Infectious Disease Compendium

Balamuthia

Microbiology

B. mandrillaris, an amoeba.

Epidemiologic Risks

Swimming in fresh water and soil. Not swimmin in soil; it is found in soil.

It has been spread in transplanted organs(Pubmed).

Syndromes

Meningoencephalitis (PubMed). Can be indolent with a granulomatous encephalitis and can mimic brain tumor.

Diagnosis difficult premortem because amebas are difficult to identify under the microscope, even with commonly used stains.

Treatment

Maybe pentamadine, maybe fluconazole, maybe ketoconazole. All at once.

"Survivors of Balamuthia infection were treated with a combination of antimicrobials, including pentamadine isothionate, 5-fluorocytosine (flucytosine), fluconazole, sulfadiazine, and a macrolide antibiotic (azithromycin or clarithromycin), with or without a phenothiazine compound (PubMed)."

Perhaps "prolonged treatment with miltefosine, fluconazole, and albendazole (PubMed)."

But usually fatal.

Notes

See McCoy, Bones.