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Case Report: Encephalitis Caused by Balamuthia Mandrillaris in a 3-Year-Old Iranian Girl Publisher Pubmed



Safavi M1 ; Mehrtash V1 ; Habibi Z2 ; Mohammadpour M3 ; Ashtiani MTH1 ; Anvari MS1 ; Zaresharifi N1 ; Shafizadeh M2 ; Jafarzadeh B1
Authors
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Authors Affiliations
  1. 1. Pathology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Neurosurgery Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Pediatric Intensive Care Division, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran

Source: American Journal of Tropical Medicine and Hygiene Published:2021


Abstract

It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world.A3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and leftsided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study. Copyright © 2021 by The American Society of Tropical Medicine and Hygiene.
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