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screening swiss water bodies for potentially pathogenic free-living amoebae.free-ling amoebae (fla) including acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris and sappinia pedata, can cause opportunistic infections leading to severe brain pathologies. human infections with pathogenic fla have been increasingly documented in many countries. in switzerland, thus far, the occurrence and distribution of potentially pathogenic fla has not been investigated. swiss water biotopes, including swimming pools, lakes, rivers and ponds, have now been screened for the pr ...200919589386
a rare but fatal case of granulomatous amebic encephalitis with brain abscess: the first case reported from turkey.the incidence of protozoal and helminthic infestations of the central nervous system (cns) is less than 1%, but these infestations tend to follow a fatal course. they are more common among children, the elderly and immunocompromised individuals. cns infections due to entamoeba histolytica have been known for a long time. in recent years, especially in developing countries, there has been an increase in cns infections due to free-living amebas (flas). acute cns infection due to naegleria fowleri, ...200919621290
diagnosis of infections caused by pathogenic free-living amoebae.naegleria fowleri, acanthamoeba spp., balamuthia mandrillaris, and sappinia sp. are pathogenic free-living amoebae. n. fowleri causes primary amoebic meningoencephalitis, a rapidly fatal disease of the central nervous system, while acanthamoeba spp. and b. mandrillaris cause chronic granulomatous encephalitis. acanthamoeba spp. also can cause cutaneous lesions and amoebic keratitis, a sight-threatening infection of the cornea that is associated with contact lens use or corneal trauma. sappinia p ...200919657454
isolation of balamuthia mandrillaris from urban dust, free of known infectious involvement.the free-living amoeba balamuthia mandrillaris can cause fatal encephalitis in humans and other mammals. the organism is associated with soils, and soil exposure has been identified as a risk factor for this pathogen. however, b. mandrillaris has been isolated only once from soils believed to be the source of the infection in child from california, usa who died of balamuthia amoebic encephalitis and once from another unrelated soil source. we report for a third time the isolation of b. mandrilla ...200919685076
balamuthia mandrillaris: role of galactose in encystment and identification of potential inhibitory targets.balamuthia mandrillaris is a causative agent of granulomatous encephalitis that almost always proves fatal. a major concern during the course of therapy is that b. mandrillaris can transform into cysts. cysts are highly resistant to physical and chemical conditions and present a problem in successful antimicrobial chemotherapy. however, the underlying mechanisms of b. mandrillaris transformation into cysts are not known. in this study, we examined the effects of exogenous sugars on b. mandrillar ...201019766634
balamuthia mandrillaris: the multiple nuclei of balamuthia amebas; their location, activity, and site of development.multiple nuclei were first noted in the pseudopodia of balamuthia mandrillaris amebas feeding on mammalian cells. phase microscope observations of live amebas in vitro reveal that while many amebas have a single nucleus, others have multiple nuclear-like structures, now confirmed as nuclei with hematoxylin and feulgen stains. in the live cultures, two nuclei located near the tip of an extended pseudopodium were seen to fuse resulting in one larger morphologic unit. such merging of nuclei has not ...201019857489
balamuthia and acanthamoeba-binding antibodies in west african human sera.little is known about the prevalence of balamuthia mandrillaris amoebae and balamuthia amoebic encephalitis in africa. as an approach, relative concentrations of amoebae-binding serum antibodies (ab) were assessed by flow cytometry using formaldehyde-fixed b. mandrillaris, acanthamoeba lenticulata 72-2 and acanthamoeba castellanii 1bu amoebae for specific ab capture (b.m.-ab, a.l.-ab, a.c.-ab). one hundred and ninety-two sera from west african (côte d'ivoire) donors aged 11-95years (mean 38 a; 5 ...201019896940
screening of swiss hot spring resorts for potentially pathogenic free-living amoebae.free-living amoebae (fla) belonging to acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris, and sappinia pedata are known to cause infections in humans and animals leading to severe brain pathologies. worldwide, warm aquatic environments have been found to be suitable habitats for pathogenic fla. the present study reports on screening for potentially pathogenic fla in four hot spring resorts in switzerland. water samples were taken from water filtration units and from the pools, respec ...201020036656
delivery of amphotericin b nanosuspensions to the brain and determination of activity against balamuthia mandrillaris amebas.amphotericin b was formulated as nanosuspensions to develop a nanoparticulate brain delivery system. nanosuspensions were produced with different surfactant solutions by high-pressure homogenization and then characterized by laser diffractometry and photon correlation spectroscopy. before in vitro and in vivo testing all nanosuspensions were investigated for protein adsorption by two-dimensional polyacrylamide gel electrophoresis to predict brain-targeting capacities. selected nanosuspensions we ...201020060497
balamuthia mandrillaris meningoencephalitis: survival of a pediatric patient.balamuthia mandrillaris infections are rare and almost always fatal. this ameba is a naturally occurring soil inhabitant that can cause disease in immunocompetent hosts, with early diagnosis typically proving difficult. we recently cared for a previously healthy 2-year-old boy who was diagnosed with meningoencephalitis secondary to b mandrillaris relatively early in his presentation, which enabled us to initiate targeted antimicrobial therapy. since discharge from the hospital the child has show ...201020123772
successful treatment of balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement.granulomatous amoebic encephalitis caused by balamuthia mandrillaris is an uncommon infection for which there is no optimal therapy. we describe a young, female patient who presented with extensive cutaneous and neurological involvement and who recovered after receiving prolonged treatment with miltefosine, fluconazole, and albendazole.201020550438
amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment.acanthamoeba spp., balamuthia mandrillaris, and naegleria fowleri, although free-living amebae, also cause devastating diseases in humans leading to death. acanthamoeba spp. and b. mandrillaris cause granulomatous amebic encephalitis, cutaneous and nasopharyngeal as well as disseminated infection. acanthamoeba also causes a vision-threatening infection of the cornea, acanthamoeba keratitis, principally in contact lens wearers. n. fowleri causes an acute, fulminating infection of the central nerv ...201020802332
balamuthia mandrillaris transmitted through organ transplantation --- mississippi, 2009.on december 14, 2009, a physician in mississippi contacted cdc to report possible transplant-transmitted encephalitis in two kidney transplant recipients who shared the same organ donor. histopathologic testing of donor autopsy brain tissue at cdc showed amebae, and subsequent testing of specimens from the donor and the two kidney recipients confirmed transmission by transplantation of balamuthia granulomatous amebic encephalitis (gae), a rare disease caused by balamuthia mandrillaris, a free-li ...201020847719
notes from the field: transplant-transmitted balamuthia mandrillaris --- arizona, 2010.on august 23, 2010, cdc was notified regarding two organ transplant recipients in arizona who had encephalitis with multiple ring-enhancing lesions revealed by cerebral magnetic resonance imaging. the common organ donor, a hispanic male landscaper aged 27 years, had died in arizona from a presumed stroke on july 21. he had a large skin lesion for approximately 6 months on his back that he had attributed to an insect bite. the ill recipients, a male liver recipient aged 56 years, and a male recip ...201020847722
balamuthia mandrillaris brain abscess successfully treated with complete surgical excision and prolonged combination antimicrobial therapy.amoebic encephalitis is an uncommon and usually fatal condition. this case describes successful treatment of a balamuthia mandrillaris brain abscess using prolonged antimicrobial agents with complete excision. it illustrates the risk of dissemination from cutaneous to cerebral amoebic lesions, potential progression with corticosteroid therapy, and the prospect for curative excision.201021073255
granulomatous amoebic meningoencephalitis in an immunocompetent patient.to report a case of granulomatous amoebic encephalitis caused by balamuthia mandrillaris.201021149814
another case of canine amoebic meningoencephalitis--the challenges of reaching a rapid diagnosis.a case of granulomatous amoebic meningoencephalitis in a previously healthy, mature, apparently immunocompetent dog, with a history of exposure to stagnant water, is reported. the case presented with ataxia and a tendency to fall to the left side. a computed tomography (ct) showed a ring-enhancing lesion within the cerebellum; an examination of cerebrospinal fluid (csf) revealed nonspecific mixed-cell pleocytosis. despite antibiotic and anti-inflammatory therapy, clinical signs progressed rapidl ...201021161275
balamuthia mandrillaris infection of the skin and central nervous system: an emerging disease of concern to many specialties in medicine.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.201121192259
best cases from the afip: balamuthia mandrillaris amebic meningoencephalitis. 201121257931
development of a nested pcr for environmental detection of the pathogenic free-living amoeba balamuthia mandrillaris.a dna extraction and nested pcr method for detecting the pathogenic amoeba balamuthia mandrillaris from the environment was developed. sixteen of 17 californian soil samples were positive compared with 0/44 from the united kingdom. this approach will enable a greater understanding of b. mandrillaris ecology, geographic distribution, and public health risk.201121435080
balamuthia mandrillaris: staining properties of cysts and trophozoites and the effect of 2,6-dichlorobenzonitrile and calcofluor white on encystment.here, we determined the staining properties of balamuthia mandrillaris cysts, and assessed the effect of 2, 6-dichlorobenzonitrile (dcb), a cellulose synthesis inhibitor, and calcofluor white, a brightening agent, on its encystment. periodic acid-schiff reagent stained the inner wall intensely and middle and outer walls weakly suggesting that the cyst wall of b. mandrillaris may contain glycans. furthermore, cysts, but not trophozoites, fluoresced when stained with calcofluor white. calcofluor w ...200921462548
fatal balamuthia mandrillaris infection in a gorilla - first case of balamuthiasis in germany.background  a 12-year-old female western lowland gorilla died in a zoological garden in germany after exhibiting general neurological signs. methods  balamuthia mandrillaris was identified as causative agent by indirect immunofluorescent staining of brain sections and confirmed by pcr and respective sequencing. results  the animal suffered from a chronic progressive necrotizing amebic meningoencephalitis. conclusion  this is the first case of balamuthia amebic encephalitis in germany.201121496054
the use of high-resolution (1)h nuclear magnetic resonance (nmr) spectroscopy in the clinical diagnosis of acanthamoeba.acanthamoeba are opportunistic protozoan pathogens that can produce sight-threatening keratitis and fatal granulomatous encephalitis. the successful prognosis requires early diagnosis and differentiation of pathogenic acanthamoeba spp. followed by aggressive treatment regimen. in this study, we tested the use of high-resolution (1)h nmr spectroscopy in the clinical diagnosis of acanthamoeba. using nmr spectroscopy combined with pattern recognition analysis (pra), we analysed variations in the bi ...201121556684
neurosurgical intervention in the diagnosis and treatment of balamuthia mandrillaris encephalitis.the authors describe the unique presentation of balamuthia mandrillaris encephalitis in a kidney donor and two recipients. all three patients suffered acute clinical deterioration, with radiological or clinical evidence of intracranial hypertension. brain autopsy in the donor and an urgent brain biopsy in a recipient established the diagnosis. firsttier therapy, with mannitol and csf drainage, successfully treated the intracranial hypertension in both recipients, while administration of a combin ...201121619411
asymptomatic aneurysm of the cavernous and supraclinoid internal carotid artery in a patient with balamuthia mandrillaris encephalitis.this is the first report to our knowledge of the successful treatment of an asymptomatic mycotic aneurysm associated with balamuthia mandrillaris encephalitis. a 27-year-old male with end-stage renal disease presented with generalized seizures following renal transplantation. mri demonstrated multiple brain masses and an aneurysm of the cavernous and supraclinoid carotid artery. autopsy of the donor's brain revealed balamuthia encephalitis. the patient was placed on an anti-amebic regimen, his c ...201121652212
