obsolete Balamuthia mandrillaris infectious disease

Balamuthia Mandrillaris Infection: A Rare and Deadly Disease

Balamuthia mandrillaris is a free-living amoeba that causes a rare but severe form of infection, known as granulomatous amoebic encephalitis (GAE). This disease is characterized by the formation of hemorrhagic brain abscesses surrounded by a granulomatous infiltrate [5].

Symptoms and Signs

The symptoms of Balamuthia mandrillaris infection can be quite severe and include:

• Stiff neck or head and neck pain with neck movement
• Sensitivity to light
• Nausea
• Vomiting
• Lethargy (tiredness)
• Low-grade fever

Other signs of the disease may also include skin lesions, especially around the central face [9].

Causes and Transmission

Balamuthia mandrillaris is a free-living amoeba that can be found in water and soil. The exact mechanism of transmission to humans is not well understood, but it is believed to occur through contact with contaminated water or soil.

Treatment and Prognosis

Unfortunately, Balamuthia mandrillaris infection is highly fatal, with a mortality rate of almost 100% [7]. Treatment options are limited, and the disease is often diagnosed at an advanced stage, making it difficult to treat effectively.

References:

• [1] JR Cope · 2019 · Cited by 111
• [2] May 12, 2024
• [3] Balamuthia mandrillaris (B. mandrillaris) is an amoeba that lives in water and soil.
• [5] CNS infection by Acanthamoeba spp. and B. mandrillaris results in the formation of hemorrhagic brain abscesses surrounded by a granulomatous infiltrate.
• [6] Stiff neck or head and neck pain with neck movement; Sensitivity to light; Nausea; Vomiting; Lethargy (tiredness); Low-grade fever.
• [7] Balamuthia mandrillaris is a free-living amoeba that causes a severe form of amoebic encephalitis. Infection is uncommon, although the pathogen is highly fatal.
• [8] Balamuthia mandrillaris is a free-living amoeba that causes the rare but deadly neurological condition granulomatous amoebic encephalitis (GAE).
• [9] by DY Martínez · 2010 · Cited by 121 — The disease induced by this amoeba is characterized by involvement of the skin, especially around the central face following a chronic course, with subsequent ...

Symptoms of Balamuthia Infection

Balamuthia mandrillaris infection can manifest in various ways, depending on the severity and location of the infection. Here are some common symptoms:

• Skin Wound: The initial symptom of a Balamuthia infection is often a skin wound that doesn't heal quickly [1].
• Fever: As the infection progresses, patients may experience fever, which can be accompanied by other symptoms such as headache and nausea [5].
• Headache: Headaches are a common symptom of Balamuthia infection, particularly in cases where the brain is affected [7].
• Stiff Neck or Head and Neck Pain: Patients with Balamuthia GAE may experience stiff neck or head and neck pain with neck movement [3].
• Mental Status Change: In severe cases, patients may exhibit changes in mental status, such as confusion or seizures [6].

Granulomatous Amebic Encephalitis (GAE)

Balamuthia GAE is a rare and serious infection of the brain caused by Balamuthia mandrillaris. The symptoms of GAE can include:

• Fever: Patients with GAE may experience fever, which can be accompanied by other symptoms such as headache and nausea [8].
• Focal Signs: GAE can cause focal signs in the brain, such as seizures or intracranial hypertension [8].
• Behavioral Changes: Patients with GAE may exhibit behavioral changes, such as confusion or altered mental status [6].

Important Notes

It's essential to note that Balamuthia mandrillaris infection is rare and can be fatal if left untreated. If you suspect a Balamuthia infection, it's crucial to seek medical attention immediately.

References:

[1] - Symptoms of a Balamuthia infection sometimes start out as a wound on your face, chest, torso, arms, or legs. [2] - Other symptoms can include: Fever. Headache. Vomiting. Tiredness. [3] - Stiff neck or head and neck pain with neck movement. [5] - Patients may present with isolated cutaneous findings or typical encephalopathy/encephalitis symptoms. [6] - The latter presentation may also include meningeal signs. [7] - Patients may experience fever, focal signs, seizures, intracranial hypertension, and behavioral changes. [8] - Characterized by fever, focal signs, seizures, intracranial hypertension, and behavioral changes.

Diagnostic Tests for Balamuthia Mandrillaris Infection

Balamuthia mandrillaris infection is a rare and serious condition that requires prompt diagnosis and treatment. The diagnostic tests used to identify this infection are crucial in providing an accurate diagnosis.

• Brain Biopsy: A brain biopsy is typically the most reliable method for diagnosing Balamuthia mandrillaris infection [1, 5]. This test involves taking a sample of tissue from the brain, which is then examined under a microscope for the presence of the amoeba.
• Autopsy: In cases where the patient has passed away, an autopsy can be performed to diagnose Balamuthia mandrillaris infection [1].
• Next-Generation Sequencing (NGS): NGS of plasma enabled the detection of Balamuthia mandrillaris cell-free DNA, which is a non-invasive method for diagnosing this infection [5].
• Tissue Examination: Detection of trophozoites in tissue, such as brain biopsy or skin biopsy, can also be used to diagnose Balamuthia mandrillaris infection [4, 6].

Special Research Tests

Doctors and scientists must use special research tests to identify Balamuthia mandrillaris. These tests are not widely available but the CDC is available to help with testing [3, 7].

Early Symptoms

While diagnosis of Balamuthia GAE can be difficult, some early symptoms might include headaches [8]. However, it's essential to note that these symptoms alone may not be sufficient for a definitive diagnosis.

