Successful Treatment of Granulomatous Amoebic Encephalitis with Combination Antimicrobial Therapy

Kato, Hideki; Mitake, Shigehisa; Yuasa, Hiroyuki; Hayashi, Shotaro; Hara, Toshihide; Matsukawa, Noriyuki

doi:10.2169/internalmedicine.52.0299

Cited by 18 publications

(7 citation statements)

References 18 publications

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“…Regarding the treatment, past reports have suggested antimicrobial therapy with flucytosine, pentamidine, fluconazole, sulfadiazine, and a macrolide antibiotic; recently, miltefosine has been suggested as a potential treatment for patients with Balamuthia infection ( 8 , 9 ). However, there is currently no established treatment for this disease, and the survival of afflicted patients is extremely rare ( 10 ). Considering the acute progression of the disease in our patient, the outcome may have been the same even if an attempt at treatment had been initiated.…”

Section: Discussionmentioning

confidence: 99%

An Acute Case of Granulomatous Amoebic Encephalitis-<i>Balamuthia mandrillaris</i> Infection

et al. 2018

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A 74-year-old woman who exhibited drowsiness was referred to our hospital. Enhanced head magnetic resonance imaging (MRI) revealed multiple ring-enhancing lesions and lesions showing partial mild hemorrhaging. The patient gradually progressed to a comatose condition with notable brain deterioration of unknown cause on follow-up MRI. On day nine, the patient inexplicably died, although brain herniation was suspected. Autopsy and histopathology revealed numerous amoebic trophozoites in the perivascular spaces and within the necrotic tissue. Brain immunostaining tested positive for Balamuthia mandrillaris. Infection due to free-living amoeba is rare in Japan; however, it may increase in the near future due to unknown reasons.

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Section: Discussionmentioning

confidence: 99%

An Acute Case of Granulomatous Amoebic Encephalitis-<i>Balamuthia mandrillaris</i> Infection

et al. 2018

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“…Unfortunately, the majority of the reported GAE cases have been diagnosed at autopsy. Nevertheless, there are reports in which GAE has been diagnosed early and successfully treated . Therefore, early biopsy of skin lesions and correct histopathologic diagnosis before patients develop advanced CNS injury may be lifesaving in some cases.…”

Section: Discussionmentioning

confidence: 99%

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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“…Usually, a combination of multiple antibiotics (approximately 4-5) have been used in successfully treated cases of GAE infections, except for 2 CNS acanthamoebiasis cases where a single drug (cotrimoxazole) had been effective in treatment of these life-threatening infections. [ 3 44 45 ] Initiation of antiretroviral agents in a patient with HIV immunosuppression and topical application of chlorhexidine/miltefosine in cases of infections with skin manifestations showed a better outcome. Certain studies show that the initiation of the miltefosine reduced mortality risk in CNS acanthamoebiasis and balamuthiasis.…”

Section: Laboratory Diagnosismentioning

confidence: 99%

Management of granulomatous amebic encephalitis: Laboratory diagnosis and treatment

Parija

Venugopal

2015

Trop Parasitol

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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.

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Successful Treatment of Granulomatous Amoebic Encephalitis with Combination Antimicrobial Therapy

Cited by 18 publications

References 18 publications

An Acute Case of Granulomatous Amoebic Encephalitis-<i>Balamuthia mandrillaris</i> Infection

An Acute Case of Granulomatous Amoebic Encephalitis-<i>Balamuthia mandrillaris</i> Infection

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection

Management of granulomatous amebic encephalitis: Laboratory diagnosis and treatment

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