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Rahmati-Holasoo H, Niyyati M, Fatemi M, Mahdavi Abhari F, Shokrpoor S, Nassiri A, Marandi A. Molecular identification, phylogenetic analysis and histopathological study of pathogenic free-living amoebae isolated from discus fish (Symphysodon aequifasciatus) in Iran: 2020-2022. BMC Vet Res 2024; 20:54. [PMID: 38347572 PMCID: PMC10860241 DOI: 10.1186/s12917-024-03902-6] [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: 11/14/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
Free-living amoebae (FLA) are capable of inhabiting diverse reservoirs independently, without relying on a host organism, hence their designation as "free-living". The majority of amoebae that infect freshwater or marine fish are amphizoic, or free-living forms that may colonize fish under particular circumstances. Symphysodon aequifasciatus, commonly referred to as the discus, is widely recognized as a popular ornamental fish species. The primary objective of the present study was to determine the presence of pathogenic free-living amoebae (FLA) in samples of discus fish. Fish exhibiting clinical signs, sourced from various fish farms, were transferred to the ornamental fish clinic. The skin, gills, and intestinal mucosa of the fish were collected and subjected to culturing on plates containing a 1% non-nutrient agar medium. The detection of FLA was conducted through morphological, histopathological and molecular methods. The construction of the phylogenetic tree for Acanthamoeba genotypes was achieved using the maximum likelihood approach. The molecular sequence analysis revealed that all cultures that tested positive for FLA were T4 genotype of Acanthamoeba and Acanthamoeba sp. The examination of gill samples using histopathological methods demonstrated the presence of lamellar epithelial hyperplasia, significant fusion of secondary lamellae, and infiltration of inflammatory cells. A multitude of cysts, varying in shape from circular to elliptical, were observed within the gills. The occurrence of interlamellar vesicles and amoeboid organisms could be observed within the epithelial tissue of the gills. In the current study, presence of the Acanthamoeba T4 genotype on the skin and gills of discus fish exhibiting signs of illness in freshwater ornamental fish farms was identified. This observation suggests the potential of a transmission of amoebic infection from ornamental fish to humans, thereby highlighting the need for further investigation into this infection among ornamental fish maintained as pets, as well as individuals who interact with them and their environment.
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Affiliation(s)
- Hooman Rahmati-Holasoo
- Department of Aquatic Animal Health, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Maryam Niyyati
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Marziye Fatemi
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mahdavi Abhari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Shokrpoor
- Department of Pathology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
| | - Alireza Nassiri
- Department of Aquatic Animal Health, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Amin Marandi
- Department of Aquatic Animal Health, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Yao S, Chen X, Qian L, Sun S, Zhao C, Bai Z, Chen Z, Wu Y. Diagnosing Balamuthia mandrillaris amebic meningoencephalitis in a 64-year-old woman from the Southwest of China. PARASITES, HOSTS AND DISEASES 2023; 61:183-193. [PMID: 37258265 DOI: 10.3347/phd.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 06/02/2023]
Abstract
Balamuthia mandrillaris amebic encephalitis (BAE) can cause a fatal condition if diagnosis is delayed or effective treatment is lacking. Patients with BAE have been previously reported in 12 provinces of China, with skin lesions being the primary symptom and encephalitis developing after several years. However, a significantly lower number of cases has been reported in Southwest China. Here we report an aggressive BAE case of a 64-year-old woman farmer with a history of skin lesions on her left hand. She was admitted to our hospital due to symptoms of dizziness, headache, cough, vomiting, and gait instability. She was initially diagnosed with syphilitic meningoencephalitis and received a variety of empirical treatment that failed to improve her symptoms. Finally, she was diagnosed with BAE combined with amebic pneumonia using next-generation sequencing (NGS), qRT-PCR, sequence analysis, and imaging studies. She died approximately 3 weeks after the onset. This case highlights that the rapid development of encephalitis can be a prominent clinical manifestation of Balamuthia mandrillaris infection.
