Mixed CNS Infection by a Balamuthia Ameba and a Mycobacterium : Two Cases from Peru
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MEDICINE
Mixed CNS Infection by a Balamuthia Ameba and a Mycobacterium: Two Cases from Peru Alfonso Martín Cabello-Vílchez 1 & Marcos Ñavincopa 2 & Asunción Terán 3 & Humberto Guerra 4 & Jessica N. Ricaldi 5 & Eduardo Gotuzzo 5,6 & Dalila Y. Martínez 5,6 Accepted: 13 April 2020 / Published online: 24 April 2020 # Springer Nature Switzerland AG 2020
Abstract Balamuthia mandrillaris are free-living amoebae (FLA) which are parasites within both humans and animals causing a wide range of sicknesses and acting as vehicles for many microorganisms such as mycobacterium. We present two young male patients, who died with highly unusual mixed infections involving Balamuthia or Balamuthia-like amoebae in the brain tissues plus Mycobacteria, one tuberculous encephalitis and the other cutaneous. Case 1 was a 21-year-old Hispanic male with 1 month of global headache, nausea, vomiting, fever (39 °C), confusion, and garbled speech, as well as pulmonary tuberculosis 1 year ago with possible meningeal TB at the time of admission to the hospital. The patient never developed skin injuries, and he died after 65 days of hospitalization, in August 2006. Case 2 was a 28-year-old male patient with mild parietal headache of 3-week evolution, associated at the beginning with light dizziness, with neurological examination at his normal admission. Twenty-five days later, he presented mental confusion and psychomotor agitation, and in the next 3 h, he suffered from cardiorespiratory arrest, being referred to intensive care; brain death was verified, and he died on January 8, 2005. To the best of our knowledge, these two cases are the first case reports of Balamuthia-like and Mycobacterium tuberculosis/Balamuthia mandrillaris and Mycobacterium sp. from Peru and are presented for academic interest. Keywords Balamuthia mandrillaris . Mycobacterium tuberculosis . Lima . Peru . Co-infection
This article is part of the Topical Collection on Medicine * Alfonso Martín Cabello-Vílchez [email protected]; [email protected] 1
Laboratorio de Protozoarios y Endosimbiontes Patógenos (LPEP), Instituto de Medicina Tropical “Alexander von Humboldt”, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima, Peru
2
Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional 2 de Mayo, Lima, Peru
3
Centro Médico Naval, Bellavista, Callao, Peru
4
Laboratorio Microbiología Clínica, Instituto de Medicina Tropical “Alexander von Humboldt”, Lima, Peru
5
Facultad de Medicina Alberto Hurtado Lima, Universidad Peruana Cayetano Heredia, Lima, Peru
6
Departamento de Enfermedades Infecciosas Tropicales y Dermatológicas, Hospital Cayetano Heredia, Av. Honorio Delgado 262, SMP, Lima, Peru
Introduction Balamuthia mandrillaris disease is frequently characterized by chronic involvement of the skin, followed by lifethreatening granulomatous encephalitis [1]. This free-living amoeba has been recognized as a pathogen in humans and animals since 1990 [2]. Around 200 cases of human encephalitis due to B. mandrillaris have been reported worldwi
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