Granulomatous Amoebic Encephalitis Caused by Balamuthia Mandrillaris in an Immunocompetent Girl

Stidd, David A.; Root, Brandon; Weinand, Martin E.; Anton, Rein

doi:10.1016/j.wneu.2011.10.040

Cited by 19 publications

(14 citation statements)

References 32 publications

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“…Alternate modes of infection reported in literature include organ transplantation . B. mandrillaris infection occurs in both immunocompromised and immunocompetent hosts, particularly children …”

Section: Discussionmentioning

confidence: 99%

“…Free‐living ameba uncommonly infect the skin but can do so in both immunocompromised and immunocompetent patients . Only a few genera of free‐living ameba are recognized as human pathogens: Acanthamoeba , Naegleria , Balamuthia and Sappinia .…”

mentioning

confidence: 99%

“…Free-living ameba uncommonly infect the skin but can do so in both immunocompromised and immunocompetent patients. 1,2 Only a few genera of free-living ameba are recognized as human pathogens: Acanthamoeba, Naegleria, Balamuthia and Sappinia. Exposure to these organisms is probably common because of their ubiquitous nature in the natural environment; however, clinically significant skin infection is quite rare.…”

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confidence: 99%

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Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

et al. 2016

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Free‐living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life‐threatening central nervous system (CNS) involvement. We report a case of a 91‐year‐old woman, who presented with a non‐healing red plaque over her right cheek. Several punch biopsies exhibited non‐specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin‐eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life‐threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.

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confidence: 99%

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Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

et al. 2016

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“…63 Acanthamoeba species and B mandrillaris typically cause chronic granulomatous amoebic encephalitis. 64,65 Also, Sappinia pedata has been identified as the cause of a nonlethal case of amoebic encephalitis. 66 Primary amoebic meningoencephalitis is an acute, fulminant, rapidly fatal disease (usually a 48-to 72-hour course) that generally occurs via olfactory mucosa in previously healthy children and young adults with a history of swimming and diving, and other recreational activities in freshwater and contaminated swimming pools.…”

Section: Amoebic Encephalitismentioning

confidence: 99%

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

Hanagandi¹,

Gonçalves²,

Amaral³

et al. 2015

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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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Granulomatous Amoebic Encephalitis Caused by Balamuthia Mandrillaris in an Immunocompetent Girl

Cited by 19 publications

References 32 publications

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

Multidisciplinary Approach to Tropical and Subtropical Infectious Diseases: Imaging with Pathologic Correlation

Granulomatous Amoebic Meningoencephalitis: A Diagnostic Dilemma

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