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Affiliation(s)
- Suhua Yao
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
- The Third Affiliated Hospital of Dali University, Dali, Yunnan province, China
| | - Xiaoting Chen
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Lian Qian
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Shizheng Sun
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Chunjing Zhao
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Zongkai Bai
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Zhaofang Chen
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Youcong Wu
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
- Key Laboratory of Medical Molecular Virology (MOE/NHC), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
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Fan X, Chen T, Yang H, Gao Y, Chen Y. Encephalomyelomeningitis Caused by Balamuthia mandrillaris: A Case Report and Literature Review. Infect Drug Resist 2023; 16:727-733. [PMID: 36756612 PMCID: PMC9901442 DOI: 10.2147/idr.s400692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023] Open
Abstract
Central nervous system infection by Balamuthia mandrillaris is a rare and severe condition, which has a fatality rate of approximately 95% and often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Here, we report a case of encephalomyelomeningitis caused by B. mandrillaris in a male who presented with transient coma, nausea, and vomiting when working in a garbage dump. Initial magnetic resonance imaging (MRI) of the brain showed normal signals. Despite receiving steroids as well as antibacterial and antiviral treatment, he developed urinary and fecal dysfunction, inability to walk, and deterioration of consciousness. Both brain and spinal cord MRI revealed abnormal findings, and next-generation sequencing of the cerebrospinal fluid showed the presence of B. mandrillaris. A combination of fluconazole and albendazole was administered; however, the patient deteriorated gradually and died 30 days after the onset. We suggest the unbiased metagenomic sequencing of the affected tissues/CSF in patients with CNS infections that are difficult to diagnose or treat, and multiple tests at different stages of the disease may be required.
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Affiliation(s)
- XueMei Fan
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - TianWen Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Yang
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yue Gao
- Department of General Practice, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Yue Gao, Tel +86 13706511908; +86 531-56006851, Email
| | - Yan Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Correspondence: Yan Chen, Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261, Huan Sha Road, Shangcheng District, Hangzhou, People’s Republic of China, Tel +86 15397086693; +86 531-56006952, Email
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Distribution and Current State of Molecular Genetic Characterization in Pathogenic Free-Living Amoebae. Pathogens 2022; 11:pathogens11101199. [PMID: 36297255 PMCID: PMC9612019 DOI: 10.3390/pathogens11101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Abstract
Free-living amoebae (FLA) are protozoa widely distributed in the environment, found in a great diversity of terrestrial biomes. Some genera of FLA are linked to human infections. The genus Acanthamoeba is currently classified into 23 genotypes (T1-T23), and of these some (T1, T2, T4, T5, T10, T12, and T18) are known to be capable of causing granulomatous amoebic encephalitis (GAE) mainly in immunocompromised patients while other genotypes (T2, T3, T4, T5, T6, T10, T11, T12, and T15) cause Acanthamoeba keratitis mainly in otherwise healthy patients. Meanwhile, Naegleria fowleri is the causative agent of an acute infection called primary amoebic meningoencephalitis (PAM), while Balamuthia mandrillaris, like some Acanthamoeba genotypes, causes GAE, differing from the latter in the description of numerous cases in patients immunocompetent. Finally, other FLA related to the pathologies mentioned above have been reported; Sappinia sp. is responsible for one case of amoebic encephalitis; Vermamoeba vermiformis has been found in cases of ocular damage, and its extraordinary capacity as endocytobiont for microorganisms of public health importance such as Legionella pneumophila, Bacillus anthracis, and Pseudomonas aeruginosa, among others. This review addressed issues related to epidemiology, updating their geographic distribution and cases reported in recent years for pathogenic FLA.
