samples collected in the ICU presented free-living amoeba cysts by light microscopy analysis. In total, 35.4% (17/48) of the air conditioning samples of the hospital were positive and, by PCR, were identified to belong to the genus Acanthamoeba spp and Balamuthia mandrillaris species. By DNA sequencing analysis, it was possible to classify the Acanthamoeba samples as belonging to the T3 and T4 genotypes. These genotypes are the main cause of keratitis in humans, and Balamuthia may cause amoebic encephalitis, and together are emerging parasitic infections. Our results show the presence of the two most important amoebas Acanthamoeba (T3 and T4 genotypes) and Balamuthia in the SC and the ICU, and these necessary precautions these sites could be propagating cysts of these amoebas and patients during their stay or discharge could present ocular and NSC alterations without perhaps arriving to the diagnosis of free-living amoeba infection.
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16
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Potentially pathogenic genera of free-living amoebae coexisting in a thermal spring. Exp Parasitol 2018; 195:54-58. [DOI: 10.1016/j.exppara.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/24/2022]
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17
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Lares-Jiménez LF, Borquez-Román MA, Alfaro-Sifuentes R, Meza-Montenegro MM, Casillas-Hernández R, Lares-Villa F. Detection of serum antibodies in children and adolescents against Balamuthia mandrillaris, Naegleria fowleri and Acanthamoeba T4. Exp Parasitol 2018; 189:28-33. [PMID: 29673623 DOI: 10.1016/j.exppara.2018.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/21/2018] [Accepted: 04/11/2018] [Indexed: 12/31/2022]
Abstract
The presence of free-living amoebae of the genera Naegleria, Acanthamoeba and Balamuthia, which contain pathogenic species for humans and animals, has been demonstrated several times and in different natural aquatic environments in the northwest of Mexico. With the aim of continuing the addition of knowledge about immunology of pathogenic free-living amoebae, 118 sera from children and adolescents, living in three villages, were studied. Humoral IgG response against B. mandrillaris, N. fowleri and Acanthamoeba sp. genotype T4, was analyzed in duplicate to titers 1: 100 and 1: 500 by enzyme-linked immunosorbent assay (ELISA). Children and adolescents ages ranged between 5 and 16 years old, with a mean of 9 years old, 55% males. All tested sera were positive for the 1: 100 dilution, and in the results obtained with the 1: 500 dilution, 116 of 118 (98.3%) were seropositive for N. fowleri, 101 of 118 (85.6%) were seropositive for Acanthamoeba sp. genotype T4, and 43 of 118 (36.4%) were seropositive for B. mandrillaris. The statistical analysis showed different distributions among the three communities and for the three species of pathogenic free-living amoebae, including age. Lysed and complete cells used as Balamuthia antigens gave differences in seropositivity.
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Affiliation(s)
- Luis Fernando Lares-Jiménez
- Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico.
| | | | - Rosalía Alfaro-Sifuentes
- Programa de Maestría en Ciencias en Recursos Naturales, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico.
| | | | - Ramón Casillas-Hernández
- Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico.
| | - Fernando Lares-Villa
- Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico; Programa de Doctorado en Ciencias en Biotecnología, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico; Programa de Maestría en Ciencias en Recursos Naturales, Instituto Tecnológico de Sonora, Cd. Obregón, Son, Mexico.
