Infectious Disease Compendium

Balamuthia

Microbiology

B. mandrillaris, an amoeba.

Epidemiologic Risks

Swimming in fresh water and soil. Has been transmitted with organ transplants.

And it has been spread in transplanted organs(Pubmed).

Syndromes

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

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)."

Notes

See McCoy, Bones.