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Xu C, Wu X, Tan M, Wang D, Wang S, Wu Y. Subacute Balamuthia mandrillaris encephalitis in an immunocompetent patient diagnosed by next-generation sequencing. J Int Med Res 2022; 50:3000605221093217. [PMID: 35505464 PMCID: PMC9073125 DOI: 10.1177/03000605221093217] [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] [Indexed: 11/15/2022] Open
Abstract
Balamuthia mandrillaris is a free-living heterotrophic amoeba found in soil that causes a rare and usually fatal granulomatous amebic encephalitis. We report an immunocompetent patient infected with B. mandrillaris encephalitis diagnosed by next-generation sequencing (NGS). Clinical manifestations included sudden headache and epilepsy with disturbance of consciousness. The opening pressure of cerebrospinal fluid (CSF) was 220 mmH2O, with mildly elevated white blood cell numbers and elevated protein levels. Cranial magnetic resonance imaging revealed abnormal signals in the right frontal lobe, left parietal lobe, and left occipital lobe. CSF NGS detected B. mandrillaris. Albendazole and metronidazole combined with fluconazole were administered to the patient immediately, but his condition deteriorated and he eventually died. Encephalitis caused by B. mandrillaris is rare and has a high mortality rate. Clinical manifestations are complex and diverse, but early diagnosis is very important for successful treatment. This can be aided by the metagenomic NGS of CSF.
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Affiliation(s)
- Changbo Xu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyan Wu
- Department of Neurology, Zengcheng District People's Hospital of Guangzhou, Guangdong, China
| | - Miaoqin Tan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dongmei Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shengnan Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongming Wu
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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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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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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Wang L, Cheng W, Li B, Jian Z, Qi X, Sun D, Gao J, Lu X, Yang Y, Lin K, Lu C, Chen J, Li C, Wang G, Gao T. Balamuthia mandrillaris infection in China: a retrospective report of 28 cases. Emerg Microbes Infect 2021; 9:2348-2357. [PMID: 33048025 PMCID: PMC7599003 DOI: 10.1080/22221751.2020.1835447] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Balamuthia mandrillaris infection is a rare and fatal disease. We have recorded 28 cases of Balamuthia mandrillaris infection during the past 20 years. Eighteen patients (64%) were male and 10 (36%) were female. Patient age ranged from 3 to 74 (mean, 27) years. Patient locations were distributed among 12 Provinces in China. Twenty-seven (96%) patients lived in rural areas, and 17 (61%) patients reported a history of trauma before the appearance of skin lesions. All cases presented with skin lesions as the primary symptom, and 16 (57%) cases developed encephalitis. Histopathology of skin lesions revealed granulomatous changes with histiocytes, lymphocytes, and plasma cells infiltration. Amebas were identified in all cases with immunohistochemical staining. Follow-up information was available in 27 (96%) cases. Fifteen (56%) patients died due to encephalitis and 12 (44%) were free of disease after treatment. Our results show that the clinical characteristics of Balamuthia mandrillaris infection in China are very different from those in the US. Infection of traumatized skin may play an important role in the pathogenesis of the disease in China. Encephalitis usually develops 3–4 years after skin lesions in Chinese cases. Patients with only skin lesions have a higher cure rate than patients with encephalitis.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Wenjing Cheng
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Bing Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Zhe Jian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Xianlong Qi
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Dongjie Sun
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Jian Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Xuetao Lu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Yi Yang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Kun Lin
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Chuanlong Lu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Jiaxi Chen
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, People's Republic of China
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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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Safavi M, Mehrtash V, Habibi Z, Mohammadpour M, Haghi Ashtiani MT, Sotoudeh Anvari M, Zaresharifi N, Shafizadeh M, Jafarzadeh B. Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl. Am J Trop Med Hyg 2021; 104:1836-1840. [PMID: 33720845 PMCID: PMC8103465 DOI: 10.4269/ajtmh.20-1257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 11/07/2022] Open
Abstract
It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.
