Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis, using human brain microvascular endothelial cells

Jayasekera, Samantha; Sissons, James; Tucker, Julie; Rogers, C. A.; Nolder, Debbie; Warhurst, David C.; Alsam, Selwa; White, Jonathan M. L.; Higgins, E. M.; Khan, Naveed Ahmed

doi:10.1099/jmm.0.45721-0

Cited by 66 publications

(51 citation statements)

References 19 publications

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“…Likewise, the CSF samples from which ameba isolation had been attempted had been refrigerated or frozen for periods of hours to days, even before arrival at the laboratory (California Health Services). Although it is generally believed that Balamuthia is not found in CSF, Jayasekera et al (11) reported isolation of Balamuthia from CSF of a recent case in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

Detection of Balamuthia Mitochondrial 16S rRNA Gene DNA in Clinical Specimens by PCR

et al. 2005

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Balamuthia mandrillaris is a free-living ameba that causes granulomatous amebic encephalitis in both immunocompromised and immunocompetent individuals. Because of a lack of pathognomonic symptoms and the difficulty in recognizing amebas in biopsied tissues, most cases are not diagnosed or effectively treated, leading to a >95% mortality. We report here on five cases of balamuthiasis that were diagnosed by indirect immunofluorescence (

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Section: Discussionmentioning

confidence: 99%

Detection of Balamuthia Mitochondrial 16S rRNA Gene DNA in Clinical Specimens by PCR

et al. 2005

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“…In addition, BAE has been reported in Asia, from Japan (two cases) (68), Thailand (one case) (30), and Australia (eight cases) (55); and in Europe, from the Czech Republic (one case) (37), Portugal (one case) (75), and the United Kingdom (one case) (83). An estimated 25 cases of BAE have been reported for previously healthy, immunocompetent individuals (5,20,24,27,30,32,34,40,44,57,83). The exact number of cases of BAE worldwide may never be known, which may be attributed to a lack of awareness, poor diagnosis, and poor public health systems, especially in less developed countries.…”

Section: Bae Epidemiology and Predisposing Factorsmentioning

confidence: 99%

Increasing Importance of Balamuthia mandrillaris

et al. 2008

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SUMMARY Balamuthia mandrillaris is an emerging protozoan parasite, an agent of granulomatous amoebic encephalitis involving the central nervous system, with a case fatality rate of >98%. This review presents our current understanding of Balamuthia infections, their pathogenesis and pathophysiology, and molecular mechanisms associated with the disease, as well as virulence traits of Balamuthia that may be potential targets for therapeutic interventions and/or for the development of preventative measures.

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“…The amoeba has been isolated from brain tissue (2,26,27) and, in a single case, from CSF obtained at autopsy (10). Neither the CSF nor unfixed brain tissue was available for attempting culture isolation of the amoeba.…”

Section: Case Reportmentioning

confidence: 99%

Diagnosis of First Case of Balamuthia Amoebic Encephalitis in Portugal by Immunofluorescence and PCR

Tavares

Costa²,

Carpenter³

et al. 2006

J Clin Microbiol

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We report here the first Portuguese case of acute fatal granulomatous encephalitis attributed to Balamuthia mandrillaris, initially thought to be a brain tumor, which had a progressive and fatal outcome. Balamuthia mandrillaris is a free-living amoeba recognized as an uncommon agent of granulomatous encephalitis. Infections have been identified in immunocompromised hosts and in immunocompetent pediatric patients. Balamuthia infections are very rare, with only two reported cases in Europe. The case presented here occurred in a previously healthy boy who died 5 weeks after the onset of the symptoms. No evidence of immunological deficiency was noted, and testing for human immunodeficiency virus antibodies was negative. The symptoms were initially thought to be the result of a tumor, but histopathologic examination showed evidence of amoebic infection. Immunofluorescence staining of brain tissue identified B. mandrillaris as the infectious agent. The diagnosis was confirmed with PCR by detecting Balamuthia DNA in formalin-fixed brain tissue sections. Despite initiation of empirical antimicrobial therapy for balamuthiasis, the patient died 3 weeks after being admitted to the hospital. No source of infection was readily apparent. CASE REPORTAn 8-year-old male was transferred to our hospital because of signs of intracranial hypertension. His past medical history was unremarkable except for an episode of varicella infection a year before. Prior to his illness, he practiced swimming in several swimming pools but had not traveled outside Portugal. Symptoms with sporadic headaches started a few months earlier but had become daily for the 2 weeks prior to admission. His parents noted medial esotropia 2 days before admission, and diplopia developed 1 day before. His headaches were more intense in the morning, he had frequent episodes of vomiting and lethargy, and papilledema was noted upon physical examination.Upon admission he appeared well, with a good general status, and his speech was age appropriate. After unilateral eye occlusion, he had no visual defects. Mycobacterium tuberculosis infection was ruled out from urine and sputum samples, and the tuberculin test (2U, SC) was negative. Human immunodeficiency virus type 1 (HIV-1) and HIV-2 serum antibodies and immunologic studies all showed no changes.Fundoscopy revealed bilateral papilledema and right retinal hemorrhages. Neither alteration of consciousness nor neurological focal deficits were noted. There was no fever. Noncontrast computerized tomography (CT) scanning revealed an expansive hypodense lesion in the right frontal lobe, causing distortion of the middle line and ventricular thinning. With contrast enhancement, a heterogeneous cortical lesion surrounded by a huge area of edema was noted for the first time in the right temporal lobe (Fig. 1A and B). A brain tumor was suspected, and dexamethasone was started because of the clinical symptoms. Upon preoperative magnetic resonance imaging (MRI), the frontal lesion was heterogeneous, with hypodense inner and hyperin...

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Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis, using human brain microvascular endothelial cells

Cited by 66 publications

References 19 publications

Detection of Balamuthia Mitochondrial 16S rRNA Gene DNA in Clinical Specimens by PCR

Detection of Balamuthia Mitochondrial 16S rRNA Gene DNA in Clinical Specimens by PCR

Increasing Importance of Balamuthia mandrillaris

Diagnosis of First Case of Balamuthia Amoebic Encephalitis in Portugal by Immunofluorescence and PCR

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