Balamuthia mandrillaris: Difference between revisions

Latest revision as of 13:09, 17 September 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 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:
- 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)

@@ Line 1: / Line 1: @@
 ==Background==
 ===Microbiology===
-* One of the [[free-living amoebae]]
+*One of the [[free-living amoebae]]
 ===Epidemiology===
-* Present in soil
-* More common in US and South America
-* More common in Hispanics
+*Present in soil
-==Clinical Presentation==
+*More common in US and South America
-* Causes '''granulomatous amebic encephalitis (GAE)''' alone, skin lesions followed by GAE, or (rarely) skin lesions alone
+*More common in Hispanics
-** Characterized by progressive hemorrhagic necrosis of brain, with 90% mortality
-** Fever, headache, altered mentation), vomiting, lethargy, seizures, and weakness
+==Clinical Manifestations==
-* Often preceded by skin lesions by a few weeks to 2 years
-** Typically affect the nose and cheeks, but also torso and limbs
+*Causes '''granulomatous amebic encephalitis (GAE)''' alone, skin lesions followed by GAE, or (rarely) skin lesions alone
-** Often a single lesion
+**Characterized by progressive hemorrhagic necrosis of brain, with 90% mortality
-** Progress over months from papulonodular erythematous plate-like areas, enlarging and eventually ulcerating
+**Fever, headache, altered mentation, vomiting, lethargy, seizures, and weakness
-** Typically painless
+*Often preceded by skin lesions by a few weeks to 2 years
-* Can also initially present with rhinitis, sinusitis, or otitis media
+**Typically affect the nose and cheeks, but also torso and limbs
-* Difficult to treat, with high mortality
+**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
+*Based on case reports
-* Combination therapy recommended by CDC:
+*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::Pentamidine]] 4 mg/kg IV once daily
-** [[Is treated by::Flucytosine]] 37.5 mg/kg PO q6h
+**[[Is treated by::Sulfadiazine]] 1.5 g PO q6h
-** [[Is treated by::Fluconazole]] 12 mg/kg PO/IV once daily
+**[[Is treated by::Flucytosine]] 37.5 mg/kg PO q6h
-** [[Is treated by::Azithromycin]] 20 mg/kg (max 500 mg) PO once daily (or [[Is treated by::clarithromycin]]
+**[[Is treated by::Fluconazole]] 12 mg/kg PO/IV once daily
-** [[Is treated by::Miltefosine]] 50 mg PO tid (if ≥45 kg) or bid (if <45 kg)
+**[[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]]