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Affiliation(s)
- Moeinadin Safavi
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;,Address correspondence to Moeinadin Safavi or Vahid Mehrtash, Pathology Department, Children’s Medical Center, No. 62, Dr Gharib St., Tehran 1419733151, Iran. E-mails: or
| | - Vahid Mehrtash
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;,Address correspondence to Moeinadin Safavi or Vahid Mehrtash, Pathology Department, Children’s Medical Center, No. 62, Dr Gharib St., Tehran 1419733151, Iran. E-mails: or
| | - Zohreh Habibi
- Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mohammadpour
- Pediatric Intensive Care Division, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Sotoudeh Anvari
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Zaresharifi
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Shafizadeh
- Neurosurgery Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Jafarzadeh
- Pathology Department, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Aoki R, Sakakima T, Ohashi A, Niwa R, Matsuyama M, Etori F, Watanabe N, Yagita K, Tanaka T. A Japanese case of amoebic meningoencephalitis initially diagnosed by cerebrospinal fluid cytology. Clin Case Rep 2020; 8:1728-1734. [PMID: 32983486 PMCID: PMC7495867 DOI: 10.1002/ccr3.2953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Microscopy can detect the presence of amoebic trophozoites in cerebrospinal fluid and tissue. The infection was confirmed in the present case by polymerase chain reaction and immunohistochemistry, but we were unable to achieve a cure. Our case rapidly progressed without any skin lesions.
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Affiliation(s)
- Ryogo Aoki
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | | | - Asuka Ohashi
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | - Riyoko Niwa
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | - Masashi Matsuyama
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | - Fumimasa Etori
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | - Naoki Watanabe
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
| | - Kenji Yagita
- Department of ParasitologyNational Institute of Infectious DiseasesTokyoJapan
| | - Takuji Tanaka
- Department of Diagnostic Pathology (DDP) & Research Center of Diagnostic Pathology (RC-DiP)Gifu Municipal HospitalGifuJapan
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12
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Kangussu-Marcolino MM, Ehrenkaufer GM, Chen E, Debnath A, Singh U. Identification of plicamycin, TG02, panobinostat, lestaurtinib, and GDC-0084 as promising compounds for the treatment of central nervous system infections caused by the free-living amebae Naegleria, Acanthamoeba and Balamuthia. Int J Parasitol Drugs Drug Resist 2019; 11:80-94. [PMID: 31707263 PMCID: PMC6849155 DOI: 10.1016/j.ijpddr.2019.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 01/11/2023]
Abstract
The free-living amebae Naegleria, Acanthamoeba, and Balamuthia cause rare but life-threatening infections. All three parasites can cause meningoencephalitis. Acanthamoeba can also cause chronic keratitis and both Balamuthia and Acanthamoeba can cause skin and systemic infections. There are minimal drug development pipelines for these pathogens despite a lack of available treatment regimens and high fatality rates. To identify anti-amebic drugs, we screened 159 compounds from a high-value repurposed library against trophozoites of the three amebae. Our efforts identified 38 compounds with activity against at least one ameba. Multiple drugs that bind the ATP-binding pocket of mTOR and PI3K are active, highlighting these compounds as important inhibitors of these parasites. Importantly, 24 active compounds have progressed at least to phase II clinical studies and overall 15 compounds were active against all three amebae. Based on central nervous system (CNS) penetration or exceptional potency against one amebic species, we identified sixteen priority compounds for the treatment of meningoencephalitis caused by these pathogens. The top five compounds are (i) plicamycin, active against all three free-living amebae and previously U.S. Food and Drug Administration (FDA) approved, (ii) TG02, active against all three amebae, (iii and iv) FDA-approved panobinostat and FDA orphan drug lestaurtinib, both highly potent against Naegleria, and (v) GDC-0084, a CNS penetrant mTOR inhibitor, active against at least two of the three amebae. These results set the stage for further investigation of these clinically advanced compounds for treatment of infections caused by the free-living amebae, including treatment of the highly fatal meningoencephalitis.
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Affiliation(s)
- Monica M Kangussu-Marcolino
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Gretchen M Ehrenkaufer
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Emily Chen
- uHTS Laboratory Rm 101, 11119 N Torrey Pines Rd. Calibr, A Division of the Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Upinder Singh
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Grant Building, S-143, 300 Pasteur Drive, Stanford, CA, 94305, USA; Department of Microbiology and Immunology, Stanford University, Stanford, CA, 94305, USA.
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