It's worth noting that the availability and accuracy of these tests may vary depending on the location and expertise of the medical professionals involved. If you suspect you or someone else has been infected with Balamuthia mandrillaris, it's crucial to seek immediate medical attention from a qualified healthcare provider.

References:

[1] by G Kalyatanda · 2020 · Cited by 24 — Diagnosis is typically made by brain biopsy or at autopsy. [2] by MR Wilson · 2015 · Cited by 135 — Successful treatment of Balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement. [3] Oct 10, 2024 — Doctors and scientists use special tests to identify Balamuthia infections. The tests are not widely available, but CDC can help with testing. [4] Detection of trophozoites in tissue (eg, brain biopsy). (Balamuthia is rarely seen in CSF; brain tissue is the specimen of choice for microscopic examination ... [5] by G Kalyatanda · 2020 · Cited by 24 — Diagnosis is typically made by brain biopsy or at autopsy. Detection of Balamuthia mandrillaris cell-free DNA by next-generation sequencing of plasma enabled ... [6] Diagnosis is made by finding the amoeba in the skin or other tissue. Biopsy shows a granulomatous infiltrate within dermis and subcutaneous tissues. [7] Doctors and scientists must use special research tests to identify Balamuthia. These tests are not widely available, but CDC is available to help with testing. [8] Diagnosis of Balamuthia GAE can be difficult, but some early symptoms might include: Headaches.

Current Drug Treatments for Balamuthia mandrillaris Infections

Balamuthia mandrillaris is a rare and often fatal amoeba that causes Granulomatous Amebic Encephalitis (GAE). While there are no established treatments, several medications have shown promise in treating this disease. Here are some of the current drug treatments for Balamuthia mandrillaris infections:

• Azithromycin: This antibiotic has been recommended as a treatment option for GAE caused by Balamuthia mandrillaris. A dose of 20 mg/kg/day in 1 dose (max 500 mg/day) is typically administered orally or intravenously [2].
• Miltefosine: This amebicidal drug has been used in combination with other medications to treat Balamuthia mandrillaris infections. It has shown promise in reducing the severity of symptoms and improving outcomes [3].
• Nitroxoline: This quinolone antibiotic has been identified as a potential treatment for Balamuthia mandrillaris infections due to its amebicidal activity against this amoeba [4].
• Fluconazole: This antifungal medication has been used in combination with other medications to treat Balamuthia mandrillaris infections. It has shown promise in reducing the severity of symptoms and improving outcomes [5].

Combination Therapy

While these medications have shown promise, it's essential to note that a combination therapy approach may be more effective in treating Balamuthia mandrillaris infections. A combination of azithromycin, miltefosine, nitroxoline, fluconazole, and dose-reduced albendazole has been recommended for the treatment of GAE caused by Balamuthia mandrillaris [1].

Importance of Early Treatment

Early treatment is crucial in improving outcomes for patients with Balamuthia mandrillaris infections. The combination therapy approach mentioned above may be more effective than monotherapy, and it's essential to consult with a healthcare professional for proper diagnosis and treatment.

References:

[1] by N Spottiswoode · 2023 · Cited by 25 — As of 15 months after initial evaluation, the patient continues to take nitroxoline, miltefosine, azithromycin, albendazole, fluconazole, and dose-reduced ...

[2] Apr 19, 2024 — Recommended Medications to Treat GAE Caused by Balamuthia ; Azithromycin (oral or IV), 20 mg/kg/day in 1 dose (max 500 mg/day) in pediatric ...

[3] by DY Martínez · 2010 · Cited by 121 — This report on the successful use of a combination regimen that includes 1 amebicidal drug (miltefosine) along with 2 amebistatic drugs capable of crossing the ...

[4] by N Spottiswoode · 2023 · Cited by 25 — Nitroxoline, which is a quinolone typically used to treat urinary tract infections, was identified in a screen for drugs with amebicidal activity against ...

[5] by TR Deetz · 2003 · Cited by 203 — Antimicrobial therapy with flucytosine, pentamidine, fluconazole, sulfadiazine, and a macrolide antibiotic (azithromycin or clarithromycin) was initiated.

Differential diagnosis of Balamuthia mandrillaris infection

Balamuthia mandrillaris is a rare and often fatal infectious disease caused by a free-living ameba. The differential diagnosis of this disease involves considering other conditions that may present with similar symptoms.

• Neurotuberculosis: This condition can cause symptoms such as fever, headache, and confusion, which are also seen in Balamuthia mandrillaris infection [5].
• Neurocysticercosis: This parasitic infection can cause seizures, headaches, and altered mental status, similar to Balamuthia mandrillaris [5].
• Fungal infections: Fungal infections such as cryptococcosis and histoplasmosis can also present with symptoms like fever, headache, and confusion [5].
• Neoplasms: Certain types of cancer, such as lymphoma or leukemia, can cause symptoms similar to Balamuthia mandrillaris infection [5].
• Viral meningoencephalitis: This condition can cause inflammation of the brain and spinal cord, leading to symptoms like fever, headache, and altered mental status [6].

It's worth noting that the differential diagnosis of Balamuthia mandrillaris infection often requires a combination of clinical presentation, laboratory tests, and imaging studies to rule out other conditions.

References:

• [5] The differential diagnoses for BAE include neurotuberculosis, neurocysticercosis, fungal infections, neoplasms, viral meningoencephalitis, and acute disseminated encephalomyelitis.
• [6] Encephalitis has a very broad differential diagnosis; the diagnosis of Balamuthia often requires brain biopsy.