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Tongkrajang N, Kobpornchai P, Dubey P, Chaisri U, Kulkeaw K. Modelling amoebic brain infection caused by Balamuthia mandrillaris using a human cerebral organoid. PLoS Negl Trop Dis 2024; 18:e0012274. [PMID: 38900784 PMCID: PMC11218984 DOI: 10.1371/journal.pntd.0012274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/02/2024] [Accepted: 06/06/2024] [Indexed: 06/22/2024] Open
Abstract
The lack of disease models adequately resembling human tissue has hindered our understanding of amoebic brain infection. Three-dimensional structured organoids provide a microenvironment similar to human tissue. This study demonstrates the use of cerebral organoids to model a rare brain infection caused by the highly lethal amoeba Balamuthia mandrillaris. Cerebral organoids were generated from human pluripotent stem cells and infected with clinically isolated B. mandrillaris trophozoites. Histological examination showed amoebic invasion and neuron damage following coculture with the trophozoites. The transcript profile suggested an alteration in neuron growth and a proinflammatory response. The release of intracellular proteins specific to neuronal bodies and astrocytes was detected at higher levels postinfection. The amoebicidal effect of the repurposed drug nitroxoline was examined using the human cerebral organoids. Overall, the use of human cerebral organoids was important for understanding the mechanism of amoeba pathogenicity, identify biomarkers for brain injury, and in the testing of a potential amoebicidal drug in a context similar to the human brain.
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Affiliation(s)
- Nongnat Tongkrajang
- Siriraj Integrative Center for Neglected Parasitic Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Porntida Kobpornchai
- Siriraj Integrative Center for Neglected Parasitic Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj-Long Read Lab, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pratima Dubey
- Siriraj Integrative Center for Neglected Parasitic Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Urai Chaisri
- Department of Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kasem Kulkeaw
- Siriraj Integrative Center for Neglected Parasitic Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj-Long Read Lab, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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2
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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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Sohn HJ, Park AY, Lee JH, Yun KH, Song KJ, Kim JH, Shin HJ. Amoebicidal effect of chlorine dioxide gas against pathogenic Naegleria fowleri and Acanthamoeba polyphaga. Parasitol Res 2024; 123:192. [PMID: 38652173 DOI: 10.1007/s00436-024-08215-z] [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: 02/19/2024] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
The pathogenic free-living amoebae, Naegleria fowleri and Acanthamoeba polyphaga, are found in freshwater, soil, and unchlorinated or minimally chlorinated swimming pools. N. fowleri and A. polyphaga are becoming problematic as water leisure activities and drinking water are sources of infection. Chlorine dioxide (ClO2) gas is a potent disinfectant that is relatively harmless to humans at the concentration used for disinfection. In this study, we examined the amoebicidal effects of ClO2 gas on N. fowleri and A. polyphaga. These amoebae were exposed to ClO2 gas from a ready-to-use product (0.36 ppmv/h) for 12, 24, 36, and 48 h. Microscopic examination showed that the viability of N. fowleri and A. polyphaga was effectively inhibited by treatment with ClO2 gas in a time-dependent manner. The growth of N. fowleri and A. polyphaga exposed to ClO2 gas for 36 h was completely inhibited. In both cases, the mRNA levels of their respective actin genes were significantly reduced following treatment with ClO2 gas. ClO2 gas has an amoebicidal effect on N. fowleri and A. polyphaga. Therefore, ClO2 gas has been proposed as an effective agent for the prevention and control of pathogenic free-living amoeba contamination.
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Affiliation(s)
- Hae-Jin Sohn
- Department of Microbiology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, 16499, Republic of Korea
| | - A-Young Park
- Department of Microbiology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Jeong-Heon Lee
- Department of Microbiology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, 16499, Republic of Korea
| | - Kyu-Hwa Yun
- Department of Biomedical Science, Graduate School of Ajou University, Suwon, 16499, Republic of Korea
| | - Kyoung-Ju Song
- Chunsu Mountain Medicinal Herb Research Association, Bundanggu, 13637, Republic of Korea
| | - Jong-Hyun Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea.
| | - Ho-Joon Shin
- Department of Microbiology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea.
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4
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Ono Y, Higashida K, Yamanouchi K, Nomura S, Hanamatsu Y, Saigo C, Tetsuka N, Shimohata T. Balamuthia mandrillaris amoebic encephalitis mimicking tuberculous meningitis. Neuropathology 2024; 44:68-75. [PMID: 37381626 DOI: 10.1111/neup.12932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
A 76-year-old female with no apparent immunosuppressive conditions and no history of exposure to freshwater and international travel presented with headache and nausea 3 weeks before the presentation. On admission, her consciousness was E4V4V6. Cerebrospinal fluid analysis showed pleocytosis with mononuclear cell predominance, elevated protein, and decreased glucose. Despite antibiotic and antiviral therapy, her consciousness and neck stiffness gradually worsened, right eye-movement restriction appeared, and the right direct light reflex became absent. Brain magnetic resonance imaging revealed hydrocephalus in the inferior horn of the left lateral ventricle and meningeal enhancement around the brainstem and cerebellum. Tuberculous meningitis was suspected, and pyrazinamide, ethambutol, rifampicin, isoniazid, and dexamethasone were started. In addition, endoscopic biopsy was performed from the white matter around the inferior horn of the left lateral ventricle to exclude brain tumor. A brain biopsy specimen revealed eosinophilic round cytoplasm with vacuoles around blood vessels, and we diagnosed with amoebic encephalitis. We started azithromycin, flucytosine, rifampicin, and fluconazole, but her symptoms did not improve. She died 42 days after admission. In autopsy, the brain had not retained its structure due to autolysis. Hematoxylin and eosin staining of her brain biopsy specimen showed numerous amoebic cysts in the perivascular brain tissue. Analysis of the 16S ribosomal RNA region of amoebas from brain biopsy and autopsy specimens revealed a sequence consistent with Balamuthia mandrillaris. Amoebic meningoencephalitis can present with features characteristic of tuberculous meningitis, such as cranial nerve palsies, hydrocephalus, and basal meningeal enhancement. Difficulties in diagnosing amoebic meningoencephalitis are attributed to the following factors: (1) excluding tuberculous meningitis by microbial testing is difficult, (2) amoebic meningoencephalitis has low incidence and can occur without obvious exposure history, (3) invasive brain biopsy is essential in diagnosing amoebic meningoencephalitis. We should recognize the possibility of amoebic meningoencephalitis when evidence of tuberculosis meningitis cannot be demonstrated.
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Affiliation(s)
- Yoya Ono
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Higashida
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kanako Yamanouchi
- Department of Bioscience and Laboratory Medicine, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan
| | - Shusuke Nomura
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuki Hanamatsu
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chiemi Saigo
- Department of Pathology and Translational Research, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuyuki Tetsuka
- Department of Infection Control, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
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Spottiswoode N, Haston JC, Hanners NW, Gruenberg K, Kim A, DeRisi JL, Wilson MR. Challenges and advances in the medical treatment of granulomatous amebic encephalitis. Ther Adv Infect Dis 2024; 11:20499361241228340. [PMID: 38312848 PMCID: PMC10838035 DOI: 10.1177/20499361241228340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
Granulomatous amebic encephalitis, caused by the free-living amebae Balamuthia mandrillaris or Acanthamoeba species, is a rare and deadly infectious syndrome with a current mortality rate of >90%. Much work remains to define the optimal treatment for these infections. Here, we provide a comprehensive overview of the supporting evidence behind antimicrobials currently recommended by the Centers for Disease Control and Prevention (CDC) with updated statistics on survival rates and medication usage from the CDC Free-Living Ameba Database. We also discuss promising treatments, especially the emerging therapeutic agent nitroxoline, and provide recommendations for the next steps in this area.
