Microbiology
B. mandrillaris, an amoeba.
Epidemiologic Risks
Swimming in freshwater and soil. Not swimming in soil; it is found in soil.
It has been spread in transplanted organs(Pubmed).
Most cases occur in the SW and in Hispanics (Pubmed).
Syndromes
Meningoencephalitis (PubMed). Can be indolent with a granulomatous encephalitis and can mimic brain tumor.
Diagnosis difficult premortem because amebas are difficult to identify under the microscope, even with commonly used stains.
Treatment
Maybe pentamadine, 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 pentamadine isothionate, 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: 05/31/19