1887

Abstract

Introduction:

This case report describes a human survivor of infection. This is a free-living amoeba that can cause infection with the devastating consequence of near universally fatal encephalitis. We report this case to demonstrate the possibility of recovery.

Case presentation:

A 26-year-old Hispanic male, a landscape gardener, presented to the hospital in March 2010 with a two month history of headache, visual disturbances and new-onset seizures. Brain imaging identified two enhancing central lesions and was later identified by brain biopsy. He received several months of various antimicrobials including miltefosine, a novel use of the drug in this disease at the time. Seven weeks into therapy, considerations were made to switch him to ‘comfort care’ because of worsening clinical status and seemingly lack of response to treatment. The patient finally demonstrated clinical and radiological improvement after eight weeks with modified therapy, despite experiencing some debilitating toxic effects likely to be related to antibiotics. Two years after his initial presentation he made a complete recovery.

Conclusion:

amoebic encephalitis is considered an almost universally fatal disease; this case demonstrates the possibility of recovery. This report outlines his treatment, drug toxicities and includes additional information regarding the therapeutic use of the drug miltefosine. Whether his survival is related to the specific antimicrobials used in this case is unknown and further investigation is warranted.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005031
2016-06-28
2024-03-28
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/3/3/jmmcr005031.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005031&mimeType=html&fmt=ahah

References

  1. Cary L. C., Maul E., Potter C., Wong P., Nelson P. T., Given C., Robertson W. 2010; Balamuthia mandrillaris meningoencephalitis: survival of a pediatric patient. Pediatrics 125:e699e703 [View Article][PubMed]
    [Google Scholar]
  2. Centers for Disease Control and Prevention (CDC) 2008; Balamuthia amebic encephalitis--California, 19992007. MMWR Morb Mortal Wkly Rep 57:768–771
    [Google Scholar]
  3. Deetz T. R., Sawyer M. H., Schuster F. L., Visvesvara G. S. 2003; Successful treatment of Balamuthia amoebic encephalitis: presentation of 2 cases. Clin Infect Dis 37:1304–1312 [View Article]
    [Google Scholar]
  4. Doyle J. S., Campbell E., Fuller A., Spelman D. W., Cameron R., Malham G., Gin D., Lewin S. R. 2011; Balamuthia mandrillaris brain abscess successfully treated with complete surgical excision and prolonged combination antimicrobial therapy. J Neurosurg 114:458–462 [View Article][PubMed]
    [Google Scholar]
  5. Greninger A. L., Messacar K., Dunnebacke T., Naccache S. N., Federman S., Bouquet J., Mirsky D., Nomura Y., Yagi S., other authors. 2015; Clinical metagenomic identification of balamuthia mandrillaris encephalitis and assembly of the draft genome: the continuing case for reference genome sequencing. Genome Med 7:113 [View Article][PubMed]
    [Google Scholar]
  6. Jung S., Schelper R. L., Visvesvara G. S., Chang H. T. 2004; Balamuthia mandrillaris meningoencephalitis in an immunocompetent patient. an unusual clinical course and a favorable outcome. Arch Pathol Lab Med 128:466–468 [View Article][PubMed]
    [Google Scholar]
  7. Martínez D. Y., Seas C., Bravo F., Legua P., Ramos C., Cabello A. M., Gotuzzo E. 2010; Successful treatment of balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement. Clin Infect Dis 51:e7e11 [View Article]
    [Google Scholar]
  8. Orozco L. D., Khan M. A., Fratkin J. D., Hanigan W. C. 2011; Asymptomatic aneurysm of the cavernous and supraclinoid internal carotid artery in a patient with Balamuthia mandrillaris encephalitis. J Clin Neurosci 18:1118–1120 [View Article][PubMed]
    [Google Scholar]
  9. Sanderson L., Dogruel M., Rodgers J., De Koning H. P., Thomas S. A. 2009; Pentamidine movement across the murine blood-brain and bloodcerebrospinal fluid barriers: effect of trypanosome infection, combination therapy, P-glycoprotein, and multidrug resistance-associated protein. J Pharmacol. 329:967–977
    [Google Scholar]
  10. Schuster F. L., Visvesvara G. S. 1996; Axenic growth and drug sensitivity studies of Balamuthia mandrillaris, an agent of amebic meningoencephalitis in humans and other animals. J Clin Microbiol 34:385–388[PubMed]
    [Google Scholar]
  11. Schuster F. L., Guglielmo B. J., Visvesvara G. S. 2006; In-vitro activity of miltefosine and voriconazole on clinical isolates of free-living amebas: Balamuthia mandrillaris, Acanthamoeba spp., and Naegleria fowleri . J Eukaryot Microbiol 53:121–126 [View Article][PubMed]
    [Google Scholar]
  12. Seas C., Bravo F. G. 2006; Encefalitis amebiana granulomatosa por Balamuthia mandrillaris: una enfermedad fatal reconocida cada vez ma´s frecuentemente. Rev Chil Infect 23:197–199 [View Article]
    [Google Scholar]
  13. Sundar S., Jha T. K., Thakur C. P., Engel J., Sindermann H., Fischer C., Junge K., Bryceson A., Berman J. 2002; Oral miltefosine for Indian Visceral Leishmaniasis. N Engl J Med 347:1739–1746 [View Article][PubMed]
    [Google Scholar]
  14. Visvesvara G. S., Martinez A. J., Schuster F. L., Leitch G. J., Wallace S. V., Sawyer T. K., Anderson M. 1990; Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol 28:2750–2756[PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005031
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005031
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error