Abstract Details

Title Balamuthia Mandrillaris in Returning Traveler and Aquarium Handler: A Death Sentence

Topic Infections/AIDS/Prion Disease

Presentation(s) P04 - (-)

Poster/Presentation
Number 019

Objective

Background BACKGROUND: Balamuthia mandrillaris a free-living soil ameba, is an emerging cause of GAE. Cerebral amebic infections are rarely diagnosed antemortem. The diagnosis of GAE is usually made on autopsy however it has been identified occasionally from brain biopsies.

Design/Methods DESIGN/METHODS: A 48 year old immunocompetent woman with PMH of migraine and hypertension came with diplopia, slurred speech and low grade fever. Three weeks earlier she developed headache different from her previous migraine attacks. Her travel history was significant for a recent visit to Florida, patient reported kayaking in the river. She also maintained aquarium in herhome.

Results RESULTS: Patient was dysarthric with left third, sixth, ninth, tenth and twelfth nerve palsies. MRI brain showed prolonged T2 signal intensity changes and enhancement in the medulla, left thalamus, and right caudate nucleus with mild focal mass effect. Cerebrospinal fluid showed: Glucose 36mg/ dL, Protein 199 mg/dL, WBC 110 cells/ mm3 , RBC 20 cells/ mm3, cytology showed abundant lymphocytes with atypia. The patient was treated empirically with intravenous antibiotics. Systemic work-up including brain biopsy was non-diagnostic. The patient eevntually hernieated despite placement of external ventricular drains and expired. Autopsy showed multiple regions of brain with extensive necrotizing encephalitis associated with marked lymphohistiocytic and neutrophilic inflammation and the presence of amebic organisms. Indirect immunofluorescence assays done at the CDC laboratory were positive for Balamuthia mandrillaris.

Conclusions CONCLUSIONS: This is the seventh case found to have B. mandrillaris infection in immunocomeptent patient. A high degree of suspicion in at-risk individuals with brain biopsy may be helpful in diagnosis. Definitive treatment, natural course of disease in the world is still unknown.

Authors/Disclosures
Kiran A. Patil, MD, FAAN (Independence Health) PRESENTER	Dr. Patil has nothing to disclose.
	No disclosure on file
Stephen J. Marks, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
RJ Wirth, PhD (Vector Psychometric Group, LLC)	RJ Wirth has received personal compensation for serving as an employee of Vector Psychometric Group, LLC.
	No disclosure on file

��ɫ��

��ɫ��