Management of granulomatous amebic encephalitis: Laboratory diagnosis and treatment

Abstract

Granulomatous amebic encephalitis is a life-threatening central nervous system (CNS) infection caused by the free-living amoebae Acanthamoeba spp., Balamuthia mandrillaris and Sappinia pedata. The disease has a subacute to chronic onset affecting commonly the immunocompromised population with high mortality rate. The diagnosis of this disease entity requires high suspicion with appropriate sample collection and testing by the laboratory experts. Radiological investigations are nonspecific and commonly confused with CNS tuberculosis, neurocysticercosis, disseminated encephalomyelitis, viral encephalitis etc., delaying the accurate diagnosis of these cases. Early diagnosis plays a crucial role in the survival of these cases since appropriate management can be initiated. No single drug is effective; hence multiple antibiotics targeting various proteins or receptors are required for successful treatment. A combination of surgical and medical interventions involving multiple specialty experts is required to prevent death and morbidity in survivors.

Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage

“…Furthermore, healthy individuals can be seropositive for Balamuthia antibodies due to the amoeba's pervasive presence in the environment, while those with GAE show low titers (Siddiqui and Khan, 2008). Additionally, cerebrospinal fluid analysis rarely demonstrates the organism (Stidd et al, 2012), and the time course for the appearance of lesions and the onset of GAE is inconsistent (Parija et al, 2015).…”

An Unusual Cause of Fever and Headache in a School-Aged Male

“…5 Multiplex real-time DNA PCR assay emerged as the most promising tool with the highest sensitivity and rapid turn-around time. 6 It targets the 18S rRNA gene of Acanthamoeba spp ., Balamuthia mandrillaris , and Naegleria fowleri , which enables simultaneous detection of all three pathogenic free-living amebae. 5 18S rRNA gene analysis of Balamuthia mandrillaris has revealed a single genotype causing human infections worldwide, and there is no cross-reaction between Balamuthia mandrillaris and Acanthamoeba spp.…”

Diagnostic approach to encephalitis and meningoencephalitis in adult returning travellers

“…They can present with life-threatening diseases such as granulomatous amoebic encephalitis and primary amoebic ME [72]. Diagnosis is made by direct examination of CSF or cerebral tissue, culture, or NAATs [73,74].…”