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Case Report

Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases

A. Krasaelap1, S. Prechawit2, J. Chansaenroj1, P. Punyahotra3, T. Puthanakit3, K. Chomtho4, S. Shuangshoti5, J. Amornfa6, Y. Poovorawan1
The Korean Journal of Parasitology 2013;51(3):335-341.
Published online: June 30, 2013

1Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

2Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

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Corresponding author (Yong.P@chula.ac.th)
• Received: January 20, 2013   • Revised: March 4, 2013   • Accepted: March 7, 2013

© 2013, Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases
Korean J Parasitol. 2013;51(3):335-341.   Published online June 30, 2013
DOI: https://doi.org/10.3347/kjp.2013.51.3.335
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Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases
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DOI: https://doi.org/10.3347/kjp.2013.51.3.335
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Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases
Image Image Image
Fig. 1 Pre- and postoperative imaging studies of the brain. (A) Axial T2-weighted MRI showing a 3.0×4.1×2.5 cm ill-defined infiltrating heterogeneous enhancing mass mainly occupying the right inferior cerebellar hemisphere with perilesional edema causing right tonsillar herniation and mild obstructive hydrocephalus. (B) Follow-up axial CT scan of the brain, 5 days post-operation, showing a hypodense lesion with perilesional vasogenic edema at the right cerebellar vermis and right cerebellar hemisphere, postoperative change.
Fig. 2 Pathology of Balamuthia amebic encephalitis. Multiple amebic trophozoites in the cerebellar lesion are illustrated. The organisms tend to cling around a blood vessel (left side image). Note dense infiltrates of lymphocytes and plasma cells at top. H-E stain, ×400, Bar=50 µm.
Fig. 3 Phylogenetic tree analysis of Balamuthia mandrillaris.

Fig. 1

Fig. 2

Fig. 3

Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases
Pub year Age Sex Place Underlying diseases Lesions Method Treatment Outcome Ref 2011 27 M Kidney recipient 21 d CNS:- multiple enhancing lesions, ICA aneurysm Donor autopsy, brain biopsy (other recipient) PCR, IIF+ Pentamidine, sulfadiazine, flucytosine, fluconazole, azithromycin, miltefosine Arm, leg paralysis, CNS: healed aneurysm 6,7 2011 80 F Australia Skin: plaques at limbs & trunk 1 y 2nd skin Bx: cutaneous amebiasis Complete excision, itraconazole, flucytosine, sulfadiazine, azithromycin×7 m, amphotericin B, pentamidine×7 w Complete recovery F/U 18 m 8,9 CNS:1 ring-enhancing mass (frontal lobe) Brain Bx- trophozoites, PCR+ 2010 21 F Lima, Peru Skin: lesions at knee 4 y Skin Bx- trophozoites culture, PCR, IIF+ Surgical resection of small lesions itraconazole, albendazole, amphotericin B×10 m, TMP-SMX×3 m; no improvement amphotericin B, itraconazole, TMP-SMX, albendazole×45d; no improvement clarithromycin, artesunate×2w; no improvement albendazole, fluconazole×7.5 m, miltefosine×7 m Skin & CNS lesions healed F/U>30 m 10 CNS:-1 ring-enhancing lesion (temporal lobe) 2010 2 M CNS: - multiple enhancing lesions Brain Bx trophozoites, IIF+ VP shunt, fluconazole, flucytosine, sulfadiazine, clarithromycin>2 m, Pentamidine, thioridazine<2 m CNS:↓size, no. of lesions, F/U>22 m 11 2008 35 M CA, USA B cell lymphoma CNS: - focal enhancing lesions Serology, PCR + Unknown Doing well 3 m lost F/U 9, 12 2006 8 M Piura, Peru Skin:- plaque on face Albendazole, itraconazole×14 m Skin & CNS healed, F/U>3 y 13 CNS: - multiple focal lesions 2006 10 F Piura, Peru Skin: plaque on face Surgical resection albendazole, itraconazole, TMP-SMX ×6 m No neurological sequelae, F/U 18 m 13 CNS:-2 ring-enhancing lesions (frontal lobe) 2004 72 F NY, USA CNS: - 2 ring-enhancing lesions (frontal and temporal lobes) Brain Bx- trophozoites IIF+ Excisional Bx 1 of 2 lesions pentamidine, sulfadiazine, fluconazole, clarithromycin×unknown duration CNS 2w: slight evolution of lesions, F/U >6 m 14 2003 64 M CA, USA Ankylosing spondylitis, MI, glaucoma, depression Skin:- raised lesion at forearm 2 w Brain Bx- granulomatous vasculitis Biopsy only flucytosine, fluconazole, sulfadiazine× 5 y clarithromycinx 2 y pentamidinex 2 w, trifluoperazine×18 d CNS 5y:- ↓ size of lesions, F/U>5 y 15 CNS:-4 ring-enhancing lesions (parietal and occipital lobes) Review of skin Bx- trophozoites, IIF+ 2003 5 F CA, USA CNS: - 2 ring-enhancing lesions (temporal and parietal lobes) Brain Bx- acute necrotizing inflammation, + trophozoites, IIF+ Partial excision 1 of 2 lesions clarithromycin, fluconazole>2.4 y, flucytosine×2.4 y thioridazine×1.8 y, pentamidine×34 d CNS 2.4 y: -↓edema, F/U>2.4 y 15
Table 1. Summary of demographic characteristics, clinical data, and treatment of the 10 survivors of Balamuthia amebic infection

F, female; M, male; d, day; w, week; m, month; y, year; CNS, central nervous system; PCR, Polymerase chain reaction; Bx, biopsy, IIF, indirect immunofluorescence; ESRD, End stage renal disease; MI, myocardial infarction; ICA, internal carotid artery; VP, ventriculoperitoneal.

Table 1.

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