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Xu H, Wang D, Cui K, Wan R, Chi Q, Wu T. 18F-FDG PET/CT findings in fatal Balamuthia Mandrillaris encephalitis in brain stem: A case report. Radiol Case Rep 2024; 19:1851-1854. [PMID: 38425772 PMCID: PMC10901688 DOI: 10.1016/j.radcr.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
We presented a case of a 66-year-old female whose initial symptom was headache without obvious inducement. The patient's condition progressed rapidly to a semi-coma state after symptomatic treatment. The 18F-FDG PET/CT scan revealed circular FDG hypermetabolism and central metabolic defect of the pons and left frontal lobe lesions. The combination of clinical findings, MRI, and Metagenomic next-generation sequencing (NGS) of cerebrospinal fluid led to the diagnosis of Balamuthia mandrillaris encephalitis. The patient died 5 days after discharge.
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Affiliation(s)
- Hualei Xu
- Department of Nuclear Medicine, Taihe County People's Hospital, Taihe, China
| | - Dawei Wang
- Department of Nuclear Medicine, Taihe County People's Hospital, Taihe, China
| | - Kunwei Cui
- Department of Laboratory Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ruimei Wan
- Department of Nuclear Medicine, Taihe County People's Hospital, Taihe, China
| | - Quan Chi
- Department of Nuclear Medicine, Taihe County People's Hospital, Taihe, China
| | - Tao Wu
- Department of Nuclear Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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2
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Spottiswoode N, Haston JC, Hanners NW, Gruenberg K, Kim A, DeRisi JL, Wilson MR. Challenges and advances in the medical treatment of granulomatous amebic encephalitis. Ther Adv Infect Dis 2024; 11:20499361241228340. [PMID: 38312848 PMCID: PMC10838035 DOI: 10.1177/20499361241228340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
Granulomatous amebic encephalitis, caused by the free-living amebae Balamuthia mandrillaris or Acanthamoeba species, is a rare and deadly infectious syndrome with a current mortality rate of >90%. Much work remains to define the optimal treatment for these infections. Here, we provide a comprehensive overview of the supporting evidence behind antimicrobials currently recommended by the Centers for Disease Control and Prevention (CDC) with updated statistics on survival rates and medication usage from the CDC Free-Living Ameba Database. We also discuss promising treatments, especially the emerging therapeutic agent nitroxoline, and provide recommendations for the next steps in this area.
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Affiliation(s)
- Natasha Spottiswoode
- Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - Julia C. Haston
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natasha W. Hanners
- Division of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Katherine Gruenberg
- Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Annie Kim
- Department of Clinical Pharmacy, Zuckerberg San Francisco General, San Francisco, CA, USA
| | - Joseph L. DeRisi
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub SF, San Francisco, CA, USA
| | - Michael R. Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
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3
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Gramp PE, Dooley J, O'Brien B, Jones A, Tan L, Robson J, Robertson T, Simos P, Fuller R, Gramp DV, Meumann EM. Fatal granulomatous amebic encephalitis initially presenting with a cutaneous lesion. Australas J Dermatol 2023; 64:e256-e261. [PMID: 37154242 DOI: 10.1111/ajd.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
We present a case of a 66-year-old man with a cutaneous Balamuthia mandrillaris lesion that progressed to fatal granulomatous amoebic encephalitis. We provide a summary of Australian cases and describe the clinical features and approach to diagnosing this rare but devastating condition, including the importance of PCR for diagnosis.
