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Acanthamoeba spp. and Balamuthia mandrillaris leading to fatal granulomatous amebic encephalitis

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Abstract

Acanthamoeba spp. and Balamuthia mandrillaris are free-living amebae known to cause disseminated and fatal central nervous system dysfunction which manifests as granulomatous amebic encephalitis (GAE) with exceedingly rare frequency. We report two lethal cases of infection with free-living amebae: an acute case of Acanthamoeba spp. infection in an immunocompromised female and a subacute case of B. mandrillaris in a Hispanic male. The Acanthamoeba spp. infection presented with an atypical lesion in the thalamus that caused rapid deterioration of the patient while the case of B. mandrillaris had a prolonged clinical course with multifocal lesions beginning in the frontal lobe. Cerebrospinal fluid results were non-specific in both cases, however, post-mortem histology demonstrated the presence of trophozoites along a perivascular distribution of necrosis and infiltrate composed primarily of neutrophils. In addition to detailing the clinical presentations of these infrequent amebic infections, we offer insight into the difficulties surrounding their diagnoses in order to aid the clinician in accurate and timely identification.

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Authors and Affiliations

  1. Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA

    Daniel C. Lee, Steven E. Fiester, James W. Fulcher, Michael E. Ward & Ryan K. Hakimi

  2. Department of Pathology, Prisma Health – Upstate, Greenville, SC, 29605, USA

    Steven E. Fiester, James W. Fulcher, Michael E. Ward & Christine Marie-Gilligan Schammel

  3. Department of Radiology, Prisma Health – Upstate, Greenville, SC, 29605, USA

    Lee A. Madeline

  4. Office of the Medical Examiner, Greenville County, SC, USA

    James W. Fulcher & Michael E. Ward

  5. Pathology Associates of Greenville, Greenville, SC, 29605, USA

    James W. Fulcher, Michael E. Ward & Christine Marie-Gilligan Schammel

  6. Department of Medicine, Neurology Division, Prisma Health – Upstate, Greenville, SC, 29605, USA

    Ryan K. Hakimi

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  1. Daniel C. Lee
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  2. Steven E. Fiester
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  3. Lee A. Madeline
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  6. Christine Marie-Gilligan Schammel
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  7. Ryan K. Hakimi
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Correspondence to Steven E. Fiester.

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Lee, D.C., Fiester, S.E., Madeline, L.A. et al. Acanthamoeba spp. and Balamuthia mandrillaris leading to fatal granulomatous amebic encephalitis. Forensic Sci Med Pathol 16, 171–176 (2020). https://doi.org/10.1007/s12024-019-00202-6

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  • DOI: https://doi.org/10.1007/s12024-019-00202-6

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