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Affiliation(s)
- Natasha Spottiswoode
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - Julia C. Haston
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha W. Hanners
- Division of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Katherine Gruenberg
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Annie Kim
- Department of Clinical Pharmacy, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub SF, San Francisco, CA, USA
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
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Atay Ünal N, Kuzucu P, Bedir Demirdağ T, Aykur M, Günsoy Kiliç Y, Güdeloğlu E, Polat M, Doğruman Al F, Kalkanci A, Börcek AÖ, Tapisiz A, Tezer H. 12-Year-old Boy With Fever, Headache and Vomiting. Pediatr Infect Dis J 2024; 43:88-90. [PMID: 38100735 DOI: 10.1097/inf.0000000000004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Affiliation(s)
- Nursel Atay Ünal
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Pelin Kuzucu
- Department of Neurosurgery Division of Pediatric Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Tuğba Bedir Demirdağ
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Mehmet Aykur
- Department of Parasitology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Yelda Günsoy Kiliç
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Elif Güdeloğlu
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Meltem Polat
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Funda Doğruman Al
- Department of Microbiology Division of Medical Parasitology, Gazi University School of Medicine, Ankara, Turkey
| | - Ayşe Kalkanci
- Department of Microbiology, Gazi University School of Medicine, Ankara, Turkey
| | - Alp Özgün Börcek
- Department of Neurosurgery Division of Pediatric Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Anil Tapisiz
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
| | - Hasan Tezer
- From the Department of Pediatric Infectious Disease, Gazi University School of Medicine, Ankara, Turkey
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Zheng J, Tan M, Chen J, Li C, Meng F, Wang L, Liao J. Diagnosis of cutaneous Balamuthia mandrillaris infection via next-generation sequencing in a Chinese woman. J Eur Acad Dermatol Venereol 2023; 37:e355-e357. [PMID: 36377799 DOI: 10.1111/jdv.18747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jiecheng Zheng
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Min Tan
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Jianhua Chen
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Chen Li
- Department of Dermatology, Zhongshan City People's Hospital, Zhongshan, China
| | - Fengjiao Meng
- Department of Pathology, Zhongshan City People's Hospital, Zhongshan, China
| | - Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military, Xi'an, China
| | - Jia Liao
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
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8
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Chen XT, Zhang Q, Wen SY, Chen FF, Zhou CQ. Pathogenic free-living amoebic encephalitis from 48 cases in China: A systematic review. Front Neurol 2023; 14:1100785. [PMID: 36846140 PMCID: PMC9947844 DOI: 10.3389/fneur.2023.1100785] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Background Free-living amoebae (FLA) including Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris can become pathogenic and cause severe cerebral infections, named primary amoebic meningoencephalitis (PAM), granulomatous amoebic encephalitis (GAE), and balamuthia amoebic encephalitis (BAE), respectively. FLA encephalitis has been reported across China, but the clinical data descriptions and analytical results of these different reports vary widely. Currently, no consensus treatment has been established. We conduct a systematic review to evaluate the exposure location, clinical symptoms, diagnosis, treatment, and prognosis of three FLA encephalitis and aim to reveal the differences between three FLA encephalitis in China. Methods We used MEDLINE (PubMed interface), EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang database, and China Biology Medicine disc (CBMdisc) databases for literatures published and manually retrieve the hospital records of our hospital. The search time was up to August 30, 2022, with no language restrictions. Results After excluding possible duplicate cases, a total of 48 patients of three FLA encephalitis were collected. One from the medical records of our hospital and 47 patients from 31 different studies. There were 11 patients of PAM, 10 patients of GAE, and 27 patients of BAE. The onset of PAM is mostly acute or subacute, and the clinical symptoms are acute and fulminant hemorrhagic meningoencephalitis. Most patients with GAE and BAE have an insidious onset and a chronic course. A total of 21 BAE patients (77.8%) had skin lesions before onset of symptoms. Additionally, 37 cases (77.1%) were diagnosed with FLA encephalitis before death. And there were 4 of PAM, 2 of GAE, and 10 of BAE diagnosed using next generation sequencing. No single agent can be proposed as the ideal therapy by itself. Only 6 cases were successfully treated. Conclusions This review provides an overview of the available data and studies of FLA encephalitis in China and identify some potential differences. FLA encephalitis is a rare but pathogenic infection, and physicians should early identify this encephalitis to improve survival.
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Affiliation(s)
| | | | | | | | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
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Martínez DY, Bravo-Cossio F, Valdivia-Tapia MDC, Carreazo NY, Cabello-Vilchez AM. Successful Treatment of Primary Amoebic Meningoencephalitis Using a Novel Therapeutic Regimen Including Miltefosine and Voriconazole. Acta Parasitol 2022; 67:1421-1424. [PMID: 35861895 DOI: 10.1007/s11686-022-00591-9] [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: 12/09/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
The genus Naegleria consists of free-living amoebae widely distributed worldwide in soil and freshwater habitats. Primary amoebic meningoencephalitis (PAM) is an uncommon and most likely fatal disease. The incubation period is approximately 7 days. The first symptoms are headache, nasal congestion, fever, vomiting, stiff neck within 3-4 days after the first symptoms, confusion, abnormal behavior, seizures, loss of balance and body control, coma, and death. We describe the case of a child who presented with PAM due to Naegleria sp., fully recovered from the infection without apparent sequels after treatment with a regimen that included miltefosine and voriconazole.
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Affiliation(s)
- Dalila Y Martínez
- Instituto de Medicina Tropical "Alexander Von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Cayetano Heredia, Lima, Perú
| | | | | | | | - Alfonso M Cabello-Vilchez
- Instituto de Medicina Tropical "Alexander Von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú.,Universidad Privada Norbert Wiener, Escuela de Tecnología Médica en Laboratorio Clínico y Anatomía Patológica, Lima, Perú
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Pengsart W, Tongkrajang N, Whangviboonkij N, Sarasombath PT, Kulkeaw K. Balamuthia mandrillaris trophozoites ingest human neuronal cells via a trogocytosis-independent mechanism. Parasit Vectors 2022; 15:232. [PMID: 35761411 PMCID: PMC9235117 DOI: 10.1186/s13071-022-05306-7] [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: 03/08/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Environmental protozoa need an adaptation mechanism to survive drastic changes in niches in the human body. In the brain parenchyma, Balamuthia mandrillaris trophozoites, which are causative agents of fatal brain damage, must acquire nutrients through the ingestion of surrounding cells. However, the mechanism deployed by the trophozoites for cellular uptake remains unknown. METHODS Amoebic ingestion of human neural cell components was investigated using a coculture system of clinically isolated B. mandrillaris trophozoites and human neuroblastoma SH-SY5Y cells. Cell-to-cell interactions were visualized in a three-dimensional manner using confocal and holotomographic microscopes. RESULTS The B. mandrillaris trophozoites first attached themselves to human neuroblastoma SH-SY5Y cells and then twisted themselves around the cytoplasmic bridge. Based on fluorescence-based cell tracking, the B. mandrillaris trophozoites then inserted invadopodia into the cytoplasm of the human cells. Subsequently, the human protein-enriched components were internalized into the trophozoites in the form of nonmembranous granules, whereas the human lipids were dispersed in the cytoplasm. Intervention of trogocytosis, a process involving nibbling on parts of the target cells, failed to inhibit this cellular uptake. CONCLUSIONS Human cell ingestion by B. mandrillaris trophozoites likely differs from trogocytosis, suggesting that a pathogen-specific strategy can be used to ameliorate brain damage.
