{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:25:38Z","timestamp":1787934338877,"version":"build-2784847793"},"reference-count":20,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Free-living amoebae rarely instigate intracranial infections that may resemble neoplastic conditions on imaging. <jats:italic>Naegleria fowleri<\/jats:italic> precipitates an acute, swiftly fatal meningoencephalitis, whereas <jats:italic>Acanthamoeba<\/jats:italic> and <jats:italic>Balamuthia<\/jats:italic> species typically manifest with a less aggressive onset but carry equally dire consequences.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>The case describes a 33-year-old woman with subacute encephalitis caused by <jats:italic>Balamuthia mandrillaris<\/jats:italic>. She experienced 2 months of back pain, 1 month of headaches, and 2 weeks of vomiting without fever, recent travel, aquatic activities, or animal exposure. Brain magnetic resonance imaging revealed a sizable, heterogeneous enhancing mass in the right temporal and frontal lobes, accompanied by vasogenic edema and midline shift. Histopathology showed marked inflammation and damage to blood vessels with amoebic trophozoites present. The trophozoites displayed specific characteristics, leading to the diagnosis of amoebic meningoencephalitis. Polymerase chain reaction and Sanger sequencing confirmed <jats:italic>B. mandrillaris<\/jats:italic> infection while testing for <jats:italic>N. fowleri<\/jats:italic> and <jats:italic>Acanthamoeba<\/jats:italic> was negative. Despite antibiotic treatment, the patient\u2019s condition deteriorated rapidly, resulting in death within 2 weeks of presentation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>This is the first confirmed case of <jats:italic>B. mandrillaris<\/jats:italic> central nervous system (CNS) infection from Pakistan. The incidence of this disease is expected to rise due to increasing temperatures due to climate change and the deteriorating quality of the water supply. <jats:italic>Balamuthia<\/jats:italic> meningoencephalitis should, therefore be on the differential for non-neoplastic CNS lesions. Furthermore, an atypical histopathologic picture, including the absence of granulomatous inflammation, needs to be recognized.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_181_2024","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T08:55:30Z","timestamp":1720774530000},"page":"238","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Non-granulomatous meningoencephalitis with <i>Balamuthia mandrillaris<\/i> mimicking a tumor: First confirmed case from Pakistan"],"prefix":"10.25259","volume":"15","author":[{"given":"Zanib","family":"Javed","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Mushtaq","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Ghanchi","sequence":"additional","affiliation":[{"name":"Department of Pathology, Aga Khan University Hospital, Karachi, Sindh, Pakistan,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Gilani","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Colorado (Children Hospital Colorado), Children\u2019s Hospital Colorado, Boulder, Colorado, United States."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Ather","family":"Enam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"10.25259\/SNI_181_2024\/ref-1","article-title":"Balamuthia mandrillaris - granulomatous amebic encephalitis (GAE)","author":"Centers for Disease Control and Prevention","year":"2019"},{"key":"10.25259\/SNI_181_2024\/ref-2","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1093\/cid\/ciy813","article-title":"The epidemiology and clinical features of Balamuthia mandrillaris disease in the United States, 1974-2016","volume":"68","author":"Cope","year":"2019","journal-title":"Clin Infect Dis"},{"key":"10.25259\/SNI_181_2024\/ref-3","doi-asserted-by":"crossref","first-page":"e59","DOI":"10.1016\/S1473-3099(20)30933-6","article-title":"Acanthamoeba castellanii encephalitis in a patient with AIDS: A case report and literature review","volume":"22","author":"Damhorst","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"10.25259\/SNI_181_2024\/ref-4","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1093\/cid\/ciw422","article-title":"Transmission of Balamuthia mandrillaris by organ transplantation","volume":"63","author":"Farnon","year":"2016","journal-title":"Clin Infect Dis"},{"key":"10.25259\/SNI_181_2024\/ref-5","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.4269\/ajtmh.17-0110","article-title":"Case series of Naegleria fowleri primary ameobic meningoencephalitis from Karachi, Pakistan","volume":"97","author":"Ghanchi","year":"2017","journal-title":"Am J Trop Med Hyg"},{"key":"10.25259\/SNI_181_2024\/ref-6","first-page":"251","article-title":"Pathogenic free-living amoebic encephalitis in Japan","volume":"39","author":"Hara","year":"2019"},{"key":"10.25259\/SNI_181_2024\/ref-7","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/neup.12151","article-title":"An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan","volume":"35","author":"Itoh","year":"2015","journal-title":"Neuropathology"},{"key":"10.25259\/SNI_181_2024\/ref-8","doi-asserted-by":"crossref","first-page":"335","DOI":"10.3347\/kjp.2013.51.3.335","article-title":"Fatal Balamuthia amebic encephalitis in a healthy child: A case report with review of survival cases","volume":"51","author":"Krasaelap","year":"2013","journal-title":"Korean J Parasitol"},{"key":"10.25259\/SNI_181_2024\/ref-9","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1086\/653609","article-title":"Successful treatment of Balamuthia mandrillaris amoebic infection with extensive neurological and cutaneous involvement","volume":"51","author":"Martinez","year":"2010","journal-title":"Clin Infect Dis"},{"key":"10.25259\/SNI_181_2024\/ref-10","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1128\/CMR.00056-07","article-title":"Increasing importance of Balamuthia mandrillaris","volume":"21","author":"Matin","year":"2008","journal-title":"Clin Microbiol Rev"},{"key":"10.25259\/SNI_181_2024\/ref-11","doi-asserted-by":"crossref","first-page":"505","DOI":"10.3171\/jns.1986.64.3.0505","article-title":"Granulomatous brain tumor caused by Acanthamoeba: Case report","volume":"64","author":"Ofori-Kwakye","year":"1986","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_181_2024\/ref-12","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/2229-5070.149889","article-title":"Management of granulomatous amebic encephalitis: Laboratory diagnosis and treatment","volume":"5","author":"Parija","year":"2015","journal-title":"Trop Parasitol"},{"key":"10.25259\/SNI_181_2024\/ref-13","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3201\/eid1702.100442","article-title":"Primary amebic meningo encephalitis caused by Naegleria fowleri, Karachi, Pakistan","volume":"17","author":"Shakoor","year":"2011","journal-title":"Emerg Infect Dis"},{"key":"10.25259\/SNI_181_2024\/ref-14","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1046\/j.1440-1789.2002.00444.x","article-title":"An autopsy case of amebic meningoencephalitis. 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