Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage

Keenan J Piper; Haidn Foster; Daniel Susanto; Cynthia L Maree; Sean D Thornton; Charles S Cobbs

doi:10.1016/j.ijid.2018.09.013

Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage

Int J Infect Dis. 2018 Dec:77:18-22. doi: 10.1016/j.ijid.2018.09.013. Epub 2018 Sep 20.

Authors

Keenan J Piper¹, Haidn Foster², Daniel Susanto³, Cynthia L Maree⁴, Sean D Thornton⁵, Charles S Cobbs⁶

Affiliations

¹ Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA. Electronic address: Keenan.Piper@swedish.org.
² Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; University of Cincinnati College of Medicine, 3235 Eden Avenue, Cincinnati, OH 45267, USA. Electronic address: Haidn.Foster@swedish.org.
³ Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; Radia Inc., 500 17th Ave, Seattle, WA 98122, USA. Electronic address: Daniel.Susanto@swedish.org.
⁴ Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA. Electronic address: Cynthia.Maree@swedish.org.
⁵ Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA; CellNetix Pathology and Laboratories, 1124 Columbia St Suite 200, Seattle, WA 98104, USA. Electronic address: Sean.Thornton@swedish.org.
⁶ Swedish Medical Group, 550 17th Avenue Suite 540, Seattle, WA 98122, USA. Electronic address: Charles.Cobbs@swedish.org.

PMID: 30243910
DOI: 10.1016/j.ijid.2018.09.013

Abstract

We report the case of a 69-year-old female who presented with a chronic nasal skin rash, new onset focal seizure, and a cerebral ring-enhancing lesion after a year of improper nasal irrigation. Despite aggressive and novel anti-amoebic treatment, she died as a result of a Balamuthia mandrillaris brain infection.

Keywords: Amoeba; Amoebic encephalitis; Balamuthia mandrillaris; Infectious encephalitis; Nasal lavage.

Publication types

Case Reports

MeSH terms

Aged
Balamuthia mandrillaris / isolation & purification*
Brain / diagnostic imaging
Brain / parasitology*
Brain Diseases / diagnostic imaging*
Brain Diseases / etiology
Brain Diseases / parasitology
Exanthema / drug therapy
Exanthema / parasitology
Fatal Outcome
Female
Humans
Nasal Lavage / adverse effects*
Nose / drug effects
Nose / parasitology
Sulfamethoxazole / therapeutic use
Trimethoprim / therapeutic use

Substances

Trimethoprim
Sulfamethoxazole