Balamuthia mandrillaris infection in China: a retrospective report of 28 cases

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.

Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic

“…Moreover, COVID-19 patients were clearly characterized by elevated d -dimer levels on admission in the present study, reflecting enhanced COVID-19 related thrombogenicity [ 19 – 22 ]. Although the increased thrombotic susceptibility in COVID-19 patients are far beyond the scope of this study, prior studies underlined that higher thrombotic burden in the acute phase of COVID-19 relies on pro-inflammatory cytokine/chemokine release [ 23 ], increased endothelial dysfunction/damage, and potential sepsis induced coagulopathy development in severe cases, all promoting coagulation activation. A recent observational study including 115 STEMI patients clarified that COVID-19 patients had an elevated d -dimer levels as well as higher thrombotic burden compared to non-COVID patients [ 24 ].…”

Cutaneous balamuthiasis: A clinicopathological study

“…[1][2][3]22 Epidemiologically, B. mandrillaris infection is reported mainly in the Americas, with few cases reported in other countries such as Japan, Thailand, Australia, Czech Republic, Portugal, and China. 6,[23][24][25][26][27][28][29][30][31] To date, approximately 200 cases of granulomatous meningitis by B. mandrillaris have been reported. This may underestimate the real incidence of the disease, considering the lack of pathognomonic findings, the difficulty in recognizing amoebas in CNS: central nervous system FLA: free-living amoeba skin biopsy tissues, and the fact that the initial cases were regarded as Acanthamoeba sp.…”

“…14,24,27,54 Occasional cyst forms have been reported in the skin. 6,55 The clinical and histopathologic differential diagnosis of cutaneous balamuthiasis includes leishmaniasis, sporotrichosis, lupus vulgaris, sarcoidosis, Wegener granulomatosis, necrobiosis lipoidica, and natural killer and T-cell lymphomas.…”

“…Balamuthia mandrillaris, 1 of the 4 species of free-living amoeba that is pathogenic to humans, is associated with subacute granulomatous encephalitis, a nearly always fatal condition. [1][2][3][4][5][6][7] The onset of balamuthiasis is subtle, the course of the disease is insidious, its outcome is poor, and diagnosis is usually made at autopsy, which is when nervous system involvement is identified. The mortality rate of this disease is [98%, although in a single case reported from our institution, a therapeutic regimen including miltefosine resulted in the regression of central nervous system (CNS) and cutaneous involvement and survival of the patient up to 14 years.…”

A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication

“…Most (99%) had encephalitis [ 4 ]. In China, there have been 28 cases of B. mandrillaris infection during the past 20 years and only 16 cases (57%) developed amoebic encephalitis [ 5 ]. Most Balamuthia cases were reported in the western and southern regions of the United States, probably because of the hot and dry environment [ 4 ].…”