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18
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Variation in Campylobacter jejuni culturability in presence of Acanthamoeba castellanii Neff. Exp Parasitol 2017; 183:178-181. [DOI: 10.1016/j.exppara.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/25/2017] [Accepted: 09/11/2017] [Indexed: 12/19/2022]
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19
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Reyes-Batlle M, Wagner C, López-Arencibia A, Sifaoui I, Martínez-Carretero E, Valladares B, Piñero JE, Lorenzo-Morales J. Isolation and molecular characterization of a Naegleria strain from a recreational water fountain in Tenerife, Canary Islands, Spain. Acta Parasitol 2017; 62:265-268. [PMID: 28426408 DOI: 10.1515/ap-2017-0033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/30/2016] [Indexed: 11/15/2022]
Abstract
Free-Living Amoebae (FLA) are widely distributed protozoa in the environment and have been isolated from many sources such as dust, soil and water. Among the pathogenic genera included in this group Acanthamoeba spp., Naegleria fowleri and Balamuthia mandrillaris have been reported to be causative agents of lethal encephalitis, disseminated infections and keratitis. Naegleria fowleri is a pathogenic FLA species which causes Primary Amoebic Meningoencephalitis (PAM). At present there are not many available data on the distribution of Naegleria species in Spain from environmental sources. Therefore, the aim of this study was to evaluate the presence of this genus in recreational water sources in the island of Tenerife, Canary Islands, Spain. In this study, ten samples collected from recreational water fountains were checked for the presence of Naegleria spp. using morphological and molecular identification tools. From the analysed samples, only one sample (seawater fountain) was positive for Naegleria spp. interestingly, not many reports of Naegleria spp. in seawater are available in the literature and thus awareness should be raised among the environmental and public health professionals.
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Affiliation(s)
- María Reyes-Batlle
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Carolina Wagner
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Atteneri López-Arencibia
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Ines Sifaoui
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Enrique Martínez-Carretero
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Basilio Valladares
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Jose E Piñero
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
| | - Jacob Lorenzo-Morales
- University Institute of Tropical Diseases and Public Health of the Canary Islands, University of La Laguna, Avda. Astrofísico Fco. Sánchez, S/N, 38203 La Laguna, Tenerife, Canary Islands
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20
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Kollipara R, Peranteau AJ, Nawas ZY, Tong Y, Woc-Colburn L, Yan AC, Lupi O, Tyring SK. Emerging infectious diseases with cutaneous manifestations: Fungal, helminthic, protozoan and ectoparasitic infections. J Am Acad Dermatol 2017; 75:19-30. [PMID: 27317513 DOI: 10.1016/j.jaad.2016.04.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/27/2022]
Abstract
Given increased international travel, immigration, changing climate conditions, and the increased incidence of iatrogenic immunosuppression, fungal, protozoan, helminthic, and ectoparasitic infections that were once uncommon are being seeing more frequently in the Western hemisphere. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. In addition, delays in the diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. We review the epidemiology, cutaneous manifestations, diagnostic modalities, and treatment options for emerging fungal, protozoan, helminthic, and ectoparasitic infections. It should be noted, however, that throughout this review we cite statistics documenting their increased incidence to back-up these infections as emerging, and although some of the diagnoses are clinical, others rely on newer laboratory tests, and the possibility exists that the increased incidence could be caused by better detection methods.
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Affiliation(s)
- Ramya Kollipara
- Department of Dermatology, Texas Tech Health Sciences Center, Lubbock, Texas
| | | | | | - Yun Tong
- Center for Clinical Studies, Houston, Texas
| | - Laila Woc-Colburn
- Section of Infectious Diseases, Department of Medicine, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Albert C Yan
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Omar Lupi
- Federal University of the State of Rio de Janeiro and Policlinica Geral do Rio de Janeiro, Rio de Janerio, Brazil
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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21
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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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22
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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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Niyyati M, Karamati SA, Lorenzo Morales J, Lasjerdi Z. Isolation of Balamuthia mandrillaris from soil samples in North-Western Iran. Parasitol Res 2016; 115:541-5. [PMID: 26468147 DOI: 10.1007/s00436-015-4770-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/01/2015] [Indexed: 01/11/2023]
Abstract
Balamuthia mandrillaris is an opportunistic free-living amoebae (FLA) which has been reported as the causative agent of the fatal Balamuthia amoebic encephalitis (BAE). Currently, the transmission dynamics of this pathogen remain poorly understood although the organism has been associated with soils, and thus, soil exposure has been identified as a risk factor for this pathogenic amoeba. Nevertheless, environmental isolation of B. mandrillaris is a rare event and strains of this amoebic species have been isolated from soil and dust sources only in seven previous reports (Iran, Mexico, USA, Peru, Costa Rica, Guinea Bissau, and Jamaica). In Iran, a previous study reported the isolation of B. mandrillaris from dust collected in the city of Tehran and free of known infectious involvement. Therefore, in this work, 55 soil samples collected from public and recreational areas of East Azerbaijan, North-Western Iran, were investigated for the presence of this pathogen. Samples were cultured in 2% non-nutrient agar plates and were monitored for the presence of B. mandrillaris-like trophozoites and/or cysts. Those samples that were positive for these amoebae by microscopic criteria were then confirmed by PCR amplification and DNA sequencing of the mitochondrial 16S ribosomal DNA (rDNA) of B. mandrillaris. The obtained results revealed the presence of this emerging pathogen in 5 of 55 samples included in the study. Homology analysis of the obtained DNA sequences revealed high similarity with previously isolated strains from clinical and environmental sources. To the best of our knowledge, this is the first report on the isolation of B. mandrillaris from soil sources in Iran related to human activity and the second time that this pathogen is isolated from the environment in this country.
