Infectious Disease Compendium

Balamuthia

Microbiology

B. mandrillaris, an amoeba.

Epidemiologic Risks

Inhalation and trauma, perhaps from water. The exact route of infection is uncertain.

It has been spread in transplanted organs (Pubmed).

Most cases occur in the SW and in Hispanics (Pubmed).

One case with nasal irrigation (Pubmed).

Syndromes

Meningoencephalitis (PubMed). Can be indolent with a granulomatous encephalitis and can mimic brain tumor. Often preceded by upper respiratory lesions.

The CDC has special testing available, including PCR and antigen tests: https://www.cdc.gov/parasites/balamuthia/diagnosis-hcp.html.

Skin lesions from direct inoculation. Usually, a single lesion, starting as a papulonodular, erythematous, plate-like lesion that enlarges over time. They are painless and can ulcerate.

Diagnosis difficult premortem because amebas are difficult to identify under the microscope, even with commonly used stains.

Treatment

Optimal therapy not unknown, it is usually some combination of multiple antibiotics. The CDC should be of help.

Maybe pentamidine, maybe fluconazole, maybe ketoconazole. All at once.

Maybe Miltefosine with fluconazole and albendazole (PubMed).

"Survivors of Balamuthia infection were treated with a combination of antimicrobials, including pentamidine isethionate, 5-fluorocytosine (flucytosine), fluconazole, sulfadiazine, and a macrolide antibiotic (azithromycin or clarithromycin), with or without a phenothiazine compound (PubMed)."

Perhaps "prolonged treatment with miltefosine, fluconazole, and albendazole (PubMed)."

But usually fatal.

Notes

See McCoy, Bones.

Last update: 01/12/20