An Emerging Pathogen, Balamuthia mandrillaris involving Skin as well as CNS with a fatal outcome, if not detected. A Comprehensive Review.: A Fatal Brain eating Pathogen

Balamuthia mandrillaris is an emerging cause of sub acute granulomatous amebic encephalitis (GAE) or Balamuthia mandrillaris amoebic infection (BMAI).

       It is an emerging pathogen causing skin lesions as well as CNS involvement with a fatal outcome if untreated.

      The infection has been described more commonly in immuno-competent individuals, mostly males, many children.

       All continents have reported the disease, although a majority of cases are seen in North and South America.

     Balamuthia mandrillaris is a free-living amoeba that can be isolated from soil.

      In published reported cases from North America, most patients will debut with neurological symptoms, whereas in other countries, a skin lesion will precede neurological symptoms.

     The classical cutaneous lesion is a plaque, mostly located on face, knee or other body parts.

     Diagnosis requires a specialized laboratory and clinical experience.

     This Amoebic encephalitis may be erroneously interpreted as a cerebral neoplasm, causing delay in the management of the infection.

     The diagnosis of this infection has proven to be difficult and is usually made post-mortem.

      Despite case fatality rates as high as > 98%, some experimental therapies have shown some success with the use of several therapeutics along with the synergistic antiprotozoal therapy.

        An attempt has been made in this Booklet to present the current understanding of Balamuthia infections, their pathogenesis and pathophysiology, and molecular mechanisms associated with the disease, as well as virulence traits of Balamuthia that may be potential targets for therapeutic interventions along with few illustrations.

…Dr. H. K. Saboowala.

                     M.B.(Bom) .M.R.S.H.(London)