"Granulomatous amoebic encephalitis (GAE), also referred to as cerebral amoebiasis, is a rare and usually fatal subacute-chronic CNS infection caused by free-living amoebae such as Acanthamoeba spp. (main cause), Balamuthia mandrillaris and Sappinia pedata, which are ubiquitous in the environment 8,11."
"This is a distinct clinical syndrome from primary amoebic meningoencephalitis, which is an acute illness that presents like a severe bacterial meningoencephalitis and is caused by Naegleria fowleri 8."
"The Centres for Disease Control and Prevention has reported 173 cases of Acanthamoeba spp. GAE between 1956 and 2020, and 109 cases of Balamuthia mandrillaris GAE between 1976 and 2016 in the United States. The majority of patients affected were male in both case series, with a median age of 40-45 years 9,10."
"In the same observational studies, nearly 90% of Acanthamoeba spp. GAE cases had at least one immunocompromising condition, the majority being concurrent HIV infection, whilst"
"Granulomatous amoebic encephalitis has a gradual and highly variable subacute-chronic course over weeks and months 1-6. Patients with granulomatous amoebic encephalitis have been described with symptoms that include: headache, low fever, seizures, hemiparesis, and coma leading to eventual death 2. This presentation is often more aggressive in cases due to Balamuthia mandrillaris when compared to cases due to Acanthamoeba spp. 4."
"It has been posited that the skin and olfactory neuroepithelium serve as portals of entry, and occasionally, an inflammatory process may indeed be observed at these primary foci 5. Skin lesions, such as plaques over the face, may especially be prominent in patients with granulomatous amoebic encephalitis due to Balamuthia mandrillaris 4."
"haemorrhagic infarcts (more common in Balamuthia mandrillaris)"
"necrosis (more common in Balamuthia mandrillaris)"
Expected headings
"CSF"
"CSF findings may be non-specific; therefore, a tissue biopsy is recommended when clinical suspicion is high 13."