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Abstract
ABSTRACT
Parasites are an important cause of human disease worldwide. The clinical severity and outcome of parasitic disease is often dependent on the immune status of the host. Specific parasitic diseases discussed in this chapter are amebiasis, giardiasis, cryptosporidiosis, cyclosporiasis, cystoisosporiasis, microsporidosis, granulomatous amebic encephalitis, toxoplasmosis, leishmaniasis, Chagas disease, malaria, babesiosis, strongyloidiasis, and scabies.
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25
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Guimaraes AJ, Gomes KX, Cortines JR, Peralta JM, Peralta RHS. Acanthamoeba spp. as a universal host for pathogenic microorganisms: One bridge from environment to host virulence. Microbiol Res 2016; 193:30-38. [PMID: 27825484 DOI: 10.1016/j.micres.2016.08.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/02/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
Free-living amoebas (FLA) are ubiquitous environmental protists that have enormously contributed to the microbiological contamination of water sources. FLAs have displayed resistance to environmental adversities and germicides and have played important roles in the population control of microbial communities due to its predatory behavior and microbicidal activity. However, some organisms have developed resistance to the intracellular milieu of amoebas, as in the case of Acanthamoebas, which in turn, have been functioning as excellent reservoirs for amoeba-resistant microorganisms (ARMs), such as bacteria, viruses and fungi. Little is known about these relationships and interaction mechanisms, but it is speculated that the FLAs need a very broad repertoire or universal class of receptors to bind and recognize these diverse species of microorganisms. By harboring these organisms as a "Trojan Horse", the Achantamoeba has been working as an excellent vector for pathogens. Moreover, studies have demonstrated that the interaction of pathogens with Acanthamoeba results in environmental selective pressure responsible for induction and maintenance of virulence factors and increase in microbial pathogenicity. This phenomenon is correlated to the observation of higher gene number and DNA content of ARMs, when compared to their relatives which are adapted to other hosts, due to allopatric or sympatric gene transfer and acquisition, contradicting the overall genome reduction theory for intracellularly adapted pathogens. Thus, adaptation to FLAs indirectly provided a "learning" environment for pathogens to resist later to macrophages; besides the evolutionary distance, these phagocytes share similar predatory mechanisms, such as phagocytosis and phagolysossomal degradation. In this mini-review, we cover the most important aspects of Acanthamoeba biology and their interactions with endemically important human pathogens.
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Affiliation(s)
- Allan J Guimaraes
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Brazil.
| | - Kamilla Xavier Gomes
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Brazil
| | - Juliana Reis Cortines
- Departamento de Virologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil
| | - José Mauro Peralta
- Departamento de Imunologia, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Brazil.