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Affiliation(s)
- Prudence E Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John Dooley
- NH Diagnostics, Gold Coast, Queensland, Australia
| | - Blake O'Brien
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Andrew Jones
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Leong Tan
- Neurosurgery Department, Pindara Hospital, Queensland, Gold Coast, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Thomas Robertson
- Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Peter Simos
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Robert Fuller
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dallas V Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ella M Meumann
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
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Yao S, Chen X, Qian L, Sun S, Zhao C, Bai Z, Chen Z, Wu Y. Diagnosing Balamuthia mandrillaris amebic meningoencephalitis in a 64-year-old woman from the Southwest of China. PARASITES, HOSTS AND DISEASES 2023; 61:183-193. [PMID: 37258265 DOI: 10.3347/phd.23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 06/02/2023]
Abstract
Balamuthia mandrillaris amebic encephalitis (BAE) can cause a fatal condition if diagnosis is delayed or effective treatment is lacking. Patients with BAE have been previously reported in 12 provinces of China, with skin lesions being the primary symptom and encephalitis developing after several years. However, a significantly lower number of cases has been reported in Southwest China. Here we report an aggressive BAE case of a 64-year-old woman farmer with a history of skin lesions on her left hand. She was admitted to our hospital due to symptoms of dizziness, headache, cough, vomiting, and gait instability. She was initially diagnosed with syphilitic meningoencephalitis and received a variety of empirical treatment that failed to improve her symptoms. Finally, she was diagnosed with BAE combined with amebic pneumonia using next-generation sequencing (NGS), qRT-PCR, sequence analysis, and imaging studies. She died approximately 3 weeks after the onset. This case highlights that the rapid development of encephalitis can be a prominent clinical manifestation of Balamuthia mandrillaris infection.
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Affiliation(s)
- Suhua Yao
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
- The Third Affiliated Hospital of Dali University, Dali, Yunnan province, China
| | - Xiaoting Chen
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Lian Qian
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Shizheng Sun
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Chunjing Zhao
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Zongkai Bai
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Zhaofang Chen
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
| | - Youcong Wu
- Department of Medical Microbiology and Immunology, School of Basic Medical Sciences, Dali University, Dali, Yunnan Province, China
- Key Laboratory of Medical Molecular Virology (MOE/NHC), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
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Liu J, Zhang W, Wu S, Zeng T, Luo F, Jiang Q, Yang R. A clinical case report of Balamuthia granulomatous amoebic encephalitis in a non-immunocompromised patient and literature review. BMC Infect Dis 2023; 23:245. [PMID: 37072710 PMCID: PMC10114318 DOI: 10.1186/s12879-023-08228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Balamuthia granulomatous amoebic encephalitis (GAE) is a peculiar parasitic infectious disease of the central nervous system, about 39% of the infected Balamuthia GAE patients were found to be immunocompromised and is extremely rare clinically. The presence of trophozoites in diseased tissue is an important basis for pathological diagnosis of GAE. Balamuthia GAE is a rare and highly fatal infection for which there is no effective treatment plan in clinical practice. CASE PRESENTATION This paper reports clinical data from a patient with Balamuthia GAE to improve physician understanding of the disease and diagnostic accuracy of imaging and reduce misdiagnosis. A 61-year-old male poultry farmer presented with moderate swelling pain in the right frontoparietal region without obvious inducement three weeks ago. Head computed tomography(CT) and magnetic resonance imaging(MRI) revealed a space-occupying lesion in the right frontal lobe. Intially clinical imaging diagnosed it as a high-grade astrocytoma. The pathological diagnosis of the lesion was inflammatory granulomatous lesions with extensive necrosis, suggesting amoeba infection. The pathogen detected by metagenomic next-generation sequencing (mNGS) is Balamuthia mandrillaris, the final pathological diagnosis was Balamuthia GAE. CONCLUSION When a head MRI shows irregular or annular enhancement, clinicians should not blindly diagnose common diseases such as brain tumors. Although Balamuthia GAE accounts for only a small proportion of intracranial infections, it should be considered in the differential diagnosis.
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Affiliation(s)
- Jun Liu
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Wenjun Zhang
- Department of Rehabilitation Medicine, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Shanlian Wu
- Department of Pathology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Tianxiang Zeng
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Fei Luo
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi Province, People's Republic of China.