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Affiliation(s)
- Worakamol Pengsart
- Faculty of Graduate Studies, Mahidol University, Nakhon Pathom, Thailand
| | - Nongnat Tongkrajang
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, 7th floor Adulyadejvikrom Building, 2 Wang Lang Road, Khwaeng Siriraj, Khet Bangkok-noi, Bangkok, 10700, Thailand
| | - Narisara Whangviboonkij
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, 7th floor Adulyadejvikrom Building, 2 Wang Lang Road, Khwaeng Siriraj, Khet Bangkok-noi, Bangkok, 10700, Thailand
| | - Patsharaporn Techasintana Sarasombath
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, 7th floor Adulyadejvikrom Building, 2 Wang Lang Road, Khwaeng Siriraj, Khet Bangkok-noi, Bangkok, 10700, Thailand
| | - Kasem Kulkeaw
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, 7th floor Adulyadejvikrom Building, 2 Wang Lang Road, Khwaeng Siriraj, Khet Bangkok-noi, Bangkok, 10700, Thailand.
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11
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Seas C, Legua P. Meningoencephalitis Due to Free-Living Amoebas in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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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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13
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Kim JY, Yi MH, Kim M, Yeom JS, Yoo HD, Kim SM, Yong TS. Diagnosis of Balamuthia mandrillaris Encephalitis by Thymine-Adenine Cloning Using Universal Eukaryotic Primers. Ann Lab Med 2022; 42:196-202. [PMID: 34635613 PMCID: PMC8548236 DOI: 10.3343/alm.2022.42.2.196] [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: 01/10/2021] [Revised: 03/07/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Identifying the causal pathogen of encephalitis remains a clinical challenge. A 50-year-old man without a history of neurological disease was referred to our department for the evaluation of an intracranial lesion observed on brain magnetic resonance imaging (MRI) scans, and the pathology results suggested protozoal infection. We identified the species responsible for encephalitis using thymine–adenine (TA) cloning, suitable for routine clinical practice. Methods We extracted DNA from a paraffin-embedded brain biopsy sample and performed TA cloning using two universal eukaryotic primers targeting the V4-5 and V9 regions of the 18S rRNA gene. The recombinant plasmids were extracted, and the inserted amplicons were identified by Sanger sequencing and a homology search of sequences in the National Center for Biotechnology Information Basic Local Alignment Search Tool. Results The infection was confirmed to be caused by the free-living amoeba Balamuthia mandrillaris. Two of 41 colonies recombinant with 18S V4-5 primers and 35 of 63 colonies recombinant with the 18S V9 primer contained B. mandrillaris genes; all other colonies contained human genes. Pathogen-specific PCR ruled out Entamoeba histolytica, Naegleria fowleri, Acanthamoeba spp., and Toxoplasma gondii infections. Conclusions This is the first report of B. mandrillaris-induced encephalitis in Korea based on molecular identification. TA cloning with the 18S rRNA gene is a feasible and affordable diagnostic tool for the detection of infectious agents of unknown etiology.
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Affiliation(s)
- Ju Yeong Kim
- Department of Environmental Medical Biology, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Hee Yi
- Department of Environmental Medical Biology, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Myungjun Kim
- Department of Environmental Medical Biology, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Dong Yoo
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Daejeon, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
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14
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Alvarez P, Torres-Cabala C, Gotuzzo E, Bravo F. Cutaneous balamuthiasis: A clinicopathological study. JAAD Int 2022; 6:51-58. [PMID: 35059659 PMCID: PMC8760460 DOI: 10.1016/j.jdin.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Patricia Alvarez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Correspondence to: Patricia Alvarez, MD, Patologia cutánea, Av. Angamos Oeste 896, Miraflores Lima, Peru.
| | - Carlos Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Francisco Bravo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Cayetano Heredia, Lima, Peru
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15
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Maehara T, Mizuno T, Tokoro M, Hara T, Tomita Y, Makioka K, Motegi SI, Yamazaki A, Matsumura N, Nobusawa S, Yokoo H. An autopsy case of granulomatous amebic encephalitis caused by Balamuthia mandrillaris involving prior amebic dermatitis. Neuropathology 2022; 42:190-196. [PMID: 35165936 PMCID: PMC9546287 DOI: 10.1111/neup.12798] [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: 09/28/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
An 82‐year‐old man, who was healthy and had worked as a farmer, experienced worsening neurological symptoms over a seven‐month period, which eventually caused his death. Multiple fluctuating brain lesions were detected radiographically. Clinically, sarcoidosis was ranked high among the differential diagnoses because of the presence of skin lesions showing granulomatous inflammation, confirmed by biopsy. The patient's cerebrospinal fluid was also examined, but no definitive diagnosis was made while he was alive. An autopsy revealed multiple granulomatous amebic encephalitis lesions in the brain. Genetic and immunohistochemical analyses identified Balamuthia (B.) mandrillaris, a free‐living ameba, which resides in soil and fresh water, as the causative organism. A retrospective examination revealed B. mandrillaris in the biopsied skin as well as cerebrospinal fluid, strongly suggesting that the ameba had spread into the brain percutaneously. Few studies have detailed the cutaneous pathology of B. mandrillaris infections. In general, granulomatous amebic encephalitis is extremely difficult to diagnose without autopsy, but the present case provides a clue that could allow similar cases to be diagnosed earlier; that is, the presence of skin lesions.
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Affiliation(s)
- Tatsuro Maehara
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsushi Mizuno
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaharu Tokoro
- Department of Global Infectious Diseases, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tatsuru Hara
- Department of Parasitology, Kurume University School of Medicine, Kurume, Japan
| | - Yui Tomita
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kouki Makioka
- Department of Neurology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ayako Yamazaki
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Nozomi Matsumura
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
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16
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Successful Treatment of a Balamuthia mandrillaris Cerebral Abscess in a Pediatric Patient With Complete Surgical Resection and Antimicrobial Therapy. Pediatr Infect Dis J 2022; 41:e54-e57. [PMID: 34862343 DOI: 10.1097/inf.0000000000003418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral amebic encephalitis due to Balamuthia mandrillaris is a rare yet typically fatal disease. As such, identification of the clinical characteristics, appropriate diagnostic workup and commencement of treatment is frequently delayed. Here, we present a case of a 4-year-old male with a B. mandrillaris cerebral abscess successfully treated with expedited neurosurgical resection and broad-spectrum antimicrobial therapy.
