Balamuthia mandrillaris: Difference between revisions
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Balamuthia mandrillaris
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* Difficult to treat, with high mortality |
* Difficult to treat, with high mortality |
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==Management== |
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* Based on case reports |
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* Combination therapy recommended by CDC: |
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** [[Is treated by::Pentamidine]] 4 mg/kg IV once daily |
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** [[Is treated by::Sulfadiazine]] 1.5 g PO q6h |
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** [[Is treated by::Flucytosine]] 37.5 mg/kg PO q6h |
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** [[Is treated by::Fluconazole]] 12 mg/kg PO/IV once daily |
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** [[Is treated by::Azithromycin]] 20 mg/kg (max 500 mg) PO once daily (or [[Is treated by::clarithromycin]] |
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** [[Is treated by::Miltefosine]] 50 mg PO tid (if ≥45 kg) or bid (if <45 kg) |
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{{DISPLAYTITLE:''Balamuthia mandrillaris''}} |
{{DISPLAYTITLE:''Balamuthia mandrillaris''}} |
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[[Category:Protozoa]] |
[[Category:Protozoa]] |
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Revision as of 02:21, 4 June 2020
Background
Microbiology
- One of the free-living amoebae
Epidemiology
- Present in soil
- More common in US and South America
- More common in Hispanics
Clinical Presentation
- 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:
- Pentamidine 4 mg/kg IV once daily
- Sulfadiazine 1.5 g PO q6h
- Flucytosine 37.5 mg/kg PO q6h
- Fluconazole 12 mg/kg PO/IV once daily
- Azithromycin 20 mg/kg (max 500 mg) PO once daily (or clarithromycin
- Miltefosine 50 mg PO tid (if ≥45 kg) or bid (if <45 kg)
