Abstract

BackgroundThe free-living amoeba Balamuthia mandrillaris may cause fatal encephalitis both in immunocompromised and in – apparently – immunocompetent humans and other mammalian species. Rapid, specific, sensitive, and reliable detection requiring little pathogen-specific expertise is an absolute prerequisite for a successful therapy and a welcome tool for both experimental and epidemiological research.ResultsA real-time polymerase chain reaction assay using TaqMan® probes (real-time PCR) was established specifically targeting the RNase P gene of B. mandrillaris amoebae. The assay detected at least 2 (down to 0.5) genomes of B. mandrillaris grown in axenic culture. It did not react with DNA from closely related Acanthamoeba (3 species), nor with DNA from Toxoplasma gondii, Leishmania major, Pneumocystis murina, Mycobacterium bovis (BCG), human brain, various mouse organs, or from human and murine cell lines. The assay efficiently detected B. mandrillaris DNA in spiked cell cultures, spiked murine organ homogenates, B. mandrillaris-infected mice, and CNS tissue-DNA preparations from 2 patients with proven cerebral balamuthiasis. This novel primer set was successfully combined with a published set that targets the B. mandrillaris 18S rRNA gene in a duplex real-time PCR assay to ensure maximum specificity and as a precaution against false negative results.ConclusionA real-time PCR assay for B. mandrillaris amoebae is presented, that is highly specific, sensitive, and reliable and thus suited both for diagnosis and for research.

Highlights

  • The free-living amoeba Balamuthia mandrillaris may cause fatal encephalitis both in immunocompromised and in – apparently – immunocompetent humans and other mammalian species

  • A real-time polymerase chain reaction (PCR) assay for B. mandrillaris amoebae is presented, that is highly specific, sensitive, and reliable and suited both for diagnosis and for research

  • Balamuthiasis is a disease of humans and a variety of mammalian species caused by the free-living amoeba Balamuthia mandrillaris [1,2]

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Summary

Introduction

The free-living amoeba Balamuthia mandrillaris may cause fatal encephalitis both in immunocompromised and in – apparently – immunocompetent humans and other mammalian species. Balamuthiasis is a disease of humans and a variety of mammalian species caused by the free-living amoeba Balamuthia mandrillaris [1,2]. Its most important clinical manifestation is Balamuthia amoebic encephalitis (BAE), described as granulomatous amebic encephalitis (GAE), in both immunocompromized hosts and in individuals apparently without immunological deficits [3,4]. B. mandrillaris is exquisitely encephalotropic and cytopathic [5], causing extensive brain tissue damage [6]. The high percentage of fatal BAE cases is due to the high frequency of misdiagnosis and subsequent false, possibly even exacerbating, treatment strat-

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