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Encephalomyelomeningitis Caused by Balamuthia mandrillaris: A Case Report and Literature Review

XueMei Fan1, TianWen Chen1, Hui Yang1

  • 1Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.

Infection and Drug Resistance
|February 9, 2023
PubMed

Insights

Balamuthia mandrillaris central nervous system infection is a rare, severe condition with a 95% fatality rate. Early diagnosis is challenging, often requiring advanced sequencing techniques for effective treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Balamuthia mandrillaris causes rare, severe central nervous system (CNS) infections.
  • These infections have a high fatality rate (approx. 95%) and are difficult to diagnose.
  • Non-specific clinical signs and rarity contribute to diagnostic delays.

Observation:

  • A case of encephalomyelomeningitis caused by B. mandrillaris in a male garbage dump worker.
  • Initial symptoms included transient coma, nausea, and vomiting with normal brain MRI.
  • Clinical deterioration occurred despite steroids, antibacterial, and antiviral treatments.

Findings:

  • Progressive neurological decline with urinary/fecal dysfunction and impaired mobility.
  • Abnormal findings on both brain and spinal cord MRI.
  • Next-generation sequencing of cerebrospinal fluid confirmed B. mandrillaris presence.
  • Treatment with fluconazole and albendazole was ineffective, leading to death 30 days post-onset.

Implications:

  • Highlights the diagnostic challenges of B. mandrillaris CNS infections.
  • Suggests unbiased metagenomic sequencing of cerebrospinal fluid (CSF) for difficult cases.
  • Emphasizes the potential need for multiple diagnostic tests at different disease stages.
  • Underscores the critical need for rapid and accurate diagnostic methods for rare CNS pathogens.
Keywords:
Balamuthia mandrillaris amoebacase reportcerebrospinal fluidencephalomyelomeningitisnext-generation sequencing

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