Granulomatous amoebic encephalitis

GAE begins slowly, with symptoms like headache, nausea, dizziness, irritability, and a low-grade fever. The CNS symptoms depend on the part of the brain that is infected. Changes in behavior are an important sign. Other CNS signs may include seizures, focal neurologic signs, diplopia (double vision), cranial nerve palsies, ataxia, confusion, and personality changes. The clinical presentation of GAE may mimic glioma (especially brainstem glioma), or other brain diseases, which may hamper timely diagnosis. The symptoms are caused by inflammatory necrosis of brain tissue brought on by compounds released from the organisms. ==Diagnosis==

The condition can be difficult for doctors to diagnose because it is a rare disease. A brain biopsy will reveal the presence of infection by pathogenic amoebas. In GAE, these present as general inflammation and sparse granules. On microscopic examination, infiltrates of amoebic cysts and/or trophozoites will be visible. ==Pathophysiology==

The causative organism for SAE was originally identified as Sappinia diploidea, but is now considered to be Sappinia pedata. ==Treatment==

Acanthamoeba Antifungal drugs including ketoconazole, miconazole, 5-flucytosine and pentamidine have been shown to be effective against Acanthamoeba in vitro. Balamuthia Like with Acanthamoeba, infection of the brain with this organism rapidly turns fatal in most cases. However some survivors have been reported: Two patients survived after being successfully treated with a therapy consisting of flucytosine, pentamidine, fluconazole, sulfadiazine, and azithromycin. Thioridazine or trifluoperazine was also given. Successful treatment in these cases was credited to "awareness of Balamuthia as the causative agent of encephalitis and early initiation of antimicrobial therapy." In one case, cloxacillin, ceftriaxone, and amphotericin B were tried, but this treatment protocol did not prove effective. Nitroxoline has shown interesting properties in vitro and might be a possible treatment for this infection. A man treated with nitroxoline at UCSF Medical Center in 2021, following a seizure that was identified to have resulted from CNS invasive Balamuthia infection, survived and recovered from the disease, indicating that nitroxoline might be a promising medication. An opinion article published in the Washington Post in 2025 mentions a pediatric patient who survived and recovered from a CNS invasive Balamuthia infection after taking nitroxoline. Sappinia It has been treated with azithromycin, pentamidine, itraconazole, and flucytosine. == Prognosis ==

Even with treatment, CNS infection with Acanthamoeba is often fatal, and there are very few recorded survivors, almost all of whom had permanent neurocognitive deficits. == See also ==