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17
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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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18
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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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19
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Mani V, Hudgins E. Balamuthia mandrillaris encephalitis in an uncontrolled diabetic patient. IDCases 2021; 25:e01174. [PMID: 34189033 PMCID: PMC8217696 DOI: 10.1016/j.idcr.2021.e01174] [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: 05/01/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
Balamuthia mandrillaris is a free-living amoeba that may result in a disseminated infection of the central nervous system called granulomatous amoebic encephalitis. We present a case of balamuthiasis in a Hispanic male with poorly controlled type 2 diabetes mellitus (hemoglobin A1C of 12.2 %) who did not have access to healthcare. He initially presented with the non-specific symptoms of blurry vision, headache and imbalance which rapidly progressed to altered mental status over two months. Imaging revealed multiple peripherally enhancing lesions throughout the cerebellum and cortical regions which corresponded to the patient's deficits. Brain biopsy showed amoebic forms consistent with Balamuthia mandrillaris and later confirmed with cerebrospinal fluid PCR. Our patient was treated with a combination of various antimicrobials, including azithromycin, fluconazole, flucytosine, sulfadiazine, and miltefosine. Unfortunately, his prognosis continued to worsen and he ultimately died after being placed on comfort care.
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Affiliation(s)
- Valli Mani
- Drexel University College of Medicine, United States
- Corresponding author.
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20
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Abstract
Infections caused by Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris result in a variety of clinical manifestations in humans. These amoebae are found in water and soil worldwide. Acanthamoeba spp. and B. mandrillaris cause granulomatous amoebic encephalitis, which usually presents as a mass, while N. fowleri causes primary amoebic meningoencephalitis. Acanthamoeba spp. can also cause keratitis, and both Acanthamoeba spp. and B. mandrillaris can cause lesions in skin and respiratory mucosa. These amoebae can be difficult to diagnose clinically as these infections are rare and, if not suspected, can be misdiagnosed with other more common diseases. Microscopy continues to be the key first step in diagnosis but the amoeba can be confused with macrophages or other infectious agents if an expert in infectious disease pathology or clinical microbiology is not consulted. Although molecular methods can be helpful in establishing the diagnosis, these are only available in referral centers. Treatment requires combination of antibiotics and antifungals and, even with prompt diagnosis and treatment, mortality for neurological disease is extremely high.
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21
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Lee JY, Yu IK, Kim SM, Kim JH, Kim HY. Fulminant Disseminating Fatal Granulomatous Amebic Encephalitis: The First Case Report in an Immunocompetent Patient in South Korea. Yonsei Med J 2021; 62:563-567. [PMID: 34027644 PMCID: PMC8149926 DOI: 10.3349/ymj.2021.62.6.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022] Open
Abstract
Central nervous system infections caused by free-living amoeba are very rare, but often fatal. The typical image findings of amebic meningoencephalitis are non-specific, showing ring-like enhancement. We report the first case of fulminant disseminating fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris in an immunocompetent patient in South Korea. Our case exhibited two interesting features: one was the unusual clinical course and the other was additional image findings. Magnetic resonance imaging revealed a rim-enhancing lesion with intralesional blooming dark signal intensity on susceptibility weighted imaging and low signal intensity on diffusion weighted images and on apparent diffusion coefficient maps. Differential diagnosis was started from a tumor or non-tumorous lesion, and diagnosis was difficult due to the rarity of the disease. Following the clinical and diagnostic courses of our case, we recommend inspecting image findings of granulomatous amebic encephalitis for early diagnosis.
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Affiliation(s)
- Ju Yeon Lee
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - In Kyu Yu
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
| | - Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ha Youn Kim
- Department of Radiology, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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22
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Alli A, Ortiz JF, Morillo Cox Á, Armas M, Orellana VA. Miltefosine: A Miracle Drug for Meningoencephalitis Caused by Free-Living Amoebas. Cureus 2021; 13:e13698. [PMID: 33833918 PMCID: PMC8020194 DOI: 10.7759/cureus.13698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
Meningoencephalitis caused by free-living amoebas (FLA) has a high mortality rate, and most treatments are ineffective. FLA includes Naegleria, Fowleri, Acanthamoeba, and Balamuthia mandrillaris (M). We explore the use of miltefosine in the treatment of one of these infections. The concerning mortality of the infection obligates us to look for more effective treatments for meningoencephalitis caused by FLA. During this review, we will consolidate the knowledge of using miltefosine in these three infections. We will investigate the mechanism by which the drug is effective in these infections as well. After this comprehensive review, we should assess if miltefosine improves the mortality and prognosis of the infection with the information collected. We used a Medical Subject Headings (MeSH) search on PubMed. Inclusion criteria included papers written in the English language and human subjects research for the past 25 years. Until today, there are no definitive guidelines to be followed when treating such patients. However, miltefosine has demonstrated promising results. Miltefosine decreases the usual mortality rate in the three infections; however, there are few reports due to the low frequency of these infections. Almost all cases we documented have survived. More information needs to be gathered for the use of miltefosine for these infections.
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Affiliation(s)
- Ammar Alli
- Internal Medicine, Tishreen University Faculty of Medicine, Lattakia, SYR
- Internal Medicine, Universitat de Barcelona, Barcelona, ESP
| | - Juan Fernando Ortiz
- Neurology, Universidad San Francisco de Quito, Quito, ECU
- Neurology, Larkin Community Hospital, Miami, USA
| | | | - Maria Armas
- Surgery, Pontificia Universidad Catolica del Ecuador, Quito, ECU
| | - Victor A Orellana
- Obstetrics and Gynecology, Pontifica Universidad Católica del Ecuador, Quito, ECU
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23
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[First case report of the Balamuthia mandrillaris in the Camaná district of Arequipa, Peru]. Rev Argent Microbiol 2020; 53:129-134. [PMID: 33012571 DOI: 10.1016/j.ram.2020.05.002] [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: 09/30/2019] [Revised: 04/11/2020] [Accepted: 05/25/2020] [Indexed: 11/21/2022] Open
Abstract
Infections by free-living amoebas cause cutaneous and neurological compromise. These conditions have a low frequency, but a high lethality more than 98%. Generally, the clinical picture is nonspecific; the laboratory tests dońt help, so it represents a diagnostic and therapeutic challenge. In this report, we present the case of a 21-year-old patient, who was hospitalized for a convulsive syndrome with brain tumors, in addition to a cutaneous lesion on the right thigh. Histopathological analysis, PCR and the clinical picture allowed the diagnosis of granulomatous amebic encephalitis. Despite the treatment, the patient had a fatal outcome.