identification of antigenic targets for immunodetection of balamuthia mandrillaris infection.the free-living amoeba balamuthia mandrillaris causes granulomatous amoebic encephalitis (gae) in humans. rapid identification of balamuthiasis is critical for effective therapeutic intervention and case management. in the present study we identified target antigens for the development of a serological assay for b. mandrillaris infection. we demonstrated by silver staining that protein profiles for all eight isolates of b. mandrillaris, independent of human or animal origin or geographic origin, ...201121653740
balamuthia amebic meningoencephalitis and mycotic aneurysms in an infant.balamuthia amebic encephalitis is rarely reported in infants. to the best of our knowledge, amebic encephalitis complicated by a mycotic aneurysm was only described once. we report on an 8-month-child with laboratory-confirmed balamuthia mandrillaris meningoencephalitis, complicated by a mycotic aneurysm of the middle cerebral artery.201121723460
granulomatous amoebic encephalitis caused by balamuthia mandrillaris.a 51-year-old immunocompetent japanese woman presented with a rare case of granulomatous amoebic encephalitis (gae) caused by balamuthia mandrillaris. she was brought to our hospital with epilepsy. magnetic resonance imaging of the brain revealed a homogeneously enhanced solitary mass in the left frontal lobe. histological diagnosis was made by a biopsy, which suggested lymphomatoid granulomatosis. after that, her neurological condition got worse. new masses were found and had spread across the ...201121946735
The public health threat from Balamuthia mandrillaris in the southern United States.Balamuthia mandrillaris, formerly known as leptomyxid ameba, is an opportunistic, free-living ameba, related to Acanthamoeba that can cause skin lesions and granulomatous amebic encephalitis in individuals with compromised or competent immune systems. In order to make recommendations for early diagnosis, management, and prevention of typically fatal Balamuthia amebic encephalitis (BAE), this review described and analyzed laboratory-confirmed US cases of BAE for any consistent behavioral, demogra ...201121954652
Granulomatous amoebic encephalitis caused by Balamuthia mandrillaris in an immunocompetent girl.OBJECTIVE: Balamuthia mandrillaris is a recently recognized cause of a rare, devastating infection, granulomatous amoebic encephalitis (GAE). Presenting symptoms of GAE are nonspecific and can last for months before becoming clinically significant. Once the infection involves the central nervous system, death often results within days to weeks. A high degree of clinical suspicion is needed to correctly diagnose this infection as definitive diagnostic tests are presently limited and even then the ...201122120559
balamuthia mandrillaris and acanthamoeba amebic encephalitis with neurotoxoplasmosis co-infection in a patient with advanced hiv infection.we describe a patient with advanced hiv infection, balamuthia mandrillaris and acanthamoeba amebic encephalitis with toxoplasma gondii co-infection. a multidisciplinary effort and state of the art diagnostic techniques were required for diagnosis. our patient is the first reported case of an hiv infected person with dual balamuthia mandrillaris and acanthamoeba amebic encephalitis with neurotoxoplasmosis co-infection.201122170911
pathogenic free-living amoebae: epidemiology and clinical review.free-living amoebae are widely distributed in soil and water. small number of them was implicated in human disease: acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris and sappinia diploidea. some of the infections were opportunistic, occurring mainly in immunocompromised hosts (acanthamoeba and balamuthia encephalitis) while others are non opportunistic (acanthamoeba keratitis, naegleria meningoencephalitis and some cases of balamuthia encephalitis). although, the number of infections ...201222520593
autopsy case of amebic granulomatous meningoencephalitis caused by balamuthia mandrillaris in japan.balamuthia mandrillaris is a free-living ameba that causes amebic encephalitis. herein, we report an autopsy case of balamuthia encephalitis proven with polymerase chain reaction (pcr) and immunohistochemistry from paraffin-embedded brain biopsy specimens. a 68-year-old japanese male presented at a hospital with progressive right hemiparesis approximately 3 months before his death. an open-brain biopsy specimen showed diffuse meningitis with massive coagulative necrosis. the perivascular spaces ...201222612511
balamuthia mandrillaris amoebic encephalitis: an emerging parasitic infection.balamuthia mandrillaris is a free living amoeba that can be isolated from soil. it is an emerging pathogen causing skin lesions as well as cns involvement with a fatal outcome if untreated. the infection has been described more commonly in inmunocompetent individuals, mostly males, many children, and with a predilection for population with hispanic background in cases occurring in the united states. except for africa, all continents have reported the disease, although a majority of cases are see ...201222729402
granulomatous encephalitis due to balamuthia mandrillaris is not limited to immune-compromised patients. 201322921039
parasitoses of the human central nervous system.cerebral involvement in parasitoses is an important clinical manifestation of most of the human parasitoses. parasites that have been described to affect the central nervous system (cns), either as the dominant or as a collateral feature, include cestodes (taenia solium (neurocysticerciasis), echinococcus granulosus (cerebral cystic echinococcosis), e. multilocularis (cerebral alveolar echinococcosis), spirometra mansoni (neurosparganosis)), nematodes (toxocara canis and t. cati (neurotoxocarias ...201323046708
killing the dead: chemotherapeutic strategies against free-living cyst-forming protists (acanthamoeba sp. and balamuthia mandrillaris).the opportunist free-living protists such as acanthamoeba spp. and balamuthia mandrillaris have become a serious threat to human life. as most available drugs target functional aspects of pathogens, the ability of free-living protists to transform into metabolically inactive cyst forms presents a challenge in treatment. it is hoped, that the development of broad spectrum antiprotist agents acting against multiple cyst-forming protists to provide target-directed inhibition will offer a viable dru ...201323346945
