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      Disseminated Balamuthia mandrillaris Infection

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          Abstract

          Balamuthia mandrillarisis a rare cause of human infection, but when infections do occur, they result in high rates of morbidity and mortality. A case of disseminated Balamuthiainfection is presented. Early diagnosis and initiation of recommended therapy are essential for increased chances of successful outcomes.

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          Balamuthia mandrillaris infection of the skin and central nervous system: an emerging disease of concern to many specialties in medicine.

          Francisco Bravo, Patricia J Alvarez, Eduardo Gotuzzo (2011)
          Balamuthia mandrillaris infection of the skin and central nervous system has been increasingly reported in the last decade, making this entity a genuine emerging disease. The ability of the clinician in recognizing the skin lesion early in the course of the disease may lead to a successful therapeutic intervention in an otherwise fatal disease.
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            Transmission of Balamuthia mandrillaris through solid organ transplantation: utility of organ recipient serology to guide clinical management.

            A A Gupte, S N Hocevar, A S Lea … (2014)
            A liver, heart, iliac vessel and two kidneys were recovered from a 39-year-old man who died of traumatic head injury and were transplanted into five recipients. The liver recipient 18 days posttransplantation presented with headache, ataxia and fever, followed by rapid neurologic decline and death. Diagnosis of granulomatous amebic encephalitis was made on autopsy. Balamuthia mandrillaris infection was confirmed with immunohistochemical and polymerase chain reaction (PCR) assays. Donor and recipients' sera were tested for B. mandrillaris antibodies. Donor brain was negative for Balamuthia by immunohistochemistry and PCR; donor serum Balamuthia antibody titer was positive (1:64). Antibody titers in all recipients were positive (range, 1:64-1:512). Recipients received a four- to five-drug combination of miltefosine or pentamidine, azithromycin, albendazole, sulfadiazine and fluconazole. Nausea, vomiting, elevated liver transaminases and renal insufficiency were common. All other recipients survived and have remained asymptomatic 24 months posttransplant. This is the third donor-derived Balamuthia infection cluster described in solid organ transplant recipients in the United States. As Balamuthia serologic testing is only available through a national reference laboratory, it is not feasible for donor screening, but may be useful to determine exposure status in recipients and to help guide chemotherapy.
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              Cytopathogenicity of Balamuthia mandrillaris, an opportunistic causative agent of granulomatous amebic encephalitis.

              Albrecht Kiderlen, Phiroze Tata, Muhsin Ozel … (2016)
              Balamuthia mandrillaris is a free-living ameba and an opportunistic agent of lethal granulomatous amebic encephalitis in humans and other mammals. Balamuthia mandrillaris is highly cytopathic but, in contrast to the related Acanthamoeba, does not feed on bacteria and seems to feed only on eukaryotic cells instead. Most likely, the cytopathogenicity of B. mandrillaris is inseparable from its infectivity and pathogenicity. To better understand the mechanisms of B. mandrillaris cytopathogenicity, an assay for measuring amebic cytolytic activity was adapted that is based on the release of a reporter enzyme by damaged target cells. The ameba is shown to lyse murine mastocytoma cells very efficiently in a time- and dose-related manner. Furthermore, experiments involving semipermeable membranes and phagocytosis inhibitors indicate that the cytolytic activity of B. mandrillaris is essentially cell contact-dependent. Standard and fluorescence light microscopy, as well as scanning and transmission electron microscopy support and extend these findings at the ultrastructural level.
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                Author and article information

                Journal
                Title: Journal of Clinical Microbiology
                Abbreviated Title: J. Clin. Microbiol.
                Publisher: American Society for Microbiology
                ISSN (Print): 0095-1137
                ISSN (Electronic): 1098-660X
                Publication date Created: August 18 2015
                Publication date Created: September 2015
                Publication date (Print): September 2015
                Publication date (Electronic): July 01 2015
                Volume: 53
                Issue: 9
                Pages: 3072-3076
                Article
                DOI: 10.1128/JCM.01549-15
                PubMed ID: 26135864
                SO-VID: 0576a12c-ffa8-4524-a3d1-e82f146db4b5
                Copyright © © 2015
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