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24
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Cope JR, Landa J, Nethercut H, Collier SA, Glaser C, Moser M, Puttagunta R, Yoder JS, Ali IK, Roy SL. The Epidemiology and Clinical Features of Balamuthia mandrillaris Disease in the United States, 1974-2016. Clin Infect Dis 2020; 68:1815-1822. [PMID: 30239654 DOI: 10.1093/cid/ciy813] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Balamuthia mandrillaris is a free-living ameba that causes rare, nearly always fatal disease in humans and animals worldwide. B. mandrillaris has been isolated from soil, dust, and water. Initial entry of Balamuthia into the body is likely via the skin or lungs. To date, only individual case reports and small case series have been published. METHODS The Centers for Disease Control and Prevention (CDC) maintains a free-living ameba (FLA) registry and laboratory. To be entered into the registry, a Balamuthia case must be laboratory-confirmed. Several sources were used to complete entries in the registry, including case report forms, CDC laboratory results, published case reports, and media information. SAS© version 9.3 software was used to calculate descriptive statistics and frequencies. RESULTS We identified 109 case reports of Balamuthia disease between 1974 and 2016. Most (99%) had encephalitis. The median age was 36 years (range 4 months to 91 years). Males accounted for 68% of the case patients. California had the highest number of case reports, followed by Texas and Arizona. Hispanics constituted 55% for those with documented ethnicity. Exposure to soil was commonly reported. Among those with a known outcome, 90% of patients died. CONCLUSIONS Balamuthia disease in the United States is characterized by a highly fatal encephalitis that affects patients of all ages. Hispanics were disproportionately affected. The southwest region of the United States reported the most cases. Clinician awareness of Balamuthia as a cause of encephalitis might lead to earlier diagnosis and initiation of treatment, resulting in better outcomes.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet Landa
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,James A. Ferguson Emerging Infectious Diseases Fellowship Program, Baltimore, Maryland
| | - Hannah Nethercut
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Tennessee
| | - Sarah A Collier
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Melanie Moser
- Office of Financial Resources, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raghuveer Puttagunta
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ibne K Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon L Roy
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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25
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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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26
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Drug Discovery against Acanthamoeba Infections: Present Knowledge and Unmet Needs. Pathogens 2020; 9:pathogens9050405. [PMID: 32456110 PMCID: PMC7281112 DOI: 10.3390/pathogens9050405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/12/2022] Open
Abstract
Although major strides have been made in developing and testing various anti-acanthamoebic drugs, recurrent infections, inadequate treatment outcomes, health complications, and side effects associated with the use of currently available drugs necessitate the development of more effective and safe therapeutic regimens. For any new anti-acanthamoebic drugs to be more effective, they must have either superior potency and safety or at least comparable potency and an improved safety profile compared to the existing drugs. The development of the so-called 'next-generation' anti-acanthamoebic agents to address this challenge is an active area of research. Here, we review the current status of anti-acanthamoebic drugs and discuss recent progress in identifying novel pharmacological targets and new approaches, such as drug repurposing, development of small interfering RNA (siRNA)-based therapies and testing natural products and their derivatives. Some of the discussed approaches have the potential to change the therapeutic landscape of Acanthamoeba infections.
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27
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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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Bravo FG. Emerging infections: mimickers of common patterns seen in dermatopathology. Mod Pathol 2020; 33:118-127. [PMID: 31685961 DOI: 10.1038/s41379-019-0399-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/09/2022]
Abstract
The following discussion deals with three emerging infection diseases that any dermatopathologist working in the northern hemisphere can come across. The first subject to be dealt with is gnathostomiasis. This parasitic disease is produced by the third larvarial stage of the parasite that in most patients is associated with the ingestion of raw fish. Epidemiologically, it is most commonly seen in South East Asia, Japan, China, and the American continent, mainly in Mexico, Ecuador, and Peru. Nowadays, the disease is also seen in travelers living in the developed countries who recently came back from visiting endemic countries. The disease produces a pattern of migratory panniculitis or dermatitis with infiltration of eosinophils in tissue. The requirements for making the diagnosis are provided, including clinical forms, common histological findings on skin biopsy as well as the use of ancillary testing. Buruli ulcer, a prevalent mycobacterial infection in Africa, is described from the clinical and histopathological point of view. The disease has been described occasionally in Central and South America as well as in developed countries such as Australia and Japan; Buruli ulcer has also been described in travelers returning from endemic areas. Clinically, the disease is characterized by large, painless ulcerations with undermined borders. Systemic symptoms are usually absent. Classical histological findings include a particular type of fat necrosis and the presence of abundant acid fast bacilli in tissue. Such findings should raise the possibility of this disease, with the purpose of early therapeutically intervention. Lastly, the infection by free living ameba Balamuthia mandrillaris, an emerging condition seen in the US and Peru, is extensively discussed. Special attention is given to clinical and histological characteristics, as well as to the clues for early diagnosis and the tools available for confirmation.
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Affiliation(s)
- Francisco G Bravo
- Universidad Peruana Cayetano Heredia, Hospital Cayetano Heredia, Lima, Peru.
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Mungroo MR, Anwar A, Khan NA, Siddiqui R. Brain-eating Amoebae Infection: Challenges and Opportunities in Chemotherapy. Mini Rev Med Chem 2019; 19:980-987. [PMID: 30868950 DOI: 10.2174/1389557519666190313161854] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/01/2019] [Accepted: 03/07/2019] [Indexed: 12/22/2022]
Abstract
Pathogenic free-living amoeba are known to cause a devastating infection of the central nervous system and are often referred to as "brain-eating amoebae". The mortality rate of more than 90% and free-living nature of these amoebae is a cause for concern. It is distressing that the mortality rate has remained the same over the past few decades, highlighting the lack of interest by the pharmaceutical industry. With the threat of global warming and increased outdoor activities of public, there is a need for renewed interest in identifying potential anti-amoebic compounds for successful prognosis. Here, we discuss the available chemotherapeutic options and opportunities for potential strategies in the treatment and diagnosis of these life-threatening infections.
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Affiliation(s)
- Mohammad Ridwane Mungroo
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Ayaz Anwar
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Naveed Ahmed Khan
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
| | - Ruqaiyyah Siddiqui
- Department of Biological Sciences, School of Science and Technology, Sunway University, Subang Jaya 47500, Selangor, Malaysia
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30
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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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Functional Assessment of 2,177 U.S. and International Drugs Identifies the Quinoline Nitroxoline as a Potent Amoebicidal Agent against the Pathogen Balamuthia mandrillaris. mBio 2018; 9:mBio.02051-18. [PMID: 30377287 PMCID: PMC6212833 DOI: 10.1128/mbio.02051-18] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Balamuthia mandrillaris is responsible for hundreds of reported cases of amoebic encephalitis, the majority of which have been fatal. Despite being an exceptionally deadly pathogen, B. mandrillaris is understudied, leaving many open questions regarding epidemiology, diagnosis, and treatment. Due to the lack of effective drugs to fight B. mandrillaris infections, mortality rates remain high even for patients receiving intensive care. This report addresses the need for new treatment options through a drug repurposing screen to identify novel B. mandrillaris inhibitors. The most promising candidate identified was the quinoline antibiotic nitroxoline, which has a long history of safe use in humans. We show that nitroxoline kills B. mandrillaris at pharmacologically relevant concentrations and exhibits greater potency and selectivity than drugs commonly used in the current standard of care. The findings that we present demonstrate the potential of nitroxoline to be an important new tool in the treatment of life-threatening B. mandrillaris infections. Balamuthia mandrillaris is a pathogenic free-living amoeba that causes a rare but almost always fatal infection of the central nervous system called granulomatous amoebic encephalitis (GAE). Two distinct forms of B. mandrillaris—a proliferative trophozoite form and a nonproliferative cyst form, which is highly resistant to harsh physical and chemical conditions—have been isolated from environmental samples worldwide and are both observed in infected tissue. Patients suffering from GAE are typically treated with aggressive and prolonged multidrug regimens that often include the antimicrobial agents miltefosine and pentamidine isethionate. However, survival rates remain low, and studies evaluating the susceptibility of B. mandrillaris to these compounds and other potential therapeutics are limited. To address the need for more-effective treatments, we screened 2,177 clinically approved compounds for in vitro activity against B. mandrillaris. The quinoline antibiotic nitroxoline (8-hydroxy-5-nitroquinoline), which has safely been used in humans to treat urinary tract infections, was identified as a lead compound. We show that nitroxoline inhibits both trophozoites and cysts at low micromolar concentrations, which are within a pharmacologically relevant range. We compared the in vitro efficacy of nitroxoline to that of drugs currently used in the standard of care for GAE and found that nitroxoline is the most potent and selective inhibitor of B. mandrillaris tested. Furthermore, we demonstrate that nitroxoline prevents B. mandrillaris-mediated destruction of host cells in cultured fibroblast and primary brain explant models also at pharmacologically relevant concentrations. Taken together, our findings indicate that nitroxoline is a promising candidate for repurposing as a novel treatment of B. mandrillaris infections.
