A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication
Abstract Background Granulomatous amoebic encephalitis (GAE) is a rare central nervous system infection caused by the Balamuthia mandrillaris or Acanthamoeba species. Diagnosis is challenging because of the non-specific clinical presentation, cerebrospinal fluid analysis, and radiological features....
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-021-07020-8 |
| _version_ | 1818752921408372736 |
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| author | Limei Peng Quan Zhou Yu Wu Xiaoli Cao Zili Lv Minghua Su Yachun Yu Wen Huang |
| author_facet | Limei Peng Quan Zhou Yu Wu Xiaoli Cao Zili Lv Minghua Su Yachun Yu Wen Huang |
| author_sort | Limei Peng |
| collection | DOAJ |
| description | Abstract Background Granulomatous amoebic encephalitis (GAE) is a rare central nervous system infection caused by the Balamuthia mandrillaris or Acanthamoeba species. Diagnosis is challenging because of the non-specific clinical presentation, cerebrospinal fluid analysis, and radiological features. There is no effective treatment for GAE to date. Case presentation A 54-year-old male was admitted to hospital after experiencing acute onset of numbness and weakness on his left limb. Due to the initial consideration of intracranial tumor, surgical removal of the right parietal lesion was performed. However, the patient had a headache accompanied by diplopia, difficulty walking and a new lesion was found in the left occipital-parietal lobe two weeks after the first operation. High-throughput next-generation sequencing (NGS) detected the presence of high copy reads of the B. mandrillaris genome sequence in the patient’s blood, cerebral spinal fluid (CSF), and brain tissue. Pathological investigation of the brain tissue showed granulomatous changes and amoebic trophozoite scattered around blood vessels under high magnification. The patient was re-operated due to developing progressive confusion caused by subfalcine herniation of the left cerebral hemisphere. The lesions of the right parietal lobe were obviously decreasing in size after the first surgery, and the lesions of the left occipital lobe and the sunfalcine herniation didn’t ameliorate two months after the second surgery. The patient was transferred to local hospital for continuous treatment with sulfamethoxazole and azithromycin. After five months of the second surgery, the patient showed good recovery with mild headache. Conclusions This is the first report of a patient with B. mandrillaris encephalitis initially confirmed by NGS and have experienced two excisions, responding favorably to the combination of surgeries and medications. Early surgical resection of intracranial lesions combined with drug treatment may offer the chance of a cure. |
| first_indexed | 2024-12-18T04:59:09Z |
| format | Article |
| id | doaj.art-bda871b38b3240ac9e8a002537c27c68 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-18T04:59:09Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-bda871b38b3240ac9e8a002537c27c682022-12-21T21:20:12ZengBMCBMC Infectious Diseases1471-23342022-01-012211810.1186/s12879-021-07020-8A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medicationLimei Peng0Quan Zhou1Yu Wu2Xiaoli Cao3Zili Lv4Minghua Su5Yachun Yu6Wen Huang7Department of Neurology, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Neurosurgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Neuroscience, University of PittsburghDepartment of Neurology, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Pathology, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Infection, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Neurology, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Neurology, The First Affiliated Hospital of Guangxi Medical UniversityAbstract Background Granulomatous amoebic encephalitis (GAE) is a rare central nervous system infection caused by the Balamuthia mandrillaris or Acanthamoeba species. Diagnosis is challenging because of the non-specific clinical presentation, cerebrospinal fluid analysis, and radiological features. There is no effective treatment for GAE to date. Case presentation A 54-year-old male was admitted to hospital after experiencing acute onset of numbness and weakness on his left limb. Due to the initial consideration of intracranial tumor, surgical removal of the right parietal lesion was performed. However, the patient had a headache accompanied by diplopia, difficulty walking and a new lesion was found in the left occipital-parietal lobe two weeks after the first operation. High-throughput next-generation sequencing (NGS) detected the presence of high copy reads of the B. mandrillaris genome sequence in the patient’s blood, cerebral spinal fluid (CSF), and brain tissue. Pathological investigation of the brain tissue showed granulomatous changes and amoebic trophozoite scattered around blood vessels under high magnification. The patient was re-operated due to developing progressive confusion caused by subfalcine herniation of the left cerebral hemisphere. The lesions of the right parietal lobe were obviously decreasing in size after the first surgery, and the lesions of the left occipital lobe and the sunfalcine herniation didn’t ameliorate two months after the second surgery. The patient was transferred to local hospital for continuous treatment with sulfamethoxazole and azithromycin. After five months of the second surgery, the patient showed good recovery with mild headache. Conclusions This is the first report of a patient with B. mandrillaris encephalitis initially confirmed by NGS and have experienced two excisions, responding favorably to the combination of surgeries and medications. Early surgical resection of intracranial lesions combined with drug treatment may offer the chance of a cure.https://doi.org/10.1186/s12879-021-07020-8Granulomatous amoebic encephalitisBalamuthia mandrillarisHigh-throughput next-generation sequencingTreatment |
| spellingShingle | Limei Peng Quan Zhou Yu Wu Xiaoli Cao Zili Lv Minghua Su Yachun Yu Wen Huang A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication BMC Infectious Diseases Granulomatous amoebic encephalitis Balamuthia mandrillaris High-throughput next-generation sequencing Treatment |
| title | A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication |
| title_full | A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication |
| title_fullStr | A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication |
| title_full_unstemmed | A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication |
| title_short | A patient with granulomatous amoebic encephalitis caused by Balamuthia mandrillaris survived with two excisions and medication |
| title_sort | patient with granulomatous amoebic encephalitis caused by balamuthia mandrillaris survived with two excisions and medication |
| topic | Granulomatous amoebic encephalitis Balamuthia mandrillaris High-throughput next-generation sequencing Treatment |
| url | https://doi.org/10.1186/s12879-021-07020-8 |
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