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Amebic encephalitis caused by Balamuthia mandrillaris: report of four cases
Anna Bakardjiev1, Parvin H Azimi, Negar Ashouri
1Children's Hospital of Oakland, Oakland, CA, USA.
Abstract:
We report four fatal cases of amebic encephalitis in children caused by the free-living pathogenic ameba Balamuthia mandrillaris. The clinical course ranged from subacute to fulminant. Provisional diagnoses were made either shortly before death or postmortem by an indirect immunofluorescent antibody test. Although the four cases occurred in different geographic locations, their common features may have diagnostic value for recognizing future cases of amebic encephalitis. The cases occurred in children 2 to 7.5 years old who were ostensibly immunocompetent and of Hispanic ethnicity. Three of the four children developed hydrocephalus during their illness. Increased awareness and timely diagnosis of this disease entity might lead to earlier intervention with improved outcome.
Insights
Four immunocompetent Hispanic children died from Balamuthia mandrillaris amebic encephalitis. Recognizing common features like hydrocephalus may improve early diagnosis and outcomes for this rare infection.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Balamuthia mandrillaris is a free-living ameba capable of causing fatal granulomatous amebic encephalitis.
- Amebic encephalitis is a rare but devastating infection of the central nervous system.
Observation:
- Four pediatric cases of Balamuthia mandrillaris infection were identified.
- The children were aged 2 to 7.5 years, appeared immunocompetent, and were of Hispanic ethnicity.
- Clinical presentations varied from subacute to fulminant, with three cases developing hydrocephalus.
Findings:
- Diagnosis was often delayed, confirmed by indirect immunofluorescent antibody testing postmortem or shortly before death.
- Despite occurring in different geographic locations, shared clinical features were noted among the cases.
- The pathogen identified was Balamuthia mandrillaris, a cause of granulomatous amebic encephalitis.
Implications:
- Increased awareness of Balamuthia mandrillaris encephalitis in children is crucial for earlier recognition.
- Identifying common diagnostic features may aid in timely intervention.
- Prompt diagnosis and treatment could potentially improve the poor prognosis associated with this infection.