in vitro efficacies of clinically available drugs against growth and viability of an acanthamoeba castellanii keratitis isolate belonging to the t4 genotype.the effects of clinically available drugs targeting muscarinic cholinergic, adrenergic, dopaminergic, and serotonergic receptors; intracellular calcium levels and/or the function of calcium-dependent biochemical pathways; ion channels; and cellular pumps were tested against a keratitis isolate of acanthamoeba castellanii belonging to the t4 genotype. in vitro growth inhibition (amoebistatic) assays were performed by incubating a. castellanii with various concentrations of drugs in the growth med ...201323669391
status of free-living amoebae (acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris) in drinking water supplies in karachi, pakistan.the ability of pathogenic free-living amoebae to produce infections is a growing concern. in this study, we investigated the presence of free-living amoebae (acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris) in drinking water supplies in karachi, pakistan. fifty-two domestic tap water samples were examined. amoebae were identified by morphological characteristics and polymerase chain reaction. thirty percent of the examined samples were positive for acanthamoeba spp., 8% for n. fowl ...201323708583
balamuthia mandrillaris: in vitro interactions with selected protozoa and algae.although balamuthia mandrillaris was identified more than two decades ago as an agent of fatal granulomatous encephalitis in humans and other animals, little is known about its ecological niche, biological behavior in the environment, food preferences and predators, if any. when infecting humans or other animals, balamuthia feeds on tissues; and in vitro culture, it feeds on mammalian cells (monkey kidney cells, human lung fibroblasts, and human microvascular endothelial cells). according to rec ...201323790262
infections with free-living amebae.acanthamoeba spp., balamuthia mandrillaris, and naegleria fowleri are mitochondria-bearing, free-living eukaryotic amebae that have been known to cause infections of the central nervous system (cns) of humans and other animals. several species of acanthamoeba belonging to several different genotypes cause an insidious and chronic disease, granulomatous amebic encephalitis (gae), principally in immunocompromised hosts including persons infected with hiv/aids. acanthamoeba spp., belonging to mostl ...201323829906
fatal balamuthia amebic encephalitis in a healthy child: a case report with review of survival cases.balamuthia mandrillaris is one of the 4 amebas in fresh water and soil that cause diseases in humans. granulomatous amebic encephalitis (gae), caused by b. mandrillaris, is a rare but life-threatening condition. a 4-year-old, previously healthy, thai girl presented with progressive headache and ataxia for over a month. neuroimaging studies showed an infiltrative mass at the right cerebellar hemisphere mimicking a malignant cerebellar tumor. the pathological finding after total mass removal revea ...201323864745
the in vitro efficacy of antimicrobial agents against the pathogenic free-living amoeba balamuthia mandrillaris.the free-living amoeba balamuthia mandrillaris causes usually fatal encephalitis in humans and animals. only limited studies have investigated the efficacy of antimicrobial agents against the organism. assay methods were developed to assess antimicrobial efficacy against both the trophozoite and cyst stage of b. mandrillaris (atcc 50209). amphotericin b, ciclopirox olamine, miltefosine, natamycin, paromomycin, pentamidine isethionate, protriptyline, spiramycin, sulconazole and telithromycin had ...201323869955
investigational drug available directly from cdc for the treatment of infections with free-living amebae.infections caused by free-living amebae (fla) are severe and life-threatening. these infections include primary amebic meningoencephalitis (pam) caused by naegleria fowleri and granulomatous amebic encephalitis caused by balamuthia mandrillaris and acanthamoeba species. although several drugs have in vitro activity against fla, mortality from these infections remains>90% despite treatment with combinations of drugs.201323965830
isolation and identification of free-living amoebae from tap water in sivas, turkey.the present work focuses on a local survey of free-living amoebae (fla) that cause opportunistic and nonopportunistic infections in humans. determining the prevalence of fla in water sources can shine a light on the need to prevent fla related illnesses. a total of 150 samples of tap water were collected from six districts of sivas province. the samples were filtered and seeded on nonnutrient agar containing escherichia coli spread. thirty-three (22%) out of 150 samples were found to be positive ...201323971043
is balamuthia mandrillaris a public health concern worldwide?balamuthia mandrillaris is an opportunistic, free-living amoeba that can cause skin lesions and the typically fatal balamuthia amoebic encephalitis (bae) both in immunocompromised and immunocompetent individuals. available data for bae cases indicate that this disease is difficult to detect because knowledge of predisposing factors is lacking, causing a challenge for diagnosing bae. the number of reported bae cases is increasing worldwide, and this is a major concern because little is known abou ...201323988231
successful treatment of granulomatous amoebic encephalitis with combination antimicrobial therapy.granulomatous amoebic encephalitis (gae) is a rare but fatal infection. due to its nonspecific symptoms and laboratory and neuroradiological findings, it is rarely diagnosed antemortem. we herein present the case of a 72-year-old japanese woman who was diagnosed with gae following the detection of a pathogen similar to balamuthia mandrillaris under a microscopic examination of cerebrospinal fluid sediment and who achieved remission with combination antimicrobial therapy. there are no previous re ...201323994995
diagnostic challenges in balamuthia mandrillaris infections.balamuthia mandrillaris is an emerging cause of subacute granulomatous amebic encephalitis (gae). the diagnosis of this infection has proven to be difficult and is usually made postmortem. early recognition and treatment may offer some benefit. this report describes a previously healthy woman who died from gae due to b. mandrillaris.201324022127
a year long study of the presence of free living amoeba in spain.free-living amoeba such as acanthamoeba and balamuthia mandrillaris can act as opportunistic parasites on a wide range of vertebrates and they are becoming a serious threat to human health due to the resistance of their cysts to harsh environmental conditions, disinfectants, some water treatment practices and their ubiquitous distribution. this work was carried out in order to study the presence of these free-living amoebae (fla) and their possible seasonality in a continental-mediterranean clim ...201324200005