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32
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Shehab KW, Aboul-Nasr K, Elliott SP. Balamuthia mandrillaris Granulomatous Amebic Encephalitis With Renal Dissemination in a Previously Healthy Child: Case Report and Review of the Pediatric Literature. J Pediatric Infect Dis Soc 2018; 7:e163-e168. [PMID: 29096002 DOI: 10.1093/jpids/pix089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 09/22/2017] [Indexed: 11/14/2022]
Abstract
Balamuthia mandrillaris is a recently described ameba known to cause a subacute to chronic central nervous system infection called granulomatous amebic encephalitis. Evidence suggests that apparently immunocompetent persons are at risk for disease and show a similar nonspecific presentation to that of immunodeficient persons. However, evidence of hematogenous dissemination, which has been found in immunodeficient patients, has been lacking in immunocompetent patients. Here, we describe a previously healthy patient with B mandrillaris-associated granulomatous amebic encephalitis in whom both central nervous system and renal disease were found during autopsy, which suggests hematogenous dissemination. We also provide a comprehensive review of the pediatric literature on this disease and its clinical presentation in children.
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Affiliation(s)
- Kareem W Shehab
- Department of Pathology, University of Arizona College of Medicine, Tucson
| | - Khalid Aboul-Nasr
- Department of Pathology, University of Arizona College of Medicine, Tucson
| | - Sean P Elliott
- Department of Pediatrics, University of Arizona College of Medicine, Tucson
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33
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Takei K, Toyoshima M, Nakamura M, Sato M, Shimizu H, Inoue C, Shimizu Y, Yagita K. An Acute Case of Granulomatous Amoebic Encephalitis-Balamuthia mandrillaris Infection. Intern Med 2018; 57:1313-1316. [PMID: 29321406 PMCID: PMC5980817 DOI: 10.2169/internalmedicine.0011-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old woman who exhibited drowsiness was referred to our hospital. Enhanced head magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions and lesions showing partial mild hemorrhaging. The patient gradually progressed to a comatose condition with notable brain deterioration of unknown cause on follow-up MRI. On day nine, the patient inexplicably died, although brain herniation was suspected. Autopsy and histopathology revealed numerous amoebic trophozoites in the perivascular spaces and within the necrotic tissue. Brain immunostaining tested positive for Balamuthia mandrillaris. Infection due to free-living amoeba is rare in Japan; however, it may increase in the near future due to unknown reasons.
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Affiliation(s)
| | | | | | | | | | - Chihiro Inoue
- Department of Pathology, Tohoku University School of Medicine, Japan
| | - Yoshio Shimizu
- Department of Pathology, Tohoku University School of Medicine, Japan
| | - Kenji Yagita
- Department of Parasitology, National Institute of Infectious Diseases, Japan
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34
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Cope JR, Yoder JS, Visvesvara GS. Protozoa. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00193-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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36
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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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37
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Lukies MW, Watanabe Y, Maeda T, Kusakabe S, Arita H, Tomiyama N. Amoebic encephalitis: case report and literature review of neuroimaging findings. BJR Case Rep 2016; 2:20150499. [PMID: 30459996 PMCID: PMC6243338 DOI: 10.1259/bjrcr.20150499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/07/2016] [Accepted: 02/12/2016] [Indexed: 11/05/2022] Open
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38
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Chang OH, Liu F, Knopp E, Muehlenbachs A, Cope JR, Ali I, Thompson R, George E. Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection. J Cutan Pathol 2016; 43:892-7. [PMID: 27251900 DOI: 10.1111/cup.12748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022]
Abstract
Free-living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life-threatening central nervous system (CNS) involvement. We report a case of a 91-year-old woman, who presented with a non-healing red plaque over her right cheek. Several punch biopsies exhibited non-specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin-eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.
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Affiliation(s)
- Oliver H Chang
- Department of Anatomic Pathology, University of Washington, Seattle, WA, USA.
| | - Fan Liu
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Eleanor Knopp
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA.,Group Health Capitol Hill Campus, Seattle, WA, USA
| | - Atis Muehlenbachs
- Infectious Diseases Pathology Branch Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer R Cope
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ibne Ali
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Evan George
- Department of Anatomic Pathology, University of Washington, Seattle, WA, USA
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39
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Vollmer ME, Glaser C. A Balamuthia survivor. JMM Case Rep 2016; 3:e005031. [PMID: 28348755 PMCID: PMC5330223 DOI: 10.1099/jmmcr.0.005031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/26/2016] [Accepted: 03/14/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: This case report describes a human survivor of Balamuthia mandrillaris infection. This is a free-living amoeba that can cause infection with the devastating consequence of near universally fatal encephalitis. We report this case to demonstrate the possibility of recovery. Case presentation: A 26-year-old Hispanic male, a landscape gardener, presented to the hospital in March 2010 with a two month history of headache, visual disturbances and new-onset seizures. Brain imaging identified two enhancing central lesions and Balamuthia mandrillaris was later identified by brain biopsy. He received several months of various antimicrobials including miltefosine, a novel use of the drug in this disease at the time. Seven weeks into therapy, considerations were made to switch him to ‘comfort care’ because of worsening clinical status and seemingly lack of response to treatment. The patient finally demonstrated clinical and radiological improvement after eight weeks with modified therapy, despite experiencing some debilitating toxic effects likely to be related to antibiotics. Two years after his initial presentation he made a complete recovery. Conclusion: Balamuthia mandrillaris amoebic encephalitis is considered an almost universally fatal disease; this case demonstrates the possibility of recovery. This report outlines his treatment, drug toxicities and includes additional information regarding the therapeutic use of the drug miltefosine. Whether his survival is related to the specific antimicrobials used in this case is unknown and further investigation is warranted.