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Zheng J, Tan M, Chen J, Li C, Meng F, Wang L, Liao J. Diagnosis of cutaneous Balamuthia mandrillaris infection via next-generation sequencing in a Chinese woman. J Eur Acad Dermatol Venereol 2023; 37:e355-e357. [PMID: 36377799 DOI: 10.1111/jdv.18747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Jiecheng Zheng
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Min Tan
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Jianhua Chen
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
| | - Chen Li
- Department of Dermatology, Zhongshan City People's Hospital, Zhongshan, China
| | - Fengjiao Meng
- Department of Pathology, Zhongshan City People's Hospital, Zhongshan, China
| | - Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military, Xi'an, China
| | - Jia Liao
- Department of Dermatology, Zhongshan Second People's Hospital, Zhongshan, China
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Chen XT, Zhang Q, Wen SY, Chen FF, Zhou CQ. Pathogenic free-living amoebic encephalitis from 48 cases in China: A systematic review. Front Neurol 2023; 14:1100785. [PMID: 36846140 PMCID: PMC9947844 DOI: 10.3389/fneur.2023.1100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Background Free-living amoebae (FLA) including Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris can become pathogenic and cause severe cerebral infections, named primary amoebic meningoencephalitis (PAM), granulomatous amoebic encephalitis (GAE), and balamuthia amoebic encephalitis (BAE), respectively. FLA encephalitis has been reported across China, but the clinical data descriptions and analytical results of these different reports vary widely. Currently, no consensus treatment has been established. We conduct a systematic review to evaluate the exposure location, clinical symptoms, diagnosis, treatment, and prognosis of three FLA encephalitis and aim to reveal the differences between three FLA encephalitis in China. Methods We used MEDLINE (PubMed interface), EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang database, and China Biology Medicine disc (CBMdisc) databases for literatures published and manually retrieve the hospital records of our hospital. The search time was up to August 30, 2022, with no language restrictions. Results After excluding possible duplicate cases, a total of 48 patients of three FLA encephalitis were collected. One from the medical records of our hospital and 47 patients from 31 different studies. There were 11 patients of PAM, 10 patients of GAE, and 27 patients of BAE. The onset of PAM is mostly acute or subacute, and the clinical symptoms are acute and fulminant hemorrhagic meningoencephalitis. Most patients with GAE and BAE have an insidious onset and a chronic course. A total of 21 BAE patients (77.8%) had skin lesions before onset of symptoms. Additionally, 37 cases (77.1%) were diagnosed with FLA encephalitis before death. And there were 4 of PAM, 2 of GAE, and 10 of BAE diagnosed using next generation sequencing. No single agent can be proposed as the ideal therapy by itself. Only 6 cases were successfully treated. Conclusions This review provides an overview of the available data and studies of FLA encephalitis in China and identify some potential differences. FLA encephalitis is a rare but pathogenic infection, and physicians should early identify this encephalitis to improve survival.
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Affiliation(s)
| | | | | | | | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
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8
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Fan X, Chen T, Yang H, Gao Y, Chen Y. Encephalomyelomeningitis Caused by Balamuthia mandrillaris: A Case Report and Literature Review. Infect Drug Resist 2023; 16:727-733. [PMID: 36756612 PMCID: PMC9901442 DOI: 10.2147/idr.s400692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023] Open
Abstract
Central nervous system infection by Balamuthia mandrillaris is a rare and severe condition, which has a fatality rate of approximately 95% and often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Here, we report a case of encephalomyelomeningitis caused by B. mandrillaris in a male who presented with transient coma, nausea, and vomiting when working in a garbage dump. Initial magnetic resonance imaging (MRI) of the brain showed normal signals. Despite receiving steroids as well as antibacterial and antiviral treatment, he developed urinary and fecal dysfunction, inability to walk, and deterioration of consciousness. Both brain and spinal cord MRI revealed abnormal findings, and next-generation sequencing of the cerebrospinal fluid showed the presence of B. mandrillaris. A combination of fluconazole and albendazole was administered; however, the patient deteriorated gradually and died 30 days after the onset. We suggest the unbiased metagenomic sequencing of the affected tissues/CSF in patients with CNS infections that are difficult to diagnose or treat, and multiple tests at different stages of the disease may be required.
