Parasites, Hosts and Diseases

The Korea Society for Parasitology and Tropical Medicine (대한기생충학·열대의학회)
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Fatal Balamuthia Amebic Encephalitis in a Healthy Child: A Case Report with Review of Survival Cases

  • Krasaelap, A. (Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University) ;
  • Prechawit, S. (Faculty of Medicine, Chulalongkorn University) ;
  • Chansaenroj, J. (Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University) ;
  • Punyahotra, P. (Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University) ;
  • Puthanakit, T. (Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University) ;
  • Chomtho, K. (Division of Neurology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University) ;
  • Shuangshoti, S. (Department of Pathology, Faculty of Medicine, Chulalongkorn University and WHO Collaborating Centre for Research and Training on Viral Zoonoses) ;
  • Amornfa, J. (Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University) ;
  • Poovorawan, Y. (Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University)
  • Received : 2013.01.20
  • Accepted : 2013.03.07
  • Published : 2013.06.30
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Abstract

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 revealed severe necrotizing inflammation, with presence of scattered amebic trophozoites. Cerebrospinal fluid (CSF) obtained from lumbar puncture showed evidence of non-specific inflammation without identifiable organisms. A combination of pentamidine, sulfasalazine, fluconazole, and clarithromycin had been initiated promptly before PCR confirmed the diagnosis of Balamuthia amebic encephalitis (BAE). The patient showed initial improvement after the surgery and combined medical treatment, but gradually deteriorated and died of multiple organ failure within 46 days upon admission despite early diagnosis and treatment. In addition to the case, 10 survivors of BAE reported in the PubMed database were briefly reviewed in an attempt to identify the possible factors leading to survival of the patients diagnosed with this rare disease.

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References

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