risk for transmission of naegleria fowleri from solid organ transplantation.primary amebic meningoencephalitis (pam) caused by the free-living ameba (fla) naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (cns) affecting predominantly young, previously healthy persons. no effective chemotherapeutic prophylaxis or treatment has been identified. recently, three transplant-associated clusters of encephalitis caused by another fla, balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-cns solid organ ...201424279908
in vitro assessment of cytokines interactions with balamuthia mandrillaris using human brain microvascular endothelial cells.balamuthia amoebic encephalitis (bae) is a life threatening human disease which, always lead to death. amoebae invasion of the bloodstream is considered an important step in bae followed by their haematogenous spread. it is more likely that balamuthia mandrillaris enters into the central nervous system through blood-brain barrier (bbb) sites. the objective of the present study was to determine the impact of cytokines on biological properties of balamuthia in vitro. human brain microvascular endo ...201424374438
balamuthia mandrillaris meningoencephalitis associated with solid organ transplantation--review of cases.we report the first identified transmission of balamuthia mandrillaris through solid organ transplantation. kidneys were transplanted from a donor with presumptive diagnosis of autoimmune encephalitis. shortly after, the recipients developed neurologic symptoms. magnetic resonance imaging of the brain from the donor and both kidney recipients demonstrated multiple ring enhancing lesions with surrounding edema and adjacent leptomeningeal extension. in addition most of the lesions demonstrated sig ...201324421953
serologic survey for exposure following fatal balamuthia mandrillaris infection.granulomatous amebic encephalitis (gae) from balamuthia mandrillaris, a free-living ameba, has a case fatality rate exceeding 90% among recognized cases in the usa. in august 2010, a gae cluster occurred following transplantation of infected organs from a previously healthy landscaper in tucson, az, usa, who died from a suspected stroke. as b. mandrillaris is thought to be transmitted through soil, a serologic survey of landscapers and a comparison group of blood donors in southern arizona was p ...201424458652
combined drug therapy in the management of granulomatous amoebic encephalitis due to acanthamoeba spp., and balamuthia mandrillaris.granulomatous amoebic encephalitis (gae) is caused by two protist pathogens, acanthamoeba spp., and balamuthia mandrillaris. although rare, it almost always results in death. in the present study, amoebae were treated with various combinations of clinically-approved drugs, targeting vital cellular receptors and biochemical pathways. the results revealed that among the seven different combinations tested, three proved highly effective against both acanthamoeba castellanii as well as b. mandrillar ...201424726699
the isolation of balamuthia mandrillaris from environmental sources from peru.balamuthia mandrillaris is an opportunistic free-living amoeba that has been reported to cause skin lesions and the fatal balamuthia amoebic encephalitis (bae) in humans and other animals. currently, around 200 human bae cases have been reported worldwide, although this number is considered to be underestimated. the highest number of bae cases has been reported in the american continent, mainly in the southwest of the usa. peru seems to be another hotspot for bae with around 55 human cases havin ...201424781021
transmission of balamuthia mandrillaris through solid organ transplantation: utility of organ recipient serology to guide clinical management.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 recip ...201424840013
balamuthia mandrillaris in south america: an emerging potential hidden pathogen in perú.balamuthia mandrillaris is a free living amoeba that can be isolated from soil. it is an emerging pathogen causing skin lesions as well as cns involvement with a fatal outcome if untreated. further, infections can sometimes can also appear in peripheral areas such as extremities (usually knee), or trunk. moreover, it often progresses to an infiltrative lesion that occasionally becomes ulcerated. in countries like peru, a skin lesion will precede other symptoms. this primary cutaneous lesion can ...201424858923
laboratory testing of clinically approved drugs against balamuthia mandrillaris.balamuthia mandrillaris is a free-living protist pathogen that can cause life-threatening granulomatous amoebic encephalitis. given the lack of effective available drugs against b. mandrillaris encephalitis with a mortality rate of more than 90%, here we screened drugs, targeting vital cellular receptors and biochemical pathways, that are already in approved clinical use for their potential clinical usefulness. amoebicidal assays were performed by incubating b. mandrillaris with drugs (3 × 10(5) ...201424875138
solid organ transplant donors with central nervous system infection.while donor-derived infections (ddi) remain uncommon, multiple reports describe ddi with pathogens that cause central nervous system (cns) infection resulting in significant recipient disease. the ad hoc disease transmission advisory committee (dtac) reviewed the records of potential donor-derived disease transmission events (pddte) to describe donor characteristics and outcomes associated with ddi from cns pathogens.201424914569
presence of potentially pathogenic free-living amoebae strains from well water samples in guinea-bissau.free-living amoebae (fla) include opportunistic pathogens such as naegleria fowleri, balamuthia mandrillaris, and the genera sappinia and acanthamoeba. in this study, a survey was conducted in order to evaluate the presence of potentially pathogenic amoebic strains in water samples collected from wells located in the western part of guinea-bissau. the samples were left to precipitate for 48 hours and then the sediments were seeded on non-nutrient agar plates containing escherichia coli spread an ...201424934796
atomic force microscopic imaging of acanthamoeba castellanii and balamuthia mandrillaris trophozoites and cysts.light microscopy and electron microscopy have been successfully used in the study of microbes, as well as free-living protists. unlike light microscopy, which enables us to observe living organisms or the electron microscope which provides a two-dimensional image, atomic force microscopy provides a three-dimensional surface profile. here, we observed two free-living amoebae, acanthamoeba castellanii and balamuthia mandrillaris under the phase contrast inverted microscope, transmission electron m ...201525041405
