Indiana University Infectious Diseases Fellowship
2 Mar,
10 tweets, 5 min read
#idboardreview 2 kidney transplant recipients post day 20 present w/ altered mental status, neutrophilic pleocytosis, MRI ring enhancing lesion. No improvement on abx & antivirals. Same donor died w/ dx of ADEM/exposure to wading pool. Diagnosis? #medEd #idmesEd #idtwitter 
#Balamuthia mandrillaris cdc.gov/mmwr/preview/m…
#Balamuthia amebas can infect skin, brain & other organs of the body. Can begin with skin wound on face, trunk, or limbs & progress to granulomatous amebic encephalitis (GAE).
Diagnosis of Balamuthia GAE can be difficult because symptoms are not specific to GAE
Diagnosis of Balamuthia GAE can be difficult because symptoms are not specific to GAE
Early symptoms might include:
•Fever
•Headache
•Vomiting
•Lethargy
•Nausea
Other signs of Balamuthia GAE might include:
•Mental health changes
•Seizures
•Weakness
•Confusion
•Partial paralysis
•Difficulty speaking
•Difficulty walking
•Fever
•Headache
•Vomiting
•Lethargy
•Nausea
Other signs of Balamuthia GAE might include:
•Mental health changes
•Seizures
•Weakness
•Confusion
•Partial paralysis
•Difficulty speaking
•Difficulty walking
#balamuthia dx indirect immunofluorescence assay (IFA) is detect antibodies in serum. In contrast, immunohistochemistry (IHC) & indirect immunofluorescence (IIF) staining use specific antibodies to detect amebas. Also PCR in brain tissues
#balamuthia treatment combination of flucytosine, pentamidine, fluconazole, sulfadiazine and either azithromycin or clarithromycin. Recently, miltefosine in combination with some of these other drugs has shown some promise.
#Balamuthia amebas live freely in soil around the world. Gardening, playing with dirt, or breathing in soil carried by the wind might increase the risk for infection . Balamuthia might also be present in fresh water.
#Balamuthia disease 🇺🇸 highly fatal encephalitis that affects patients of all ages. Hispanics were disproportionately affected. The southwest region reported most cases. academic.oup.com/cid/article/68…
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