Balamuthia mandrillaris is a free-living leptomyxid amoeba which is known to cause amoebiasis in
humans, especially the deadly neurological condition known as granulomatous amoebic encephalitis
(GAE). Balamuthia has not been definitively isolated in nature, but it is believed to be distributed
throughout the temperate regions of the world. This is supported somewhat by the presence of
antibodies to Balamuthia present in healthy individuals. The Balamuthia genus is named in honor of the
late Professor William Balamuth for his contributions to the studies of parasitic and free-living amoebas.
1. Balamuthia mandrillaris Transmitted Through Organ Transplantation — Mississippi, 2009 CDC
Division of News and Electronic Media (404) 639-3286
CDC reports the first known transmission of a rare brain infection, Balamuthia granulomatous amebic
encephalitis (GAE), through organ transplantation. The organ donor died of encephalitis that was
initially thought to be non-transmissible. Among the four recipients of organs from this donor, two
became ill with one dying and the two other recipients remain well. These cases illustrate the risk of
transmitting undetected infections via organ transplantation, especially when the cause of death in the
organ donor is not clearly defined. Physicians and transplant centers should be aware of the possibility
of undetected infections (such as GAE) in potential organ donors, and should avoid using organs from
potential donors who die of encephalitis of uncertain origin. Organ procurement organizations should
carefully consider the medical suitability of potential organ donors with encephalitis of uncertain
etiology. Furthermore, transplant centers should avoid transplantation of organs from these donors,
whose organs might pose an elevated risk for fatal infection in recipients.
Am. J. Trop. Med. Hyg., 70(6), 2004, pp. 666-669
BALAMUTHIA MANDRILLARIS MENINGOENCEPHALITIS: THE FIRST CASE IN SOUTHEAST ASIA POJ
INTALAPAPORN, CHUSANA SUANKRATAY, SHANOP SHUANGSHOTI, KAMMANT PHANTUMCHINDA,
SOMBOON KEELAWAT, AND HENRY WILDE Section of Infectious Diseases and Section of Neurology,
Department of Medicine, and Department of Pathology, Chulalongkorn University, Bangkok, Thailand;
Queen Saovabha Memorial Institute, Bangkok, Thailand
We present a case of 23-year-old man with acute meningoencephalitis, accompanied by inflammation
of a nasal ulcer. He had been healthy until six months prior to admission to the hospital when he had a
motorcycle accident. A star-shaped wound at his nose was incurred after falling into a swamp. A
computed tomogram of the brain showed two nonenhancing hypodense lesions at the left caudate
nucleus and the right parietal lobe, ependymitis and leptomeningeal enhancement. A skin biopsy
showed chronic noncaseous granulomatous inflammation without demonstrated microorganisms. The
patient did not respond to the empirical treatment with cloxacillin, ceftriaxone, and amphotericin B, and
eventually died on the thirteenth day of hospitalization. At autopsy, hematoxylin and eosin–stained
brain sections showed a chronic necrotizing inflammation with numerous amebic trophozoites and rare
cysts. Definitive identification of Balamuthia mandrillaris was made by fluorescent immunohistochemical
analysis. There were 10 Naegleria fowleri primary amebic meningoencephalitis, eight Acanthamoeba
granulomatous amebic encephalitis, and three Acanthamoeba meningitis in Thailand. To our
knowledge, this case is the first reported case of B. mandrillaris in Southeast Asia.
Balamuthia Amebic Encephalitis Risk, Hispanic Americans
Frederick L. Schuster,* Carol Glaser,* Somayeh Honarmand,* James H. Maguire,† and Govinda S.
*California Department of Health Services, Richmond, California, USA; and †Centers for Disease
Control and Prevention, Atlanta, Georgia, USA
Suggested citation for this article: Schuster FL, Glaser C, Honarmand S, Maguire JH, Visvesvara GS.