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Affiliation(s)
- Michael Eric Vollmer
- Infectious Disease Doctors Medical Group, 365 Lennon Lane Suite 200 , Walnut Creek, CA 94598 , USA
| | - Carol Glaser
- The Permanente Medical Group, Oakland Medical Center , 3505 Broadway St, Oakland, CA 94611 , USA
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40
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Farnon EC, Kokko KE, Budge PJ, Mbaeyi C, Lutterloh EC, Qvarnstrom Y, da Silva AJ, Shieh WJ, Roy SL, Paddock CD, Sriram R, Zaki SR, Visvesvara GS, Kuehnert MJ. Transmission ofBalamuthia mandrillarisby Organ Transplantation. Clin Infect Dis 2016; 63:878-888. [DOI: 10.1093/cid/ciw422] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/14/2016] [Indexed: 11/13/2022] Open
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41
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Balamuthia mandrillaris en el Perú, lesiones cutáneas, meningoencefalitis y métodos de cultivo. INFECTIO 2016. [DOI: 10.1016/j.infect.2015.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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42
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Cope JR, Conrad DA, Cohen N, Cotilla M, DaSilva A, Jackson J, Visvesvara GS. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. Clin Infect Dis 2016; 62:774-6. [PMID: 26679626 PMCID: PMC4775347 DOI: 10.1093/cid/civ1021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine.
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Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Alexandre DaSilva
- Centers for Disease Control and Prevention, Atlanta, Georgia US Food and Drug Administration, Laurel, Maryland
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Greninger AL, Messacar K, Dunnebacke T, Naccache SN, Federman S, Bouquet J, Mirsky D, Nomura Y, Yagi S, Glaser C, Vollmer M, Press CA, Kleinschmidt-DeMasters BK, Klenschmidt-DeMasters BK, Dominguez SR, Chiu CY. Clinical metagenomic identification of Balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing. Genome Med 2015; 7:113. [PMID: 26620704 PMCID: PMC4665321 DOI: 10.1186/s13073-015-0235-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023] Open
Abstract
Background Primary amoebic meningoencephalitis (PAM) is a rare, often lethal, cause of encephalitis, for which early diagnosis and prompt initiation of combination antimicrobials may improve clinical outcomes. Methods In this study, we sequenced a full draft assembly of the Balamuthia mandrillaris genome (44.2 Mb in size) from a rare survivor of PAM, and recovered the mitochondrial genome from six additional Balamuthia strains. We also used unbiased metagenomic next-generation sequencing (NGS) and SURPI bioinformatics analysis to diagnose an ultimately fatal case of Balamuthia mandrillaris encephalitis in a 15-year-old girl. Results and Discussion Comparative analysis of the mitochondrial genome and high-copy number genes from six additional Balamuthia mandrillaris strains demonstrated remarkable sequence variation, and the closest Balamuthia homologs corresponded to other amoebae, hydroids, algae, slime molds, and peat moss. Real-time NGS testing of hospital day 6 CSF and brain biopsy samples detected Balamuthia on the basis of high-quality hits to 16S and 18S ribosomal RNA sequences present in the National Center for Biotechnology Information (NCBI) nt reference database. The presumptive diagnosis of PAM by visualization of amoebae on brain biopsy histopathology and NGS analysis was subsequently confirmed at the US Centers for Disease Control and Prevention (CDC) using a Balamuthia-specific PCR assay. Retrospective analysis of a day 1 CSF sample revealed that more timely identification of Balamuthia by metagenomic NGS, potentially resulting in a better clinical outcome, would have required availability of the complete genome sequence. Conclusions These results underscore the diverse evolutionary origins of Balamuthia mandrillaris, provide new targets for diagnostic assay development, and will facilitate further investigations of the biology and pathogenesis of this eukaryotic pathogen. The failure to identify PAM from a day 1 sample without a fully sequenced Balamuthia genome in the database highlights the critical importance of whole-genome reference sequences for microbial detection by metagenomic NGS. Electronic supplementary material The online version of this article (doi:10.1186/s13073-015-0235-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander L Greninger
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Kevin Messacar
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Samia N Naccache
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Scot Federman
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - Jerome Bouquet
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA.,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA
| | - David Mirsky
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Yosuke Nomura
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shigeo Yagi
- California Department of Public Health, Richmond, CA, USA
| | | | | | - Craig A Press
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Samuel R Dominguez
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, 185 Berry Street, Box 0134, San Francisco, CA, 94107, USA. .,UCSF-Abbott Viral Diagnostics and Discovery Center, San Francisco, CA, 91407, USA. .,Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, 94107, USA.
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44
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Capewell LG, Harris AM, Yoder JS, Cope JR, Eddy BA, Roy SL, Visvesvara GS, Fox LM, Beach MJ. Diagnosis, Clinical Course, and Treatment of Primary Amoebic Meningoencephalitis in the United States, 1937-2013. J Pediatric Infect Dis Soc 2015; 4:e68-75. [PMID: 26582886 DOI: 10.1093/jpids/piu103] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/22/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND Primary amoebic meningoencephalitis (PAM) is a rapidly progressing waterborne illness that predominately affects children and is nearly always fatal. PAM is caused by Naegleria fowleri, a free-living amoeba found in bodies of warm freshwater worldwide. METHODS We reviewed exposure location, clinical signs and symptoms, diagnostic modalities, and treatment from confirmed cases of PAM diagnosed in the United States during 1937-2013. Patients were categorized into the early (ie, flu-like symptoms) or late (ie, central nervous system signs) group on the basis of presenting clinical characteristics. Here, we describe characteristics of the survivors and decedents. RESULT The median age of the patients was 12 years (83% aged ≤18 years); males (76%) were predominately affected (N = 142). Most infections occurred in southern-tier states; however, 4 recent infections were acquired in northern states: Minnesota (2), Kansas (1), and Indiana (1). Most (72%) of the patients presented with central nervous system involvement. Cerebrospinal fluid analysis resembled bacterial meningitis with high opening pressures, elevated white blood cell counts with predominantly neutrophils (median, 2400 cells/μL [range, 5-26 000 cells/μL]), low glucose levels (median, 23 mg/dL [range, 1-92 mg/dL]), and elevated protein levels (median, 365 mg/dL [range, 24-1210 mg/dL]). Amoebas found in the cerebrospinal fluid were diagnostic, but PAM was diagnosed for only 27% of the patients before death. Imaging results were abnormal in approximately three-fourths of the patients but were not diagnostic for amoebic infection. Three patients in the United States survived. CONCLUSIONS To our knowledge, this is the first comprehensive clinical case series of PAM presented in the United States. PAM is a fatal illness with limited treatment success and is expanding into more northern regions. Clinicians who suspect that they have a patient with PAM should contact the US Centers for Disease Control and Prevention at 770-488-7100 (available 24 hours/day, 7 days/week) to discuss diagnostic testing and treatment options (see cdc.gov/naegleria).