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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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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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Diminazene aceturate—An antiparasitic drug of antiquity: Advances in pharmacology & therapeutics. Pharmacol Res 2015; 102:138-57. [DOI: 10.1016/j.phrs.2015.10.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/28/2015] [Accepted: 10/09/2015] [Indexed: 12/31/2022]
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Wilson MR, Shanbhag NM, Reid MJ, Singhal NS, Gelfand JM, Sample HA, Benkli B, O'Donovan BD, Ali IKM, Keating MK, Dunnebacke TH, Wood MD, Bollen A, DeRisi JL. Diagnosing Balamuthia mandrillaris Encephalitis With Metagenomic Deep Sequencing. Ann Neurol 2015; 78:722-30. [PMID: 26290222 PMCID: PMC4624031 DOI: 10.1002/ana.24499] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/18/2015] [Accepted: 08/02/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Identification of a particular cause of meningoencephalitis can be challenging owing to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. Metagenomic deep sequencing (MDS) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis. METHODS We present the case of a 74-year-old woman with endophthalmitis followed by meningoencephalitis. MDS of her cerebrospinal fluid (CSF) was performed to identify an infectious agent. RESULTS Sequences aligning to Balamuthia mandrillaris ribosomal RNA genes were identified in the CSF by MDS. Polymerase chain reaction subsequently confirmed the presence of B. mandrillaris in CSF, brain tissue, and vitreous fluid from the patient's infected eye. B. mandrillaris serology and immunohistochemistry for free-living amoebas on the brain biopsy tissue were positive. INTERPRETATION The diagnosis was made using MDS after the patient had been hospitalized for several weeks and subjected to costly and invasive testing. MDS is a powerful diagnostic tool with the potential for rapid and unbiased pathogen identification leading to early therapeutic targeting.
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Affiliation(s)
- Michael R Wilson
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA.,Department of Neurology, University of California, San Francisco, CA
| | - Niraj M Shanbhag
- Department of Neurology, University of California, San Francisco, CA
| | - Michael J Reid
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA
| | - Neel S Singhal
- Department of Neurology, University of California, San Francisco, CA
| | - Jeffrey M Gelfand
- Department of Neurology, University of California, San Francisco, CA
| | - Hannah A Sample
- Department of Neurology, University of California, San Francisco, CA
| | | | - Brian D O'Donovan
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA
| | - Ibne K M Ali
- Free-Living and Intestinal Amebas Laboratory, Centers for Disease Control and Prevention, Atlanta, GA
| | - M Kelly Keating
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thelma H Dunnebacke
- California Department of Public Health, Viral and Rickettsial Disease Laboratory, Richmond, CA
| | - Matthew D Wood
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA
| | - Andrew Bollen
- Department of Pathology, Division of Neuropathology, University of California, San Francisco, CA
| | - Joseph L DeRisi
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA.,Howard Hughes Medical Institute, Chevy Chase, MD
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Lares-Jiménez LF, Gámez-Gutiérrez RA, Lares-Villa F. Novel culture medium for the axenic growth of Balamuthia mandrillaris. Diagn Microbiol Infect Dis 2015; 82:286-8. [PMID: 25957459 DOI: 10.1016/j.diagmicrobio.2015.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/20/2015] [Accepted: 04/22/2015] [Indexed: 11/25/2022]
Abstract
Until now, for axenic cultivation of Balamuthia mandrillaris, the BM-3 culture medium and the Modified Chang's special medium have been the only ones recommended, but they have some disadvantages, as both require many components and their preparations are laborious. Therefore, we developed a novel culture medium for B. mandrillaris axenic cultivation. Each one of the 11 components of BM-3 was combined with Cerva's medium as basal culture medium. Ten strains of B. mandrillaris including the reference strain CDC:V039 and 9 environmental isolates were used during trials. After testing all combinations, the basal medium complemented with 10× Hank's balanced salt solution was the only one that supported confluent growth of B. mandrillaris. Cell shape and motility of trophozoites were normal. This developed medium is as useful as BM-3 for axenization. The development of a cheaper and easy-to-prepare medium for B. mandrillaris opens the possibility of increasing its study.
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Affiliation(s)
- Luis Fernando Lares-Jiménez
- Programa de Doctorado en Ciencias en Biotecnología, Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Mexico.
| | - Ricardo Alfredo Gámez-Gutiérrez
- Programa de Ingeniero en Biosistemas, Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Mexico.
| | - Fernando Lares-Villa
- Programa de Doctorado en Ciencias en Biotecnología, Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Mexico; Programa de Ingeniero en Biosistemas, Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Mexico.
