Granulomatous amoebic encephalitis medical therapy

Overview
Granulomatous amoebic encephalitis is a central nervous system disease caused by certain species of amoeba, especially Balamuthia mandrillaris.

Medical therapy
GAE can, in general, must be treated by killing the pathogenic amoebas which cause it. Even with treatment, the condition is often fatal, and there are very few recorded survivors, almost all of whom suffered permanent neurocognitive deficits. Several drugs have been shown to be effective against GAE-causing organisms in vitro.

Treatment

Trophozoites of B. mandrillaris in culture. Photo credit: DPDx, CDC

Although there have been more than 200 cases of Balamuthia infection worldwide, few patients are known to have survived as a result of  successful drug treatment[1,2]. Early diagnosis and treatment might increase the chances for survival[3].

Drugs used in treating Granulomatous Amebic Encephalitis (GAE) caused by Balamuthia have included a combination of flucytosine, pentamidine, fluconazole, sulfadiazine and either azithromycin  or clarithromycin[1,2,4,5]. Recently, miltefosine in combination with some of these other drugs has shown some promise[2]. Much more information is needed in treating patients with GAE due to Balamuthia.

References

Perez MT, Bush LM. Balamuthia mandrillaris amebic encephalitis. Curr Infect Dis Rep. Jul 2007;9(4):323-328. Martinez DY, Seas C, Bravo F, et al. Successful treatment of Balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement. Clin Infect Dis. Jul 15 2010;51(2):e7-11. Siddiqui R, Khan NA. Balamuthia amoebic encephalitis: an emerging disease with fatal consequences. Microb Pathog. Feb 2008;44(2):89-97. Cary LC, Maul E, Potter C, et al. Balamuthia mandrillaris meningoencephalitis: survival of a pediatric patient. Pediatrics. Mar 2010;125(3):e699-703. Drugs for Parasitic Infections: The Medical Letter; 2010.