Encephalitis due to a free-living amoeba (Balamuthia mandrillaris): Case report with literature review

Deol, Inderjit; Robledo, Laura; Meza, Armando; Visvesvara, Govinda S.; Andrews, Russell J.

doi:10.1016/s0090-3019(00)00232-9

Cited by 68 publications

(41 citation statements)

References 20 publications

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“…A review of the literature suggests that cases involving males are more prevalent. [3][4][5][6][7][8][9][10][11][12][13][14][15] Characteristic symptoms of GAE include fever, headaches, nausea, seizures, and other focal neurologic indicators, such as brain lesions. B. mandrillaris usually is found within localized areas of the brain and clustered around blood vessels.…”

Section: Introductionmentioning

confidence: 99%

“…Infections also have caused skin lesions, and in a few cases amebae have been found in the kidneys and lungs. 4,10,[13][14][15]17,18 Hemorrhaging of organs in many clinical cases provides evidence that B. mandrillaris had been present in these locations even when amebae were not isolated from the tissue samples. Eventually, patients die of a massive central nervous system infection.…”

Section: Introductionmentioning

confidence: 99%

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GENOTYPING OF BALAMUTHIA MANDRILLARIS BASED ON NUCLEAR 18S AND MITOCHONDRIAL 16S rRNA GENES

Booton¹,

Carmichael²,

Visvesvara³

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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Abstract. Balamuthia mandrillaris is an opportunistically pathogenic ameba that causes fatal granulomatous amebic encephalitis (GAE) in vertebrates. Previous phylogenetic analyses that included the sequence of a single nuclear small subunit ribosomal RNA gene (18S or ssu rDNA) from this ameba suggested that Balamuthia is closely related to Acanthamoeba, another opportunistically pathogenic amebic genus, which includes multiple ssu rDNA genotypes. We tested whether this also is true for Balamuthia. The nuclear ssu rDNA from 4 isolates and the mitochondrial ssu rDNA from 7 isolates of B. mandrillaris have been sequenced. No variation in the nuclear rDNA sequences and low levels of variation in the mitochondrial rDNA were found. Both gene sequences were consistent with a single genotype for B. mandrillaris. The mitochondrial sequences of B. mandrillaris are unique and should be useful for development of genus-specific diagnostic probes for use with clinical, environmental, and archived specimens.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

GENOTYPING OF BALAMUTHIA MANDRILLARIS BASED ON NUCLEAR 18S AND MITOCHONDRIAL 16S rRNA GENES

Booton¹,

Carmichael²,

Visvesvara³

et al. 2003

The American Journal of Tropical Medicine and Hygiene

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“…The other amoebae, i.e. Balamuthia mandrillaris [4][5][6][7][8][9][10] and Acanthamoeba cause granulomatous amoebic encephalitis (GAE), which is a more subacute or chronic infection. The presentation of GAE can mimic a brain abscess, aseptic or chronic meningitis or CNS malignancy.…”