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Affiliation(s)
- XueMei Fan
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - TianWen Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hui Yang
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Yue Gao
- Department of General Practice, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Yue Gao, Tel +86 13706511908; +86 531-56006851, Email
| | - Yan Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China,Correspondence: Yan Chen, Department of Neurology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, No. 261, Huan Sha Road, Shangcheng District, Hangzhou, People’s Republic of China, Tel +86 15397086693; +86 531-56006952, Email
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Law CTY, Nivesvivat T, Xiong Q, Kulkeaw K, Shi L, Ruenchit P, Suwanpakdee D, Suwanpakdee P, Tongkrajang N, Sarasombath PT, Tsui SKW. Mitochondrial genome diversity of Balamuthia mandrillaris revealed by a fatal case of granulomatous amoebic encephalitis. Front Microbiol 2023; 14:1162963. [PMID: 37213512 PMCID: PMC10196457 DOI: 10.3389/fmicb.2023.1162963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Balamuthia (B.) mandrillaris is a free-living amoeba that can cause rare yet fatal granulomatous amoebic encephalitis (GAE). However, efficacious treatment for GAE is currently unavailable, especially when genomic studies on B. mandrillaris are limited. Methods In this study, B. mandrillaris strain KM-20 was isolated from the brain tissue of a GAE patient, and its mitochondrial genome was de novo assembled using high-coverage Nanopore long reads and Illumina short reads. Results and Discussion Phylogenetic and comparative analyses revealed a range of diversification in the mitochondrial genome of KM-20 and nine other B. mandrillaris strains. According to the mitochondrial genome alignment, one of the most variable regions was observed in the ribosomal protein S3 (rps3), which was caused by an array of novel protein tandem repeats. The repeating units in the rps3 protein tandem region present significant copy number variations (CNVs) among B. mandrillaris strains and suggest KM-20 as the most divergent strain for its highly variable sequence and highest copy number in rps3. Moreover, mitochondrial heteroplasmy was observed in strain V039, and two genotypes of rps3 are caused by the CNVs in the tandem repeats. Taken together, the copy number and sequence variations of the protein tandem repeats enable rps3 to be a perfect target for clinical genotyping assay for B. mandrillaris. The mitochondrial genome diversity of B. mandrillaris paves the way to investigate the phylogeny and diversification of pathogenic amoebae.
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Affiliation(s)
- Cherie Tsz-Yiu Law
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thirapa Nivesvivat
- Infectious Disease Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Qing Xiong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kasem Kulkeaw
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ling Shi
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Pichet Ruenchit
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Detchvijitr Suwanpakdee
- Infectious Disease Unit, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Piradee Suwanpakdee
- Neurology Division, Department of Pediatrics, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nongnat Tongkrajang
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patsharaporn T. Sarasombath
- Siriraj Integrative Center for Neglected Parasitic Diseases, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Patsharaporn T. Sarasombath, ;
| | - Stephen Kwok-Wing Tsui
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Hong Kong Bioinformatics Centre, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- *Correspondence: Stephen Kwok-Wing Tsui,
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10
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Zinc Oxide Nanoconjugates against Brain-Eating Amoebae. Antibiotics (Basel) 2022; 11:antibiotics11101281. [DOI: 10.3390/antibiotics11101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Naegleria fowleri and Balamuthia mandrillaris are opportunistic protists, responsible for fatal central nervous system infections such as primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) with mortality rates higher than 90%. Threatening a rise in cases is the increase in temperature due to global warming. No effective treatment is currently available. Herein, nanotechnology was used to conjugate Zinc oxide with Ampicillin, Ceftrixon, Naringin, Amphotericin B, and Quericitin, and the amoebicidal activity and host cell cytotoxicity of these resulting compounds were investigated. The compounds ZnO-CD-AMPi, ZnO-CD-CFT, ZnO-CD-Nar, ZnO-CD-AMB, and ZnO-CD-QT were found to reduce N. fowleri viability to 35.5%, 39.6%, 52.0%, 50.8%, 35.9%, and 69.9%, respectively, and B. mandrillaris viability to 40.9%, 48.2%, 51.6%, 43.8%, and 62.4%, respectively, when compared with their corresponding controls. Furthermore, the compounds reduced N. fowleri-mediated and B. mandrillaris-mediated host cell death significantly. Additionally, the compounds showed limited cytotoxicity against human cells; cell toxicity was 35.5%, 36.4%, 30.9%, 36.6%, and 35.6%, respectively, for the compounds ZnO-CD-AMPi, ZnO-CD-CFT, ZnO-CD-Nar, ZnO-CD-AMB, and ZnO-CD-QT. Furthermore, the minimum inhibitory concentrations to inhibit amoeba growth by 50% were determined for N. fowleri and B. mandrillaris. The MIC50 for N. fowleri were determined to be 69.52 µg/mL, 82.05 µg/mL, 88.16 µg/mL, 95.61 µg/mL, and 85.69 µg/mL, respectively; the MIC50 of the compounds for B. mandrillaris were determined to be 113.9 µg/mL, 102.3 µg/mL, 106.9 µg/mL, 146.4 µg/mL, and 129.6 µg/mL, respectively. Translational research to further develop therapies based on these compounds is urgently warranted, given the lack of effective therapies currently available against these devastating infections.