emerging trends in free-living amebic infections of the brain: implications for organ transplantation.this epidemiological review analyzed cases of naegleria fowleri primary amebic meningoencephalitis (pam) and balamuthia mandrillaris granulomatous amebic encephalitis (gae) for behavioral and demographic risk factors for pathogen exposures and potential transmission by organ transplantation. the centers for disease control and prevention (cdc) naegleria workgroup registry provided 121 cases of laboratory-confirmed pam over the period, 1937-2007. the cdc and the california encephalitis project pr ...201625073256
genetic analysis among environmental strains of balamuthia mandrillaris recovered from an artificial lagoon and from soil in sonora, mexico.since the first report of balamuthia mandrillaris as a causative agent of granulomatous amoebic encephalitis in humans, the environmental niche of this amoeba was assumed to be restricted to soil and dust. a single isolation from water was recently made independently by us from northern mexico. now we report the isolation of 8 new strains of b. mandrillaris from mexico. this continues the pattern of an excess of isolates from north america, compared to other parts of the world. all of the new is ...201425076486
isolation and molecular characterization of acanthamoeba and balamuthia mandrillaris from combination shower units in costa rica.free living amoebae (fla) are ubiquitous protozoa, which may behave as parasites under certain conditions. four genera are recognized as causal agents of infections in humans and animals: naegleria, sappinia, acanthamoeba and balamuthia. this work determines the presence of fla in combination shower units and employs molecular biology for the characterization of isolates. the morphological analysis and partial sequencing of the 18s rdna gene revealed the presence of acanthamoeba genotype t4 in 3 ...201425134946
encephalitis caused by pathogens transmitted through organ transplants, united states, 2002-2013.the cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. during 2002-2013, the us centers for disease control and prevention investigated several encephalitis clusters among transplant recipients. cases were caused by infections from transplant-transmitted pathogens: west nile virus, rabies virus, lymphocytic choriomeningitis virus, and balamuthia mandrillaris amebae. in many of the clusters, iden ...025148201
an autopsy case of balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in japan.balamuthia mandrillaris is an amoeba found in fresh water and soil that causes granulomatous amoebic encephalitis. we report herein an autopsy case of b. mandrillaris amoebic encephalitis, which was definitely diagnosed by pcr. an 81-year-old man, who had sjögren's syndrome, manifested drowsiness 2 months before his death with progressive deterioration. neuroimaging demonstrated foci of t2- and fluid-attenuated inversion recovery high and t1 low-intensity with irregular post-contrast ring enhanc ...201525186798
a multisystemic acanthamoeba infection in a dog in tenerife, canary islands, spain.a 22-month-old male spanish water dog was hospitalized after its physical examination revealed fever and movement difficulty. after 24h, the dog was found to have a high fever (39.5 °c) and was treated empirically with doxycycline/ciprofloxacin. at 48 h, after submission the fever rose to 41 °c and the animal presented with a stiff neck and dehydration. peripheral blood and cerebrospinal fluid (csf) were sampled and trophozoites with an acanthamoeba-like morphology were observed in the csf. pcr ...201425193180
balamuthia mandrillaris therapeutic mud bath in jamaica.balamuthia mandrillaris is an emerging cause of encephalitis in humans. the transmission dynamics are poorly understood due to the high fatality rate and the sporadic nature of cases. seventy-two soil samples were collected from beaches and the banks of lagoons, rivers, ponds, mineral springs and streams from across jamaica and assayed for the presence of b. mandrillaris. seventy-nine sites were sampled and the mitochondrial 16s rdna gene of b. mandrillaris was amplified and sequenced to confirm ...201525335452
resistance to intranasal infection with balamuthia mandrillaris amebae is t-cell dependent.t and b cell-deficient balb/c scid mice become severely ill and die of amebic encephalitis after intranasal infection with balamuthia mandrillaris, while adult immunocompetent balb/c wild-type (wt) mice are resistant. to further investigate the role of lymphocytes in protection from balamuthia amebic encephalitis (bae), scid mice were reconstituted with and wt mice selectively depleted of lymphocytes before infection. reconstitution of scid mice with whole spleen cells from wt mice rendered the ...201525363468
balamuthia mandrillaris: morphology, biology, and virulence.balamuthia mandrillaris is a protist pathogen that can cause encephalitis with a fatality rate of >95%. this is due to our incomplete understanding of the pathogenesis and pathophysiology of b. mandrillaris encephalitis. b. mandrillaris has two stages in its life cycle, an active trophozoite stage during which it divides mitotically. however, under unfavorable conditions, the trophozoite transforms into a dormant cyst stage. a major concern during the course of therapy is that b. mandrillaris ca ...201725709948
management of granulomatous amebic encephalitis: laboratory diagnosis and treatment.granulomatous amebic encephalitis is a life-threatening central nervous system (cns) infection caused by the free-living amoebae acanthamoeba spp., balamuthia mandrillaris and sappinia pedata. the disease has a subacute to chronic onset affecting commonly the immunocompromised population with high mortality rate. the diagnosis of this disease entity requires high suspicion with appropriate sample collection and testing by the laboratory experts. radiological investigations are nonspecific and co ...201525709949
fatal granulomatous amebic encephalitis due to balamuthia mandrillaris in new mexico: a case report.balamuthia mandrillaris is a free-living amoeba that can cause granulomatous amebic encephalitis (gae). we report a case in an individual with a history of alcohol abuse, cocaine use, and ditch water exposure. this is the first reported case of gae due to b mandrillaris in new mexico.201425734132
emergence of balamuthia mandrillaris meningoencephalitis in india.we report two cases of fatal chronic meningoencephalitis caused by balamuthia mandrillaris in immunocompetent men. diagnosis of amoebic meningoencephalitis was made ante-mortem in one case and postmortem in another by histopathological examination and confirmed by demonstration of b. mandrillaris deoxyribonucleic acid (dna) by polymerase chain reaction (pcr).201525865989
[fatal encephalitis caused by a parasite].encephalitis caused by a free-living amoeba is relatively rare and usually fatal. this is because the diagnosis is often made late and treatment is difficult.201525873217
