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Amebic meningoencephalitis caused by Balamuthia mandrillaris
D A Griesemer1, L L Barton, C M Reese
1Department of Neurology, Medical University of South Carolina, Charleston 29425.
Pediatric Neurology
|May 1, 1994
Summary
Balamuthia mandrillaris, a soil ameba, caused fatal central nervous system infections in two children. This organism should be considered in pediatric stroke diagnoses.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Central nervous system (CNS) infections in children are primarily caused by Acanthamoeba and Naegleria.
- Leptomyxid ameba, recently classified as Balamuthia mandrillaris, is an emerging cause of CNS infections.
Observation:
- Two previously healthy children presented with CNS infections due to Balamuthia mandrillaris.
- Clinical manifestations included hemiparesis, aphasia, headache, diplopia, and facial weakness.
- Cerebrospinal fluid analysis revealed mononuclear pleocytosis and mildly elevated protein.
Findings:
- Both children developed severe neurological complications, including seizures, cerebrovascular occlusions, hydrocephalus, and coma.
- Autopsy in one child revealed necrotizing meningoencephalitis, arteritis, and amebic trophozoites and cysts.
- Indirect immunofluorescence confirmed CNS infection with B. mandrillaris in both cases.
Implications:
- Balamuthia mandrillaris, previously considered a non-pathogenic soil organism, is a significant cause of pediatric CNS disease.
- This ameba should be included in the differential diagnosis for atypical or progressive childhood stroke.
- Early diagnosis and treatment are crucial for improving outcomes in Balamuthia mandrillaris infections.