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11
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Tao K, Wang T, Zhang L, Yang XC, Zhai ZF. Fatal Balamuthia mandrillaris infection with red plaques on the nasal dorsum as the first presentation. An Bras Dermatol 2022; 97:498-500. [PMID: 35691739 PMCID: PMC9263639 DOI: 10.1016/j.abd.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022] Open
Abstract
Balamuthia mandrillaris infection is a rare infectious disease around the world, with high rates of morbidity and mortality. Its early and correct diagnosis is a big challenge for us, and without it the delay in starting effective treatment can lead to the development of encephalitis. This is a report of a case of Balamuthia mandrillaris infection in a Chinese boy, with red plaques on the nasal dorsum as the first presentation, who finally developed into fatal encephalitis. The authors have reviewed the related literature and share the special skin features in order to favor the early diagnosis of the disease and increase the chances of survival.
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Affiliation(s)
- Kang Tao
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ting Wang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Lian Zhang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xi-Chuan Yang
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhi-Fang Zhai
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical University, Chongqing, China.
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12
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Wang L, Li B, Zhao T, Wang L, Jian Z, Cheng W, Chen J, Li C, Wang G, Gao T. Treatment of cutaneous Balamuthia mandrillaris infection with diminazene aceturate: a report of 4 cases. Clin Infect Dis 2022; 75:1637-1640. [PMID: 35514134 DOI: 10.1093/cid/ciac356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Indexed: 11/14/2022] Open
Abstract
Four cases of cutaneous Balamuthia mandrillaris infection were treated with diminazene aceturate. One patient was cured with mainly monotherapy, 2 patients were cured with diminazene aceturate and excision, and 1 patient died of drug induced liver damage. This is the first report of Balamuthia mandrillaris infection treated with diminazene aceturate.
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Affiliation(s)
- Lei Wang
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Bing Li
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Tao Zhao
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Lu Wang
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Zhe Jian
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Wenjing Cheng
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Jiaxi Chen
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, the Fourth Military Medical University, No. 127 of Changlexi Road, Xian 710032, China
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13
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Levinson S, Kumar KK, Wang H, Tayyar R, Dunning M, Toland A, Budvytiene I, Vogel H, Chang A, Banaei N, Shuer L. Balamuthia mandrillaris brain infection: a rare cause of a ring-enhancing central nervous system lesion. Illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE2268. [PMID: 36303497 PMCID: PMC9379710 DOI: 10.3171/case2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND An 80-year-old man presented with subacute mental status change, dizziness, and left-sided vision loss. Magnetic resonance imaging demonstrated a ring-enhancing right parietooccipital lesion. OBSERVATIONS Biopsy and laboratory testing demonstrated an amoebic Balamuthia mandrillaris infection. Fewer than 200 cases of this infection have been recognized in the United States, and no standardized treatment regimen currently exists. LESSONS Rapid antimicrobial therapy with miltefosine, azithromycin, fluconazole, flucytosine, sulfadiazine, and albendazole was initiated. The pathophysiology, diagnosis, and management of this infection and the patient’s course were reviewed. The importance of biopsy for pathologic and laboratory diagnosis and rapid treatment initiation with a multidisciplinary team was reinforced.