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31
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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: 26] [Impact Index Per Article: 2.9] [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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Abstract
Balamuthia mandrillaris is an emerging cause of encephalitis in humans. The transmission dynamics are poorly understood due to the high fatality rate and the sporadic nature of cases. Seventy-two soil samples were collected from beaches and the banks of lagoons, rivers, ponds, mineral springs and streams from across Jamaica and assayed for the presence of B. mandrillaris. Seventy-nine sites were sampled and the mitochondrial 16S rDNA gene of B. mandrillaris was amplified and sequenced to confirm the presence of the amoeba. One isolate of B. mandrillaris was recovered from soil from mineral spring which hosts an informal therapeutic mud bath business. Although B. mandrillaris is less frequently isolated from soil than other free-living amoebae, rubbing mud containing the organism onto the skin increases the likelihood of exposure and infection. This first report on the isolation of B. mandrillaris in the Caribbean and its presence in soil where human contact is likely warrants further investigation using serological methods to elucidate exposure patterns.
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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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Isolation and molecular characterization of Acanthamoeba and Balamuthia mandrillaris from combination shower units in Costa Rica. Parasitol Res 2014; 113:4117-22. [DOI: 10.1007/s00436-014-4083-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022]
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Pindyck TN, Dvorscak LE, Hart BL, Palestine MD, Gallant JE, Allen SE, SantaCruz KS. Fatal Granulomatous Amebic Encephalitis Due to Balamuthia mandrillaris in New Mexico: A Case Report. Open Forum Infect Dis 2014; 1:ofu062. [PMID: 25734132 PMCID: PMC4281802 DOI: 10.1093/ofid/ofu062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/11/2014] [Indexed: 11/13/2022] Open
Abstract
Balamuthia mandrillaris is a free-living amoeba that can cause granulomatous amebic encephalitis (GAE). We report a case in an individual with a history of alcohol abuse, cocaine use, and ditch water exposure. This is the first reported case of GAE due to B mandrillaris in New Mexico.
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Affiliation(s)
| | | | - Blaine L Hart
- Radiology , University of New Mexico Health Sciences Center , Albuquerque
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Lares-Jiménez LF, Booton GC, Lares-Villa F, Velázquez-Contreras CA, Fuerst PA. Genetic analysis among environmental strains of Balamuthia mandrillaris recovered from an artificial lagoon and from soil in Sonora, Mexico. Exp Parasitol 2014; 145 Suppl:S57-61. [PMID: 25076486 DOI: 10.1016/j.exppara.2014.07.007] [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: 12/17/2013] [Revised: 07/06/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
Since the first report of Balamuthia mandrillaris as a causative agent of granulomatous amoebic encephalitis in humans, the environmental niche of this amoeba was assumed to be restricted to soil and dust. A single isolation from water was recently made independently by us from Northern Mexico. Now we report the isolation of 8 new strains of B. mandrillaris from Mexico. This continues the pattern of an excess of isolates from North America, compared to other parts of the world. All of the new isolates are environmental isolates, 7 from water samples and one from soil. The identity of each isolate was confirmed by PCR and by examining the sequences of the mitochondrial 16S-like rRNA gene. Success in amplification was determined using comparisons of amplifications of DNA from the strain CDC: V039 and the water strain (ITSON-BM1) as positive controls. The DNA sequences of the new isolates were compared to older strains from clinical cases using phylogenetic analysis, showing very high sequence similarity. The similarity among the new isolates and with previous clinical and environmental isolates of B. mandrillaris was also examined using biochemical and immunological studies. High homogeneity of total protein products, and similarity in antigenic moiety among the eight new isolates and two controls was found. Taken together, the molecular and biochemical studies indicate very low levels of genetic variation within B. mandrillaris.
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Affiliation(s)
- Luis Fernando Lares-Jiménez
- Programa de Doctorado en Ciencias en Biotecnología, Instituto Tecnológico de Sonora, Ciudad Obregón, Son., Mexico.
| | - Gregory C Booton
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA.
| | - Fernando Lares-Villa
- Programa de Doctorado en Ciencias en Biotecnología, Instituto Tecnológico de Sonora, Ciudad Obregón, Son., Mexico; Departamento de Ciencias Agronómicas y Veterinarias, Instituto Tecnológico de Sonora, Ciudad Obregón, Son., Mexico.
| | | | - Paul A Fuerst
- Department of Molecular Genetics, The Ohio State University, Columbus, OH, USA; Department of Evolution, Ecology and Organismal Biology, The Ohio State University, Columbus, OH, USA.