fatal balamuthia mandrillaris meningoencephalitis in the netherlands after travel to the gambia. 201525897644
pathogenesis of amoebic encephalitis: are the amoebae being credited to an 'inside job' done by the host immune response?pathogenic free living amoeba like naegleria fowleri, acanthamoeba spp., and balamuthia mandrillaris are known to cause fatal "amoebic meningoencephalitis" by acquiring different route of entries to the brain. the host immune response to these protist pathogens differs from each another, as evidenced by the postmortem gross and microscopic findings from the brains of the affected patients. cited with the expression of 'brain eating amoeba' when the infection is caused by n. fowleri, this express ...201525930186
novel culture medium for the axenic growth of balamuthia mandrillaris.until now, for axenic cultivation of balamuthia mandrillaris, the bm-3 culture medium and the modified chang's special medium have been the only ones recommended, but they have some disadvantages, as both require many components and their preparations are laborious. therefore, we developed a novel culture medium for b. mandrillaris axenic cultivation. each one of the 11 components of bm-3 was combined with cerva's medium as basal culture medium. ten strains of b. mandrillaris including the refer ...201525957459
in vitro growth, cytopathic effects and clearance of monolayers by clinical isolates of balamuthia mandrillaris in human skin cell cultures.balamuthia mandrillaris is a free-living ameba (fla) that has been isolated or its dna identified in soil, dust and water. it causes a fatal central nervous system infection in humans and animals. although it is environmental as acanthamoeba and naegleria fowleri, the two other free-living amebae that also cause cns infections in humans and other animals, balamuthia does not feed on bacteria as the other fla. in the laboratory, it can be grown on a variety of mammalian cell cultures. in this stu ...201525980370
acute encephalitis in the immunocompromised individual.this article describes recent advances in the diagnosis and management of encephalitis in immunocompromised individuals.201526098507
disseminated balamuthia mandrillaris infection.balamuthia mandrillaris is a rare cause of human infection, but when infections do occur, they result in high rates of morbidity and mortality. a case of disseminated balamuthia infection is presented. early diagnosis and initiation of recommended therapy are essential for increased chances of successful outcomes.201526135864
a proposed cascade of vascular events leading to granulomatous amoebic encephalitis.granulomatous amoebic encephalitis due to acanthamoeba is a chronic disease that almost always results in death. hematogenous spread is a pre-requisite followed by amoebae invasion of the blood-brain barrier to enter the central nervous system. given the systemic nature of this infection, a significant latent period of several months before the appearance of clinical manifestations is puzzling. based on reported cases, here we propose pathogenetic mechanisms that explain the above described late ...201526276705
diagnosing balamuthia mandrillaris encephalitis with metagenomic deep sequencing.identification of a particular cause of meningoencephalitis can be challenging owing to the myriad bacteria, viruses, fungi, and parasites that can produce overlapping clinical phenotypes, frequently delaying diagnosis and therapy. metagenomic deep sequencing (mds) approaches to infectious disease diagnostics are known for their ability to identify unusual or novel viruses and thus are well suited for investigating possible etiologies of meningoencephalitis.201526290222
balamuthia mandrillaris: further morphological observations of trophozoites by light, scanning and transmission electron microscopy.additional morphological features of balamuthia mandrillaris observed by light and electron microscopy are reported. trophozoites were extremely pleomorphic: their cell shapes ranged from rounded to elongated and sometimes they appeared exceptionally stretched out and branched. by transmission electron microscopy it was possible to observe two different cytoplasmic areas, the ectoplasm and the endoplasm and often sections of rough endoplasmic reticulum were found in the transition zone. the cyto ...201526297955
assessment of blood-brain barrier penetration of miltefosine used to treat a fatal case of granulomatous amebic encephalitis possibly caused by an unusual balamuthia mandrillaris strain.balamuthia mandrillaris, a free-living ameba, causes rare but frequently fatal granulomatous amebic encephalitis (gae). few patients have survived after receiving experimental drug combinations, with or without brain lesion excisions. some gae survivors have been treated with a multi-drug regimen including miltefosine, an investigational anti-leishmanial agent with in vitro amebacidal activity. miltefosine dosing for gae has been based on leishmaniasis dosing because no data exist in humans conc ...201526329128
first draft genome sequence of balamuthia mandrillaris, the causative agent of amoebic encephalitis.the free-living amoeba balamuthia mandrillaris is a rare but highly lethal agent of amoebic encephalitis in humans and many other mammalian species. here, we announce the first draft genome sequence of the original 1990 isolate cultured from the brain of a deceased mandrill baboon.201526404594
isolation of balamuthia mandrillaris from soil samples in north-western iran.balamuthia mandrillaris is an opportunistic free-living amoebae (fla) which has been reported as the causative agent of the fatal balamuthia amoebic encephalitis (bae). currently, the transmission dynamics of this pathogen remain poorly understood although the organism has been associated with soils, and thus, soil exposure has been identified as a risk factor for this pathogenic amoeba. nevertheless, environmental isolation of b. mandrillaris is a rare event and strains of this amoebic species ...201626468147
vannellid species isolated from freshwater source in a park in jamaica, west indies.free-living amoebae (fla) occupy a wide range of freshwater, marine, and soil habitats, and are opportunistic pathogens in human beings. while acanthamoeba spp., naegleria fowleri, and balamuthia mandrillaris are well-known opportunistic organisms, vannella epipetala is nonpathogenic. sediments were collected from a freshwater source from a park in jamaica to investigate the presence of fla. acanthamoeba and naegleria spp. were not recovered; however, a vannellid species identified by microscopy ...201526512204