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Affiliation(s)
| | | | | | - Ralph Tayyar
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
| | - Megan Dunning
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
| | | | | | | | - Amy Chang
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
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14
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Seas C, Legua P. Meningoencephalitis Due to Free-Living Amoebas in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40475-022-00254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Zhang Z, Liang J, Wei R, Feng X, Wang L, Wang L, Zhao P, Yu H, Gu Y, Yao Z. Facial Balamuthia mandrillaris infection with neurological involvement in an immunocompetent child. THE LANCET. INFECTIOUS DISEASES 2022; 22:e93-e100. [PMID: 34838200 DOI: 10.1016/s1473-3099(21)00334-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Cutaneous infection by Balamuthia mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement. It often evades timely diagnosis due to its rarity and non-specific clinical manifestations. Patients can be either immunocompetent or immunocompromised. It is probably transmitted via inhalation or inoculation through broken skin, and then spreads to the brain and other organs through haematogenous spread. It is important for clinicians to be aware of this disease because rapid diagnosis and subsequent therapy has, in some cases, been associated with survival. In this Grand Round, we report the case of a 7-year-old boy who presented with large, chronic plaques on his face. Several biopsies showed non-specific granulomatous inflammation. The patient deteriorated rapidly and died within 1 month of displaying abnormal symptoms in the CNS. Immunohistochemical staining of skin tissue identified B mandrillaris as the infectious agent. The diagnosis was confirmed with PCR, which detected B mandrillaris DNA in formalin-fixed skin tissue sections. B mandrillaris infection should be considered in the differential diagnosis of patients with chronic granulomatous lesions. We also reviewed the epidemiology, B mandrillaris in nature and in the laboratory, clinical manifestations, histopathology, diagnosis, and treatment of infection.
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Affiliation(s)
- Zhen Zhang
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianying Liang
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ruoqu Wei
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaobo Feng
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Liuhui Wang
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Piaoping Zhao
- Department of Dermatology, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Yu
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Gu
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, and Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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16
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Alvarez P, Torres-Cabala C, Gotuzzo E, Bravo F. Cutaneous balamuthiasis: A clinicopathological study. JAAD Int 2022; 6:51-58. [PMID: 35059659 PMCID: PMC8760460 DOI: 10.1016/j.jdin.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Patricia Alvarez
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Correspondence to: Patricia Alvarez, MD, Patologia cutánea, Av. Angamos Oeste 896, Miraflores Lima, Peru.
| | - Carlos Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Francisco Bravo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Cayetano Heredia, Lima, Peru
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17
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Peng L, Zhou Q, Wu Y, Cao X, Lv Z, Su M, Yu Y, Huang W. A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication. BMC Infect Dis 2022; 22:54. [PMID: 35032997 PMCID: PMC8760828 DOI: 10.1186/s12879-021-07020-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Granulomatous amoebic encephalitis (GAE) is a rare central nervous system infection caused by the Balamuthia mandrillaris or Acanthamoeba species. Diagnosis is challenging because of the non-specific clinical presentation, cerebrospinal fluid analysis, and radiological features. There is no effective treatment for GAE to date. CASE PRESENTATION A 54-year-old male was admitted to hospital after experiencing acute onset of numbness and weakness on his left limb. Due to the initial consideration of intracranial tumor, surgical removal of the right parietal lesion was performed. However, the patient had a headache accompanied by diplopia, difficulty walking and a new lesion was found in the left occipital-parietal lobe two weeks after the first operation. High-throughput next-generation sequencing (NGS) detected the presence of high copy reads of the B. mandrillaris genome sequence in the patient's blood, cerebral spinal fluid (CSF), and brain tissue. Pathological investigation of the brain tissue showed granulomatous changes and amoebic trophozoite scattered around blood vessels under high magnification. The patient was re-operated due to developing progressive confusion caused by subfalcine herniation of the left cerebral hemisphere. The lesions of the right parietal lobe were obviously decreasing in size after the first surgery, and the lesions of the left occipital lobe and the sunfalcine herniation didn't ameliorate two months after the second surgery. The patient was transferred to local hospital for continuous treatment with sulfamethoxazole and azithromycin. After five months of the second surgery, the patient showed good recovery with mild headache. CONCLUSIONS This is the first report of a patient with B. mandrillaris encephalitis initially confirmed by NGS and have experienced two excisions, responding favorably to the combination of surgeries and medications. Early surgical resection of intracranial lesions combined with drug treatment may offer the chance of a cure.
