Neurosurgical Biopsy and Resection for Diagnosis and Treatment of Balamuthia mandrillaris Amebic Encephalitis, United States

The article describes a case of a 5-year-old patient in the southwestern United States with amebic encephalitis caused by Balamuthia mandrillaris, treated with nitroxoline according to 2021 Centers for Disease Control and Prevention recommendations and undergoing two neurosurgical resections. Balamuthia mandrillaris is a free-living ameba found in soil and water that causes granulomatous amebic encephalitis with high mortality. In the United States, fewer than 20 cases are reported annually, but more than 90 percent of patients with central nervous system involvement die. The authors conducted a systematic literature review and found no substantial difference in prognosis between the group of patients with complete resection and the group with biopsy only. A 2018 study showed that nitroxoline is the most effective agent against B. mandrillaris ameba compared to other tested agents, including drugs from the recommended regimen. The case and systematic review provide evidence that treatment with nitroxoline combined with neurosurgical resection may contribute to survival in patients with amebic encephalitis.