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Affiliation(s)
- Linda G Capewell
- Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - Aaron M Harris
- Epidemic Intelligence Service Program, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services
| | - Jonathan S Yoder
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - Jennifer R Cope
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - Brittany A Eddy
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - Sharon L Roy
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - Govinda S Visvesvara
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
| | - LeAnne M Fox
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J Beach
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases
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45
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Roy SL, Atkins JT, Gennuso R, Kofos D, Sriram RR, Dorlo TPC, Hayes T, Qvarnstrom Y, Kucerova Z, Guglielmo BJ, Visvesvara GS. Assessment of blood-brain barrier penetration of miltefosine used to treat a fatal case of granulomatous amebic encephalitis possibly caused by an unusual Balamuthia mandrillaris strain. Parasitol Res 2015; 114:4431-9. [PMID: 26329128 DOI: 10.1007/s00436-015-4684-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022]
Abstract
Balamuthia mandrillaris, a free-living ameba, causes rare but frequently fatal granulomatous amebic encephalitis (GAE). Few patients have survived after receiving experimental drug combinations, with or without brain lesion excisions. Some GAE survivors have been treated with a multi-drug regimen including miltefosine, an investigational anti-leishmanial agent with in vitro amebacidal activity. Miltefosine dosing for GAE has been based on leishmaniasis dosing because no data exist in humans concerning its pharmacologic distribution in the central nervous system. We describe results of limited cerebrospinal fluid (CSF) and serum drug level testing performed during clinical management of a child with fatal GAE who was treated with a multiple drug regimen including miltefosine. Brain biopsy specimens, CSF, and sera were tested for B. mandrillaris using multiple techniques, including culture, real-time polymerase chain reaction, immunohistochemical techniques, and serology. CSF and serum miltefosine levels were determined using a liquid chromatography method coupled to tandem mass spectrometry. The CSF miltefosine concentration on hospital admission day 12 was 0.4 μg/mL. The serum miltefosine concentration on day 37, about 80 h post-miltefosine treatment, was 15.3 μg/mL. These are the first results confirming some blood-brain barrier penetration by miltefosine in a human, although with low-level CSF accumulation. Further evaluation of brain parenchyma penetration is required to determine optimal miltefosine dosing for Balamuthia GAE, balanced with the drug's toxicity profile. Additionally, the Balamuthia isolate was evaluated by real-time polymerase chain reaction (PCR), demonstrating genetic variability in 18S ribosomal RNA (18S rRNA) sequences and possibly signaling the first identification of multiple Balamuthia strains with varying pathogenicities.
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Affiliation(s)
- Sharon L Roy
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Jane T Atkins
- Methodist Children's Hospital, San Antonio, TX, 78229, USA
| | | | - Danny Kofos
- Methodist Children's Hospital, San Antonio, TX, 78229, USA
| | - Rama R Sriram
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Thomas P C Dorlo
- Department of Pharmacy and Pharmacology, Slotervaart Hospital-The Netherlands Cancer Institute, 1066 EC, Amsterdam, The Netherlands.,Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, Utrecht, The Netherlands
| | - Teresa Hayes
- Department of Pathology, Methodist Hospital, San Antonio, TX, 78229, USA
| | - Yvonne Qvarnstrom
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Zuzana Kucerova
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - B Joseph Guglielmo
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Govinda S Visvesvara
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
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46
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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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47
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Disseminated Balamuthia mandrillaris Infection. J Clin Microbiol 2015; 53:3072-6. [PMID: 26135864 DOI: 10.1128/jcm.01549-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022] Open
Abstract
Balamuthia mandrillaris is a rare cause of human infection, but when infections do occur, they result in high rates of morbidity and mortality. A case of disseminated Balamuthia infection is presented. Early diagnosis and initiation of recommended therapy are essential for increased chances of successful outcomes.
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48
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Linam WM, Ahmed M, Cope JR, Chu C, Visvesvara GS, da Silva AJ, Qvarnstrom Y, Green J. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics 2015; 135:e744-8. [PMID: 25667249 PMCID: PMC4634363 DOI: 10.1542/peds.2014-2292] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury.
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Affiliation(s)
- W. Matthew Linam
- Pediatric Infectious Diseases Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Mubbasheer Ahmed
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Jennifer R. Cope
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Craig Chu
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | | | | | - Yvonne Qvarnstrom
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jerril Green
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
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49
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Dowell JD, Mukherjee S, Raghavan P, Rehm PK. AIDS Presenting as Granulomatous Amebic Encephalitis: PET and MR Imaging correlation. J Neuroimaging 2015; 25:1047-9. [PMID: 25678445 DOI: 10.1111/jon.12212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 11/24/2014] [Accepted: 12/10/2014] [Indexed: 11/28/2022] Open
Abstract
Granulomatous amebic encephalitis (GAE) is a rare and oftentimes fatal disease in immune compromised patients caused by free living amebae Acanthamoeba and Balamuthia. We report a patient in whom GAE secondary to Acanthamoeba was the initial presentation of acquired immunodeficiency syndrome in a 41-year-old male, and discuss the FDG positron emission tomography (PET) and magnetic resonance imaging findings that preceded the pathological diagnosis. The PET results provided complementary information when coupled with the MR brain findings. Improved understanding of the clinical and imaging findings of this deadly disease is the best hope for early diagnosis and treatment of this uncommon but deadly disease.
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Affiliation(s)
- Joshua D Dowell
- Department of Radiology, Ohio State University Medical Center, Columbus, OH
| | - Sugoto Mukherjee
- Department of Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | | | - Patrice K Rehm
- Department of Radiology & Medical Imaging, University of Virginia Health System, Charlottesville, VA
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50
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Gupte AA, Hocevar SN, Lea AS, Kulkarni RD, Schain DC, Casey MJ, Zendejas-Ruiz IR, Chung WK, Mbaeyi C, Roy SL, Visvesvara GS, da Silva AJ, Tallaj J, Eckhoff D, Baddley JW. Transmission of Balamuthia mandrillaris through solid organ transplantation: utility of organ recipient serology to guide clinical management. Am J Transplant 2014; 14:1417-24. [PMID: 24840013 PMCID: PMC4642815 DOI: 10.1111/ajt.12726] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/06/2014] [Accepted: 02/24/2014] [Indexed: 01/25/2023]
Abstract
A liver, heart, iliac vessel and two kidneys were recovered from a 39-year-old man who died of traumatic head injury and were transplanted into five recipients. The liver recipient 18 days posttransplantation presented with headache, ataxia and fever, followed by rapid neurologic decline and death. Diagnosis of granulomatous amebic encephalitis was made on autopsy. Balamuthia mandrillaris infection was confirmed with immunohistochemical and polymerase chain reaction (PCR) assays. Donor and recipients' sera were tested for B. mandrillaris antibodies. Donor brain was negative for Balamuthia by immunohistochemistry and PCR; donor serum Balamuthia antibody titer was positive (1:64). Antibody titers in all recipients were positive (range, 1:64-1:512). Recipients received a four- to five-drug combination of miltefosine or pentamidine, azithromycin, albendazole, sulfadiazine and fluconazole. Nausea, vomiting, elevated liver transaminases and renal insufficiency were common. All other recipients survived and have remained asymptomatic 24 months posttransplant. This is the third donor-derived Balamuthia infection cluster described in solid organ transplant recipients in the United States. As Balamuthia serologic testing is only available through a national reference laboratory, it is not feasible for donor screening, but may be useful to determine exposure status in recipients and to help guide chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Won K. Chung
- University of Texas Medical Branch at Galveston, TX
| | | | - Sharon L. Roy
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | - Jose Tallaj
- University of Alabama at Birmingham, Birmingham, AL
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