Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl

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. 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.

Antiamoebic Properties of Metabolites against Naegleria fowleri and Balamuthia mandrillaris

“…Balamuthia mandrillaris and Naegleria fowleri are two highly fatal, protozoan pathogens distributed widely in the environment [3,[26][27][28]. Furthermore, although these parasites are distributed globally, they favor warmer temperatures; hence, global warming is of concern [2,3].…”

Diagnosing Balamuthia mandrillaris amebic meningoencephalitis in a 64-year-old woman from the Southwest of China

“…However, a study on the soil gene search of B. mandrillaris demonstrated that this type of opportunistic ameba can spread to wider climatic areas, even in areas characterized by blizzards [11]. Consequently, during the last few years, several Asian regions, such as South Korea [12,13], Japan [11,14], Thailand [15][16][17], India [18], Iran [19], and China [20][21][22][23], have reported 64 cases of infection with B. mandrillaris, of which 32 were recently reported in 12 provinces in China. Patients infected Diagnosing Balamuthia mandrillaris amebic meningoencephalitis in a 64-year-old woman from the Southwest of China by B. mandrillaris can present symptoms of subacute to chronic cutaneous lesions or central nervous system (CNS) infection with granulomatous amebic encephalitis.…”

Molecular identification of Acanthamoeba genotypes isolated from oral cavity of heart transplant patients in Iran

“…In Iran, there is only one case report of Primary Amoebic Meningoencephalitis, seen in an infant, and also a case of Balamuthia mandrillaris Encephalitis in a 3‐year‐old girl. Other brain diseases related to FLA is not reported yet mainly due to unawareness of physicians and laboratory technicians 14,15 …”

“…Other brain diseases related to FLA is not reported yet mainly due to unawareness of physicians and laboratory technicians. 14,15 Several studies demonstrated DA, cerebral abscess, and cutaneous acanthamoeba infection in organ-transplant recipients such as patients with liver, hematopoietic stem cell, lung, and kidney transplant patients. [16][17][18][19] In 2007, the first reported case of DA was published by Barete et al in a 39-year-old heart transplant patient who was infected with Acanthamoeba T5 genotype.…”