| Naegleria fowleri | Acanthamoeba species | Balamuthia mandrillaris | |
|---|---|---|---|
| Clinical presentation | Primary amebic meningoencephalitis (PAM), with fulminant disease within days and death within 1-2 weeks | Granulomatous amebic encephalitis (GAE), with subacute presentations followed by fatal acute stage; may have cutaneous or sinus lesions; amebic keratitis | GAE as well, similarly subacute; may have skin lesions |
| Risk factors | Healthy children or young adults with recreational warm fresh-water exposure | Immunocompromised people; contact lens wearers, for keratitis | Immunocompromised people, but also immunocompetent children and elderly, and Hispanics |
| Neuroimaging | Nonspecific | Space-occupying or ring-enhancing lesion (GAE) | Space-occupying or ring-enhancing lesion |
| Diagnosis | CSF wet mount or PCR | Cysts in brain biopsy, immunostaining or PCR; trophozoites or cysts on corneal scraping | Cysts in brain biopsy, immunostaining or PCR |
| Treatment | Intrathecal and intravenous amphotericin B, azoles, rifampin, miltefosine | Pentamidine, azoles, flucytosine, sulfadiazine, miltefosine, amikacin, voriconazole | Pentamidine, azithromcin, fluconazole, sulfadiazine, flucytosine, miltefosine |