acanthamoeba genotypes t3 and t4 as causative agents of amoebic keratitis in mexico.free-living amoebae (fla) are widely distributed worldwide. some genera included in this group act as opportunistic pathogens causing fatal encephalitis and acanthamoeba keratitis (ak), a sight-threatening infection of the cornea associated with the use of soft contact lenses that could even end in blindness if an early diagnosis and treatment are not achieved. furthermore, the numbers of ak cases keep rising worldwide mainly due to an increase of contact lens wearers and lack of hygiene in the ...201626581373
clinical metagenomic identification of balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing.primary amoebic meningoencephalitis (pam) is a rare, often lethal, cause of encephalitis, for which early diagnosis and prompt initiation of combination antimicrobials may improve clinical outcomes.201526620704
balamuthia mandrillaris encephalitis: survival of a child with severe meningoencephalitis and review of the literature.balamuthia mandrillaris causes granulomatous amoebic encephalitis, which is frequently fatal. there are few reports of survival in children. a 4-year-old child developed severe meningoencephalitis with multiple intracranial ring-enhancing lesions. empiric therapy was commenced after a biopsy was performed, and the patient had a good clinical response. molecular testing and indirect immunofluorescence later confirmed the diagnosis of balamuthia encephalitis. diagnosis of balamuthia encephalitis i ...201426624913
erratum to: clinical metagenomic identification of balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing. 201626750923
neurologic amebiasis caused by balamuthia mandrillaris in an indian flying fox (pteropus giganteus).a 4-5-month-old intact male indian flying fox (pteropus giganteus) was presented to the baton rouge zoo's veterinary hospital with an acute onset of obtundation that was diagnosed with amebic encephalitis. histologic examination revealed numerous amebic trophozoites within necrotic foci, affecting the occipital cerebrum and surrounding the mesencephalic aqueduct. the etiologic agent, balamuthia mandrillaris, was determined by multiplex quantitative real-time polymerase chain reaction, immunohist ...201626762405
amoebic meningoencephalitis and disseminated infection caused by balamuthia mandrillaris in a western lowland gorilla (gorilla gorilla gorilla).case description a 22-year-old male gorilla (gorilla gorilla gorilla) housed in a zoo was evaluated for signs of lethargy, head-holding, and cervical stiffness followed by development of neurologic abnormalities including signs of depression, lip droop, and tremors. clinical findings physical examination under general anesthesia revealed a tooth root abscess and suboptimal body condition. a cbc and serum biochemical analysis revealed mild anemia, neutrophilia and eosinopenia consistent with a st ...201626799111
detection of balamuthia mandrillaris dna in the storage case of contact lenses in germany.acanthamoeba spp. are frequently the etiological agents of a severe form of sight-threatening keratitis, called acanthamoeba keratitis. the contact lens storage solution of a patient with keratitis of unknown genesis was screened using our diagnostic tools to detect potentially pathogenic free-living amoebae (fla). culture methods and a triplex quantitative real-time polymerase chain reaction (qpcr) targeting acanthamoeba spp., naegleria fowleri, and balamuthia mandrillaris were used in context ...201626965426
isolation of balamuthia mandrillaris-specific antibody fragments from a bacteriophage antibody display library.balamuthia mandrillaris is a protist pathogen that can cause encephalitis with a mortality rate of more than 95%. early diagnosis followed by aggressive treatment is a pre-requisite for successful prognosis. current methods for identifying this organism rely on culture and microscopy, antibody-based methods using animals, or involve the use of molecular tools that are expensive. here, we describe the isolation of antibody fragments that can be used for the unequivocal identification of b. mandri ...201627055361
isolation and molecular identification of vermamoeba vermiformis strains from soil sources in el hierro island, canary islands, spain.free-living amoebae (fla) are widely distributed protozoa in the environment and have been isolated from many sources such as dust, soil and water. furthermore, some genera/species of fla such as naegleria fowleri, balamuthia mandrillaris and acanthamoeba spp. are also able to cause opportunistic infections in humans and other animals. more recently, fla have been reported to be environmental carriers of pathogenic bacteria, fungi and viruses, and thus have gained further importance from the pub ...201627056561
isolation and identification of acanthamoeba spp. from thermal swimming pools and spas in southern brazil.free-living amoebae (fla) are widely distributed in soil and water. a few number of them are implicated in human disease: acanthamoeba spp., naegleria fowleri, balamuthia mandrillaris and sappinia diploidea. species of acanthamoeba can cause keratitis and brain infections. in this study, 72 water samples were taken from both hot tubs and thermal swimming pools in the city of porto alegre, rs, brazil, to determine the presence of acanthamoeba in the water as well as perform the phenotypic and gen ...201627078644
presence of balamuthia mandrillaris in hot springs from mazandaran province, northern iran.balamuthia mandrillaris is an opportunistic free-living amoeba that has been reported to cause cutaneous lesions and balamuthia amoebic encephalitis. the biology and environmental distribution of b. mandrillaris is still poorly understood and isolation of this pathogen from the environment is a rare event. previous studies have reported that the presence of b. mandrillaris in the environment in iran may be common. however, no clinical cases have been reported so far in this country. in the prese ...201627086943
centrofacial balamuthiasis: case report of a rare cutaneous amebic infection.free-living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. balamuthia mandrillaris has a predilection for infecting skin of the central face. infection may be restricted to the skin or associated with life-threatening central nervous system (cns) involvement. we report a case of a 91-year-old woman, who presented with a non-healing red plaque over her right cheek. several punch biopsies exhibited non-specific granulomatous inflammation without demonstrable fungi ...201627251900
transmission of balamuthia mandrillaris by organ transplantation.during 2009 and 2010, 2 clusters of organ transplant-transmitted balamuthia mandrillaris, a free-living ameba, were detected by recognition of severe unexpected illness in multiple recipients from the same donor.201627358357
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