View source for Balamuthia mandrillaris

==Background==
===Microbiology===

*One of the [[free-living amoebae]]

===Epidemiology===

*Present in soil
*More common in US and South America
*More common in Hispanics

==Clinical Manifestations==

*Causes '''granulomatous amebic encephalitis (GAE)''' alone, skin lesions followed by GAE, or (rarely) skin lesions alone
**Characterized by progressive hemorrhagic necrosis of brain, with 90% mortality
**Fever, headache, altered mentation, vomiting, lethargy, seizures, and weakness
*Often preceded by skin lesions by a few weeks to 2 years
**Typically affect the nose and cheeks, but also torso and limbs
**Often a single lesion
**Progress over months from papulonodular erythematous plate-like areas, enlarging and eventually ulcerating
**Typically painless
*Can also initially present with rhinitis, sinusitis, or otitis media
*Difficult to treat, with high mortality

==Management==

*Based on case reports
*Combination therapy recommended by CDC:
**[[Is treated by::Pentamidine]] 4 mg/kg IV once daily
**[[Is treated by::Sulfadiazine]] 1.5 g PO q6h
**[[Is treated by::Flucytosine]] 37.5 mg/kg PO q6h
**[[Is treated by::Fluconazole]] 12 mg/kg PO/IV once daily
**[[Is treated by::Azithromycin]] 20 mg/kg (max 500 mg) PO once daily (or [[Is treated by::clarithromycin]]
**[[Is treated by::Miltefosine]] 50 mg PO tid (if ≥45 kg) or bid (if <45 kg)
{{DISPLAYTITLE:''Balamuthia mandrillaris''}}
[[Category:Protozoa]]