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Journal of Clinical Microbiology, July 2006, p. 2660-2663, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00479-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

CASE REPORT

Diagnosis of First Case of Balamuthia Amoebic Encephalitis in Portugal by Immunofluorescence and PCR

Marta Tavares,1 Jose M. Correia da Costa,2 S. Stirling Carpenter,3 L. A. Santos,1 Caldas Afonso,1 Álvaro Aguiar,1 Josue Pereira,4 Ana Isabel Cardoso,5 Frederick L. Schuster,6 Shigeo Yagi,6 Rama Sriram,7 and Govinda S. Visvesvara7*

Department of Pediatrics, Hospital de S. João, Porto, Portugal,1 Center of Parasite Immunology and Biology, INSA, Porto, Portugal,2 Departments of Pathology,3 Neurosurgery, Hospital de S. João, Porto, Portugal,4 Public Health Services, Póvoa do Varzim, Portugal,5 California Department of Health Services, Richmond, California,6 Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia7

Received 6 March 2006/ Returned for modification 10 April 2006/ Accepted 26 April 2006

We report here the first Portuguese case of acute fatal granulomatous encephalitis attributed to Balamuthia mandrillaris, initially thought to be a brain tumor, which had a progressive and fatal outcome. Balamuthia mandrillaris is a free-living amoeba recognized as an uncommon agent of granulomatous encephalitis. Infections have been identified in immunocompromised hosts and in immunocompetent pediatric patients. Balamuthia infections are very rare, with only two reported cases in Europe. The case presented here occurred in a previously healthy boy who died 5 weeks after the onset of the symptoms. No evidence of immunological deficiency was noted, and testing for human immunodeficiency virus antibodies was negative. The symptoms were initially thought to be the result of a tumor, but histopathologic examination showed evidence of amoebic infection. Immunofluorescence staining of brain tissue identified B. mandrillaris as the infectious agent. The diagnosis was confirmed with PCR by detecting Balamuthia DNA in formalin-fixed brain tissue sections. Despite initiation of empirical antimicrobial therapy for balamuthiasis, the patient died 3 weeks after being admitted to the hospital. No source of infection was readily apparent.

* Corresponding author. Mailing address: Division of Parasitic Diseases, MS-F-36, Chamblee Campus, Bldg. 109, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724. Phone: (770) 488-4417. Fax: (770) 488-4253. E-mail: gsv1{at}cdc.gov.

Journal of Clinical Microbiology, July 2006, p. 2660-2663, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00479-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Matin, A., Siddiqui, R., Jayasekera, S., Khan, N. A. (2008). Increasing Importance of Balamuthia mandrillaris. Clin. Microbiol. Rev. 21: 435-448 [Abstract] [Full Text]  
  • Silva-Vergara, M. L., Da Cunha Colombo, E. R., De Figueiredo Vissotto, E., Silva, A. C. A. L., Chica, J. E. L., Etchebehere, R. M., Adad, S. J. (2007). Disseminated Balamuthia mandrillaris Amoeba Infection in an AIDS Patient from Brazil. Am J Trop Med Hyg 77: 1096-1098 [Abstract] [Full Text]  
  • Matin, A., Siddiqui, R., Jung, S.-Y., Kim, K. S., Stins, M., Khan, N. A. (2007). Balamuthia mandrillaris interactions with human brain microvascular endothelial cells in vitro. J Med Microbiol 56: 1110-1115 [Abstract] [Full Text]  


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