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Disseminated Balamuthia mandrillaris Amoeba Infection in an AIDS Patient from Brazil

This report describes a 32-year-old male AIDS patient. He presented with a clinical picture characterized by severe headache, blurred vision, and fever that had lasted for 10 days. At admission, no remarkable neurologic abnormalities were observed. Cranial tomography showed a ring-enhanced lesion with edema and a mass effect in the right occipital lobe. The initial diagnosis was toxoplasmosis, and treatment of this was administered. However, 5 days later, the patient’s clinical status worsened and he died. The necropsy showed necrotizing and hemorrhagic encephalitis, with trophozoites similar to an amoeba species. Furthermore, the kidneys, adrenal glands, thyroid gland, and liver were also involved. The amoeba Balamuthia mandrillaris was identified by an immunofluorescence test.

Received April 23, 2007. Accepted for publication August 27, 2007.

Acknowledgments: We thank Ann M. Nelson of the Division of AIDS and Emerging Infectious Diseases, Armed Forces Institute of Pathology, Washington, DC, and the Centers for Disease Control and Prevention, Atlanta, GA, for amoeba identification.

Financial support: This study was supported by FAPEMIG.

^* Address correspondence to Mario León Silva-Vergara, Avenida Getúlio Guaritá, s/n, Uberaba, Minas Gerais, Brazil 380001-970. E-mail: marioleon.dip{at}mednet.com.br

Authors’ addresses: Mario León Silva-Vergara, Av. Getúlio Guarita, s/n Uberaba-MG 38001-970, Brazil, Telephone: 55-34-33185286, Fax: 55-34-33185279. Eduardo Rodrigues da Cunha Colombo and Travessa Coronel José Ferreira, 200 Apt. 1100 Uberaba-MG 38010-320, Brazil, Telephone: 55-34-33331578. Eduardo de Figueiredo, Vissotto Rua Vigário Silva, 389, Apt 301 Uberaba-MG 38010-130, Brazil, Telephone: 55-34-33322954. Ana Cristina Araújo Lemos Silva, Av. Getúlio Guarita, s/n Uberaba-MG 38001-970, Brazil, Telephone: 55-34-33185644. Javier Emilio Lazo Chica, Av. Frei Paulino, 30 Uberaba-MG 38025-180, Brazil, Telephone: 55-34-33185644. Renata Margarida Etchebehere and Sheila Jorge Adad, Av. Getúlio Guarita, s/n Uberaba-MG 38001-970, Brazil, Telephone: 55-34-33185644.