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Affiliation(s)
- Limei Peng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Quan Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yu Wu
- Department of Neuroscience, University of Pittsburgh, 15262, Pittsburgh, PA, USA
| | - Xiaoli Cao
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Zili Lv
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Minghua Su
- Department of Infection, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, China
| | - Yachun Yu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Wen Huang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
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18
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Ai J, Zhang H, Yu S, Li J, Chen S, Zhang W, Mao R. A case of fatal amoebic encephalitis caused by Balamuthia mandrillaris, China. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 97:105190. [PMID: 34954104 DOI: 10.1016/j.meegid.2021.105190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
We reported a case of B.mandrillaris amoebic encephalitis in mainland China. Metagenomics next-generation sequencing helped initial diagnosis and then polymerase chain reaction of the B.mandrillaris in the infected nasal skin tissues reported positive and amoeba cysts were found in the tissue under microscopic observation.
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Affiliation(s)
- Jingwen Ai
- Huashan Hospital of Fudan University, Shanghai, China
| | - Hanyue Zhang
- Huashan Hospital of Fudan University, Shanghai, China.
| | - Shenglei Yu
- Huashan Hospital of Fudan University, Shanghai, China
| | - Jian Li
- Huashan Hospital of Fudan University, Shanghai, China
| | - Shu Chen
- Huashan Hospital of Fudan University, Shanghai, China.
| | - Wenhong Zhang
- Huashan Hospital of Fudan University, Shanghai, China
| | - Richeng Mao
- Huashan Hospital of Fudan University, Shanghai, China.
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19
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Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease. Front Med 2021; 15:842-866. [PMID: 34825341 DOI: 10.1007/s11684-021-0865-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/25/2021] [Indexed: 10/19/2022]
Abstract
Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which Naegleria fowleri followed by Acanthamoeba spp. and Balamuthia mandrillaris have been successively discovered. As the three dominant genera responsible for infections, Acanthamoeba and Balamuthia work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas Naegleria induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.
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20
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Bhosale NK, Parija SC. Balamuthia mandrillaris: An opportunistic, free-living ameba - An updated review. Trop Parasitol 2021; 11:78-88. [PMID: 34765527 PMCID: PMC8579774 DOI: 10.4103/tp.tp_36_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023] Open
Abstract
Balamuthia mandrillaris is an opportunistic, free-living ameba that is pathogenic to humans. It has a worldwide distribution but is mainly detected in warmer regions. Balamuthia infections are rare but have been reported in both immunocompetent and immunocompromised individuals of all ages. B. mandrillaris can enter through wounds on the skin or the nose and cause cutaneous lesions and the usually fatal Balamuthia amebic encephalitis (BAE). Infection usually spreads from the lungs or through nerve fibers, and attacks the central nervous system, forming granulomatous lesions and necrosis in the brain. Balamuthia infection is usually chronic, and patients initially present with nonspecific symptoms, including headache, nausea, myalgia, and low-grade fever. As the disease progresses, the patient becomes paralyzed and comatose, often leading to death. Lack of knowledge of predisposing factors, specific treatment, and standardized detection tools have resulted in a nearly cent percent fatality rate. Although only about 200 cases have been reported worldwide since its characterization in the 1990s, the number of reported cases has increased over the years. BAE is an emerging disease and a major health concern. Few patients have survived Balamuthia infections with antimicrobial treatment that has largely been empirical. Early diagnosis is the key and requires familiarity with the disease and a high degree of suspicion on the part of the diagnostician. There are currently no specific treatment and prevention recommendations. This review highlights our current understanding of B. mandrillaris in terms of its pathogenicity, genomics, and novel diagnostic and therapeutic approaches against BAE infections.