Section: Commentarymentioning

confidence: 99%

Granulomatous Amoebic Meningoencephalitis: A Diagnostic Dilemma

Vyas¹,

Sakhuja²,

Radotra³

et al. 2013

Journal of Postgraduate Medicine, Education and Research

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An 18-year-old male presented with headache since 30 days, right upper limb weakness and slurring of speech since 20 days and altered sensorium since 5 days. The headache was holocranial, persistent throughout the day, continuous, severe and associated with vomiting. The right-sided hemiparesis was acute in onset and gradually progressive, started with slurring of speech and right upper limb weakness which progressed over 10 days to involve the right leg. He could not recognize his relatives, eat or speak. On general physical examination, he was drowsy (E4 M5 V1), pulse was 64/minute, BP: 114/70 mm Hg and respiratory rate was 24/min. Central nervous system (CNS) examination revealed neck rigidity, right UMN 7th nerve palsy, spasticity in all four limbs (right > left) and plantars were bilateral and equivocal. The hemoglobin was 16 gm%, TLC was 29 × 10 3 with 90% polymorphs and the platelets were normal.Blood biochemistry revealed a serum creatinine of 2.4 mg%, blood urea of 133 mg%, serum bilirubin of 1.3 mg%, OT: 829, PT: 587, alkaline phosphatase: 123, albumin: 2.5 gm% and globulin: 1.6 gm%. The CSF done outside revealed 27 cells (25 lymphocytes); glucose: 72; protein: 65; ADA: 2.17. The CSF done in PGI revealed 20 cells (all lymphocytes); glucose: 71; protein: 130; cryptococcal Ag negative, culture negative, TB-PCR negative. CT brain done revealed gyri in left parietal lobe to appear bulky and hyperdense forming a focal lesion measuring 3.1 × 2.9 cm with surrounding white matter edema and postcontrast enhancement with central hypodensity. This was effacing the ipsilateral lateral ventricle, causing a midline shift of 3 mm to the right side. A similar lesion was seen in right parafalcine right frontal lobe measuring 1.3 × 0.8 cm. Leptomeningeal enhancement was seen in left frontoparietal temporal region. The impression was focal cerebritis with leptomeningitis in above described regions. MRI brain ( Fig. 7) revealed multiple ill-defined heterogeneous intra-axial mass lesions seen in the left cerebellum, bilateral frontoparietal, left temporal and left occipital lobes. These lesions were appearing hypointense with faint hyperintensity within it on T1 and predominantly hyperintense on FLAIR/T2-weighted images. These lesions were showing blooming on SWI suggestive of hemorrhage within the lesions. On postcontrast scans, these lesions showed mild enhancement. Moderate perilesional white matter edema was seen around these lesions with lesion in left frontoparietal lobe producing mass effect seen as partial effacement of the left lateral ventricle with midline shift of about 5 mm. One of the mass is also involving the corpus callosum. A diagnosis of septic emboli/ tubercular meningitis was considered. He was managed with vancomycin and ceftriaxone. He was on antitubercular treatment since 24th Dec 2012, which was continued. He was also given antiedema measures with steroids. However, he did not improve and had further worsening of sensorium and expired on 5th Jan 2013. The unit's diagnosis was multiple space occupyi...

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“…With the exception of Entamoeba histolytica which may possibly cause brain, lung and liver abscess from a primary focus on the large intestine, pathogenic amoeba species such as Acanthamoeba spp., Naegleria folweri and Balamunthia mandrillaris can cause central nervous system disability called primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) (1,2). According to some studies, Acanthamoeba species can be classified based on their structure (3).…”

Section: Introductionmentioning

confidence: 99%

Soil Contamination With Free-Living Amoeba in North of Iran

et al. 2016

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Background: Free-living amoebas are very abundant in nature, especially in water and soil. Some species of amoebas cause serious and sometimes fatal infections such a keratitis in people with normal and suppressed immune systems. Based on the prevalence of amoebic keratitis in Iran, it is important to consider the free-living amoeba. Objectives: The current study aimed to determine the presence of Acanthamoeba and Hartmannella spp. in soil samples of Sari, North of Iran. Patients and Methods: A total of 96 soil samples from three areas of Sari were collected to be examined for soil contamination with Acanthamoeba and Hartmannella spp. Soil samples were investigated for the presence of these parasites by Sheather's flotation technique and Gimsa staining method. The identification of Acanthamoeba and Hartmannella spp. at the genus level in this study was based on distinctive features of double walled cysts. Results: Of the 96 studied samples, from different environmental locations in Sari, 38 (39.6%) Acanthamoeba and 5 (5.2%) Hartmannella species were identified. Conclusions:The results of the present study revealed that soil resources of these areas were contaminated with opportunistic amoebas such as Acanthamoeba and Hartmannella spp. and this may lead to severe diseases in high-risk people, such as immunocompromised patients.

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Encephalitis due to a free-living amoeba (Balamuthia mandrillaris): Case report with literature review

Cited by 68 publications

References 20 publications

GENOTYPING OF BALAMUTHIA MANDRILLARIS BASED ON NUCLEAR 18S AND MITOCHONDRIAL 16S rRNA GENES

GENOTYPING OF BALAMUTHIA MANDRILLARIS BASED ON NUCLEAR 18S AND MITOCHONDRIAL 16S rRNA GENES

Granulomatous Amoebic Meningoencephalitis: A Diagnostic Dilemma

Soil Contamination With Free-Living Amoeba in North of Iran

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