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Baquero RA, Reyes-Batlle M, Nicola GG, Martín-Navarro CM, López-Arencibia A, Guillermo Esteban J, Valladares B, Martínez-Carretero E, Piñero JE, Lorenzo-Morales J. Presence of potentially pathogenic free-living amoebae strains from well water samples in Guinea-Bissau. Pathog Glob Health 2014; 108:206-11. [PMID: 24934796 DOI: 10.1179/2047773214y.0000000143] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Free-living amoebae (FLA) include opportunistic pathogens such as Naegleria fowleri, Balamuthia mandrillaris, and the genera Sappinia and Acanthamoeba. In this study, a survey was conducted in order to evaluate the presence of potentially pathogenic amoebic strains in water samples collected from wells located in the western part of Guinea-Bissau. The samples were left to precipitate for 48 hours and then the sediments were seeded on non-nutrient agar plates containing Escherichia coli spread and cultures were checked daily for the presence of FLA. Identification of FLA strains was based on the morphological and polymerase chain reaction (PCR) using the 18S rDNA or 16S mitochondrial rDNA genes in the case of Naegleria and Balamuthia genera, respectively. In the case of positive samples of Acanthamoeba, strains were further classified at the genotype level by sequencing the diagnostic fragment 3 (DF3) region located in the 18S rDNA gene as previously described. Sappinia sp. was not isolated during the study and thus, no molecular analysis was performed for this genus. The obtained results revealed the presence of Acanthamoeba (genotypes T3 and T4), Naegleria fowleri, and Balamuthia mandrillaris. To the best of our knowledge, this is the first report demonstrating the presence of FLA in water bodies from Guinea-Bissau and the first report on the isolation of Balamuthia mandrillaris from environmental sources in Africa.
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Cabello-Vílchez AM, Reyes-Batlle M, Montalbán-Sandoval E, Martín-Navarro CM, López-Arencibia A, Elias-Letts R, Guerra H, Gotuzzo E, Martínez-Carretero E, Piñero JE, Maciver SK, Valladares B, Lorenzo-Morales J. The isolation of Balamuthia mandrillaris from environmental sources from Peru. Parasitol Res 2014; 113:2509-13. [PMID: 24781021 DOI: 10.1007/s00436-014-3900-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/09/2014] [Indexed: 11/29/2022]
Abstract
Balamuthia mandrillaris is an opportunistic free-living amoeba that has been reported to cause skin lesions and the fatal Balamuthia amoebic encephalitis (BAE) in humans and other animals. Currently, around 200 human BAE cases have been reported worldwide, although this number is considered to be underestimated. The highest number of BAE cases has been reported in the American continent, mainly in the southwest of the USA. Peru seems to be another hotspot for BAE with around 55 human cases having been identified, usually involving cutaneous infection, especially lesions in the central face area. The isolation of Balamuthia from environmental sources has been reported on only three prior occasions, twice from Californian soils and once from dust in Iran and so it seems that this amoeba is relatively rarely encountered in samples from the environment. We investigated that possibility of finding the amoebae in soil samples from different regions where clinical cases have been reported in Peru. Twenty-one samples were cultured in non-nutrient agar plates and were checked for the presence of B. mandrillaris-like trophozoites and/or cysts. Those samples that were positive for these amoebae by microscopic criteria were then confirmed by PCR amplification and DNA sequencing of the mitochondrial 16S rDNA gene of B. mandrillaris. We have detected the presence of B. mandrillaris in four samples collected in the regions of Piura (3) and Lima (1) where infection cases have been previously reported. We hypothesize that B. mandrillaris is present in Peru in soil and dust which therefore constitutes a source of the infection for the BAE cases previously reported in this country. Further studies should be carried out in the area to confirm the generality of this finding.
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Affiliation(s)
- Alfonso Martín Cabello-Vílchez
- 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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