Balamuthia mandrillaris, an opportunistic agent of granulomatous amebic encephalitis, infects the brain via the olfactory nerve pathway

Kiderlen, Albrecht F.; Laube, Ulrike

doi:10.1007/s00436-004-1163-z

Cited by 69 publications

(45 citation statements)

References 12 publications

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“…Humans become infected either through the inhalation of contaminated material or through cuts or abrasions in the skin. It is also thought that Balamuthia can enter the brain through the nose via the olfactory nerves (321). Balamuthia infection in animals has also been reported (85,325).…”

Section: Balamuthia Mandrillarismentioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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SUMMARY There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.

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Section: Balamuthia Mandrillarismentioning

confidence: 99%

Importance of Nonenteric Protozoan Infections in Immunocompromised People

et al. 2010

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“…Balamuthia mandrillaris, an opportunistic free-living amoeba that can cause granulomatous amoebic encephalitis, was also shown to enter the CNS directly from the nasal cavity after penetrating the olfactory epithelium and cribriform plate in immunodeficient mice following intranasal infection (395). However, the implications of these findings in humans are unclear, as B. mandrillaris is thought to cause CNS infections primarily due to hematogenous spread from the lungs or through cuts or skin abrasions (396).…”

Section: Protozoamentioning

confidence: 99%

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

et al. 2014

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SUMMARY The brain is well protected against microbial invasion by cellular barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB). In addition, cells within the central nervous system (CNS) are capable of producing an immune response against invading pathogens. Nonetheless, a range of pathogenic microbes make their way to the CNS, and the resulting infections can cause significant morbidity and mortality. Bacteria, amoebae, fungi, and viruses are capable of CNS invasion, with the latter using axonal transport as a common route of infection. In this review, we compare the mechanisms by which bacterial pathogens reach the CNS and infect the brain. In particular, we focus on recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.

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“…The organisms are then believed to either migrate through tissue or via hematogenous spread to the location or locations where disease becomes manifest, which can include the brain and skin most commonly but other organs as well. A mouse model of Balamuthia encephalitis proposes the following as one possible mode of infection: the organism is inhaled through the nasal passages, adheres to the nasal epithelium, and then travels along the olfactory nerve into the central nervous system (CNS) (10).…”

Section: Microbiologymentioning

confidence: 99%

Disseminated Balamuthia mandrillaris Infection

et al. 2015

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f 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. CASE REPORTT he patient was an 82-year-old white male with a history of necrobiosis lipoidica versus granuloma annulare of the right hand who was admitted in April 2012 for acute onset of fevers, chills, nausea, vomiting, lethargy, and altered mental status (AMS). He initially presented to an outside-hospital emergency department with a temperature of 38.5°C, a heart rate of 97 beats per min, and oxygen saturation of 88% on room air. His oxygen saturation improved with administration of nasal cannula oxygen. A chest X-ray (CXR) procedure was performed and demonstrated findings concerning for granulomatous disease. Due to his condition, he was transferred to our tertiary care center for further evaluation and treatment.Per his family, he had been healthy and without complaints prior to his current presentation. For approximately 15 months, he had been treated by a dermatologist for skin lesions located on his right thigh and hand as well as left upper extremity (LUE) and abdomen. He had multiple skin biopsy specimens from the right hand, LUE, and right thigh with negative bacterial, acid-fast bacillus (AFB), and fungal analysis results. During this period of time, he took itraconazole for 3 months without clinical response and was thus started on prednisone. All lesions resolved except those on his right hand. He was treated with a 14-day course of doxycycline and cephalexin for possible cellulitis of the right hand prior to this admission. Previous workup included a negative syphilis screen and a normal angiotensin-converting enzyme (ACE) level (drawn for possible sarcoidosis). A CXR performed at that time revealed nonspecific interstitial changes.A review of the patient's symptoms was obtained from family members given the patient's AMS. Per their report, the patient reported a headache but no neck pain or stiffness. He had no history of mouth sores or genital ulcers and had a remote history of shingles. He had had an episode of bronchitis 1 month prior to admission (PTA) that was slow to improve but gradually resolved.In terms of exposures, he had no history of international travel but did have seawater exposure on the Gulf Coast of Alabama 1 month prior to admission. He had no pets but had been mowing grass and spreading grass seed PTA. He had no known tick bites but spent time outdoors using a metal detector for treasure hunting and digging in soil. Previously, he had taught a bible study group in a prison but had no known tuberculosis (TB) exposure and no previous TB testing.In an initial physical examination, he was febrile to 38.2°C and his oxygen saturation was 94% with 2 liters of oxygen administered using a nasal cannula. He was initially agitated and confused but progressed to somnolence o...

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Balamuthia mandrillaris, an opportunistic agent of granulomatous amebic encephalitis, infects the brain via the olfactory nerve pathway

Cited by 69 publications

References 12 publications

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Importance of Nonenteric Protozoan Infections in Immunocompromised People

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

Disseminated Balamuthia mandrillaris Infection

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