Balamuthia amebic encephalitis risk, Hispanic Americans [letter]. Emerg Infect Dis [serial on the
Internet]. 2004 Aug [date cited]. Available from: http://www.cdc.gov/ncidod/EID/vol10no8/04-0139.htm
To the Editor: Balamuthia mandrillaris, a free-living soil ameba, can cause granulomatous amebic
encephalitis as well as nasopharyngeal, cutaneous, and disseminated infections in humans, nonhuman
primates, and other animals. Approximately 100 published and unpublished cases of Balamuthia
amebic encephalitis (BAE) have been reported; most were fatal. Diagnosis of BAE is usually made at
autopsy, and rarely by biopsy, in part because the amebas can be overlooked in histopathologic
preparations. In recognizing BAE as a type of encephalitis that might otherwise be undiagnosed, the
California Encephalitis Project (1) has been screening selected serum samples from patients with
encephalitis for evidence of antibodies to Balamuthia.
We describe cases of BAE in California and compare data with national data collected on Balamuthia
infections since the discovery of the organism in 1990. Since 1998, serum and other samples
(cerebrospinal fluid [CSF], throat and rectal swabs, brain tissue) from patients with encephalitis have
been submitted to the California Encephalitis Project by participating physicians throughout California.
The goal of the California Encephalitis Project is to provide enhanced diagnostic testing for etiologic
agents of encephalitis through an intensive testing algorithm. The case definition of encephalitis is
encephalopathy, plus one or more of the following: fever, seizures, focal neurologic findings, CSF
pleocytosis, or electroencephalographic or neuroimaging findings consistent with encephalitis (1).
Persons with HIV/AIDS, severely immunocompromised patients, and patients <6 months of age are
excluded from the project.
Amoeba blamed in 2 more organ transplant deaths
(AP) – 2 hours ago [Sept 16, 2010]
ATLANTA — U.S. health officials say two Arizona organ transplant recipients died of an infection from a
microscopic parasite they got from their organ donor.
The deaths are the second confirmed cluster of tranplant-related encephalitis caused by Balamuthia
mandrillaris, an amoeba found in soil. It is especially dangerous to people undergoing organ
transplants and who have weakened immune systems. The first cluster occurred in Mississippi last year.
The donor, a 27-year-old male landscaper, died in Arizona in July from what doctors believed was a
stroke. A 56-year-old male liver recipient died Aug. 17. A 24-year-old male kidney and pancreas
recipient died Aug. 30. Two other recipients, one who got a heart and another a kidney, are alive and
A huge effort for Isla
01 Sep, 2010 09:40 AM
$10,000 target for Telethon
LOSING a loved one is heartbreaking, and each and everyone left behind, mourns and deals with the
loss in his or her own way.
But losing an eight-month-old child is devastating and naturally the question is why someone so young
and so innocent is taken.
Such is the case for Kristian and Gemma Collins, a Bunbury couple with strong Donnybrook
Isla Grace Anne Collins was born on July 7, 2009, and died of Balamuthia mandrillaris (BM) on March
29 this year after a three-week illness.
BM is a rare brain infection, a type of amoebic encephalitis.
The environmental organism Balamuthia can be found in soil or airborne and can enter the body
through the lower respiratory tract or breaks in the skin.
Despite this, infection is very rare and the amoeba is not considered a cause for public health concern.
Because of the disease’s rarity, specialists at Princess Margaret Hospital were baffled by Isla’s illness.
There are so many varied symptoms, and Isla’s early symptoms — general “not being well” — could
have been related to teething.
Her doctors could not say where or how she would have contracted the infection.
Only about 100 recognised cases of BM have been documented in the world and four of these were
Two cases were successfully treated with a cocktail of antibiotics and antiparasitics but both victims
suffered permanent neurological damage as a result of the infection.
Isla’s immune system did not recognise this particular bug and her condition was a puzzle.
Due to its rarity and aggressive nature, diagnosis and treatment of this condition is extremely difficult.
Gemma said PMH doctors at couldn’t be faulted, and they never stopped trying to diagnose Isla’s
condition. Because the symptoms can mimic other diseases, their task was enormous.
In memory of Isla — and in recognition of and thanks to the dedicated, compassionate, untiring work of
the specialists, doctors and nursing staff who attended Isla in PMH — Kristian, Gemma and the City of
Bunbury Surf Lifesaving Club are hoping to raise $10,000 for Telethon