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Affiliation(s)
- Namrata K Bhosale
- Department of Microbiology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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21
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Sarink MJ, van der Meijs NL, Denzer K, Koenderman L, Tielens AGM, van Hellemond JJ. Three encephalitis-causing amoebae and their distinct interactions with the host. Trends Parasitol 2021; 38:230-245. [PMID: 34758928 DOI: 10.1016/j.pt.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 01/21/2023]
Abstract
Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba spp. can cause devastating brain infections in humans which almost always result in death. The symptoms of the three infections overlap, but brain inflammation and the course of the disease differ, depending on the amoeba that is responsible. Understanding the differences between these amoebae can result in the development of strategies to prevent and treat these infections. Recently, numerous scientific advancements have been made in the understanding of pathogenicity mechanisms in general, and the basic biology, epidemiology, and the human immune response towards these amoebae in particular. In this review, we combine this knowledge and aim to identify which factors can explain the differences between the lethal brain infections caused by N. fowleri, B. mandrillaris, and Acanthamoeba spp.
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Affiliation(s)
- Maarten J Sarink
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Nadia L van der Meijs
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Kristin Denzer
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Center for Translational Immunology (CTI), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aloysius G M Tielens
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands
| | - Jaap J van Hellemond
- Erasmus MC, University Medical Center Rotterdam, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands.
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22
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Abstract
Infections caused by Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris result in a variety of clinical manifestations in humans. These amoebae are found in water and soil worldwide. Acanthamoeba spp. and B. mandrillaris cause granulomatous amoebic encephalitis, which usually presents as a mass, while N. fowleri causes primary amoebic meningoencephalitis. Acanthamoeba spp. can also cause keratitis, and both Acanthamoeba spp. and B. mandrillaris can cause lesions in skin and respiratory mucosa. These amoebae can be difficult to diagnose clinically as these infections are rare and, if not suspected, can be misdiagnosed with other more common diseases. Microscopy continues to be the key first step in diagnosis but the amoeba can be confused with macrophages or other infectious agents if an expert in infectious disease pathology or clinical microbiology is not consulted. Although molecular methods can be helpful in establishing the diagnosis, these are only available in referral centers. Treatment requires combination of antibiotics and antifungals and, even with prompt diagnosis and treatment, mortality for neurological disease is extremely high.
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23
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Matsushita K, Hess S, Marchandot B, Sato C, Truong DP, Kim NT, Weiss A, Jesel L, Ohlmann P, Morel O. Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic. J Thromb Thrombolysis 2020; 52:95-104. [PMID: 33200333 PMCID: PMC7668406 DOI: 10.1007/s11239-020-02340-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 02/07/2023]
Abstract
Although a reduction in hospital admissions of acute coronary syndromes (ACS) patients has been observed globally during the coronavirus disease 2019 (COVID-19) pandemic, clinical features of those patients have not been fully investigated. The aim of the present analysis is to investigate the incidence, clinical presentation, and outcomes of patients with ACS during the COVID-19 pandemic. We performed a retrospective analysis of consecutive patients who were admitted for ACS at our institution between March 1 and April 20, 2020 and compared with the equivalent period in 2019. Admissions for acute myocardial infarction (AMI) reduced by 39.5% in 2020 compared with the equivalent period in 2019. Owing to the emergency medical services (EMS) of our region, all time components of ST-elevated myocardial infarction care were similar during the COVID-19 outbreak as compared with the previous year’s dataset. Among the 106 ACS patients in 2020, 7 patients tested positive for COVID-19. Higher incidence of type 2 myocardial infarction (29% vs. 4%, p = 0.0497) and elevated D-dimer levels (5650 μg/l [interquartile range (IQR) 1905–13,625 μg/l] vs. 400 μg/l [IQR 270–1050 μg/l], p = 0.02) were observed in COVID-19 patients. In sum, a significant reduction in admission for AMI was observed during the COVID-19 pandemic. COVID-19 patients were characterized by elevated D-dimer levels on admission, reflecting enhanced COVID-19 related thrombogenicity. The prehospital evaluation by EMS may have played an important role for the timely revascularization for STEMI patients.
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Affiliation(s)
- Kensuke Matsushita
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Sebastien Hess
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Benjamin Marchandot
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Chisato Sato
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Dinh Phi Truong
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Ngoc Thanh Kim
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Anne Weiss
- Centre Hospitalier Universitaire, SAMU 67, Strasbourg, France
| | - Laurence Jesel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France.,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Patrick Ohlmann
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France
| | - Olivier Morel
- Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg cedex, France. .,UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France.
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