Disseminated Balamuthia mandrillaris Amoeba Infection in an AIDS Patient from Brazil

Abstract

This report describes a 32-year-old male AIDS patient. He presented with a clinical picture characterized by severe headache, blurred vision, and fever that had lasted for 10 days. At admission, no remarkable neurologic abnormalities were observed. Cranial tomography showed a ring-enhanced lesion with edema and a mass effect in the right occipital lobe. The initial diagnosis was toxoplasmosis, and treatment of this was administered. However, 5 days later, the patient's clinical status worsened and he died. The necropsy showed necrotizing and hemorrhagic encephalitis, with trophozoites similar to an amoeba species. Furthermore, the kidneys, adrenal glands, thyroid gland, and liver were also involved. The amoeba Balamuthia mandrillaris was identified by an immunofluorescence test.

Importance of Nonenteric Protozoan Infections in Immunocompromised People

“…The clinical course of Balamuthia infection is generally subacute, often extending over a matter of weeks to months and usually concluding with the death of the patient (28,310,452,469,544). The disease spectrum of B. mandrillaris infection can include skin lesions, rhinitis (588), and disseminated disease (523). However, the most common clinical manifestation of Balamuthia infection is GAE, which presents with a clinical picture similar to that of Acanthamoeba GAE.…”

“…Several cases of Balamuthia infection have been reported for AIDS patients (380,620). While most Balamuthia-HIV coinfections manifest as BAE, disseminated disease due to Balamuthia-HIV coinfection has also been reported (523). In one AIDS patient, encephalitis without a granulomatous reaction was observed, along with involvement of the kidneys, adrenal glands, thyroid gland, and liver (523).…”

“…Neurological abnormalities will usually prompt a CT scan or MRI of the brain (291). Brain lesions caused by Balamuthia can appear similar to those caused by other protozoa, which may lead to a misdiagnosis and incorrect treatment (523). For a definitive diagnosis, microscopy, PCR, and/or IFAT must be employed.…”

Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

“…The first case was reported in 1988, occurring in a 26-year-old man who presented with CNS disease and multiple skin abscesses and had disseminated disease involving the adrenal glands and kidneys (2). Another case reported in 1998 presented with GAE and disseminated disease involving the adrenal glands, kidneys, and thyroid (24). Both of these patients died soon after their initial presentation.…”

Granulomatous Amoebic Meningoencephalitis in an Immunocompetent Patient

“…To our knowledge, only 2 cases have been described in Brazil, one associated with AIDS and the other, with alcoholism as a risk factor. 1 Most cases of GAE are related to host immunosuppression and are caused by amoebae of the genus Acanthamoeba. 2,3 A case of GAE caused by Balamuthia mandrillaris in an adult immunocompetent patient is reported herein.…”