Case Report: Encephalitis Caused by Balamuthia mandrillaris in a 3-Year-Old Iranian Girl.

It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.

Extradural spinal hydatid cyst causing hindlimb ataxia in a horse.

INTRODUCTION: This case report describes a 13-year-old cob-cross gelding presented for evaluation of recent onset hindlimb ataxia. The gelding had undergone general anaesthesia and tenoscopy of the right hindlimb digital flexor tendon sheath at a nearby clinic three months earlier and had appeared normal at routine post-operative assessments until the sudden onset of neurological deficits. Spinal trauma was suspected initially but radiography and scintigraphy were unremarkable. Due to the severity and progressive nature of the clinical signs the -gelding was subjected to euthanasia. Post mortem examinations (computed tomography, dissection and histopathology) revealed spinal cord compression caused by a single extradural hydatid cyst (Echinococcus equinus), confirmed with PCR, at the level of the 15th thoracic vertebra. This is the first report of a spinal hydatid cyst causing hindlimb ataxia and should therefore be considered a potential differential diagnosis for ataxia in the equine patient.

INTRODUCTION: Ce rapport décrit le cas d'un hongre croisé cob de 13 ans présenté pour l'évaluation d'une ataxie des membres postérieurs d'apparition récente. Le hongre avait subi une anesthésie générale et une ténoscopie de la gaine du tendon du fléchisseur digital du membre postérieur droit dans une clinique voisine trois mois auparavant et avait semblé normal lors des évaluations postopératoires de routine jusqu'à l'apparition soudaine de déficits neurologiques. Un traumatisme rachidien était suspecté au départ, mais la radiographie et la scintigraphie étaient sans particularité. En raison de la gravité et de la nature progressive des signes cliniques, le hongre a été euthanasié. Les examens post mortem (tomodensitométrie, dissection et histopathologie) ont révélé une compression de la moelle épinière provoquée par un unique kyste hydatique extradural (Echinococcus equinus), confirmé par PCR, au niveau de la 15e vertèbre thoracique. Il s'agit du premier cas rapporté d'un kyste hydatique au niveau de la colonne vertébrale causant une ataxie des membres postérieurs et doit donc être considéré comme un diagnostic différentiel potentiel de l'ataxie chez le patient équin.

Chagas disease in a Texan horse with neurologic deficits.

A 10-year-old Quarter Horse gelding presented to the Texas A&M University Veterinary Teaching Hospital with a six month-history of ataxia and lameness in the hind limbs. The horse was treated presumptively for equine protozoal myeloencephalitis (EPM) based on clinical signs but was ultimately euthanized after its condition worsened. Gross lesions were limited to a small area of reddening in the gray matter of the thoracic spinal cord. Histologically, trypanosome amastigotes morphologically similar to Trypanosoma cruzi, the agent of Chagas disease in humans and dogs, were sporadically detected within segments of the thoracic spinal cord surrounded by mild lymphoplasmacytic inflammation. Ancillary testing for Sarcocystis neurona, Neospora spp., Toxoplasma gondii and Leishmania spp. was negative. Conventional and real time polymerase chain reaction (PCR) of affected paraffin embedded spinal cord were positive for T. cruzi, and sequencing of the amplified T. cruzi satellite DNA PCR fragment from the horse was homologous with various clones of T. cruzi in GenBank. While canine Chagas disease cases have been widely reported in southern Texas, this is the first report of clinical T. cruzi infection in an equid with demonstrable amastigotes in the spinal cord. In contrast to previous instances of Chagas disease in the central nervous system (CNS) of dogs and humans, no inflammation or T. cruzi amastigotes were detected in the heart of the horse. Based on clinical signs, there is a potential for misdiagnosis of Chagas disease with other infectious diseases that affect the equine CNS. T. cruzi should be considered as a differential diagnosis in horses with neurologic clinical signs and histologic evidence of meningomyelitis that originate in areas where Chagas disease is present. The prevalence of T. cruzi in horses and the role of equids in the parasite life cycle require further study.

Alveolar echinococcosis of liver presenting with neurological symptoms due to brain metastases with simultaneous lung metastasis: a case report.

Alveolar echinococcosis (AE) is a chronic and serious, even lethal, parasitic infection caused by the helminth Echinococcus multilocularis (EM). AE is an endemic disease in Turkey and it is particularly common in people living in the eastern Anatolia Region. In addition to various clinical presentations, symptoms which lead to diagnosis, however, are usually associated with the metastatic lesions. We herein reported a 62-year-old man who had liver alveolar hydatid disease with simultaneous lung and brain metastasis. We think there was only one therapeutic option, namely medical treatment with albendazol, which is the usual treatment for patients living in eastern Anatolia and who are admitted late resulting in a subsequent inoperable situation. Thus, radiological screening studies for the public in this region may increase the possibility of surgical treatment for alveolar hydatid disease.

Parelaphostrongylus tenuis in captive pronghorn antelope (Antilocapra americana) in Nebraska.

Lesions in four captive pronghorn antelope (Antilocapra americana) naturally infected with Parelaphostrongylus tenuis in eastern Nebraska (USA) are described in this report. Animals were bright and alert with hind limb ataxia that progressed to sternal or lateral recumbency between July 28 and October 17, 1998. Animals were euthanized due to disease progression despite therapy. Multifocal decubital ulcers over bony prominences occurred in two animals and chronic unilateral otitis media was present in one animal. Histopathologic examination revealed severe Wallerian degeneration randomly scattered throughout the spinal cords of all four animals. Spinal cord sections from two animals contained adult nematode parasites consistent with P. tenuis. This is the first report of naturally occurring P. tenuis infection in pronghorn antelope. Pronghorn antelope should be considered susceptible to P. tenuis infection and contact with infected white-tailed deer as well as intermediate gastropod hosts of P. tenuis should be prevented in endemic areas.

[Developmental aspects of a bilharziasis caused by Schistosoma mansoni]. / Aspects évolutifs d'une myelopathie bilharzienne à Schistosoma mansoni.

The diagnosis of meningo-radiculitis of unknown etiology was posed on a adult Caucasian male patient, based on clinical and biological symptoms offered since 1991, February (CSF: lymphocytic with hyperproteinosis). The patient had stayed in different bilharzia endemic zones. Confronted with a lack of improvement, even an aggravation and facing an appearance of a pyramidal symptom of the limbs, mostly at left, with ataxia preventing walking, one admitted the patient several times to do biological and radiological tests. They confirmed the troubles at the level of the CSF, already above mentioned; the MRI showed a hypersignal at the low dorso-lumbar level and at the terminal cone without any sign of tumoral processus, associated to an abnormal contrast at the level of meninges. All of that revealed a significant aspect of a meningo-myelo-radiculitis. In front of the various negative sero-bacteriological, viral, parasitic test, of the unresults of the research of any systemic symptom, one decided to perform a neurosurgical intervention to get a biopsy. So was revealed the presence of ovoid elements PAS+with a lateral spur and parasitic aspect. Consequently the diagnosis of bilharziosis was established. A cure of Praziquantel has been prescribed: 3 tablets/day for 10 days, and four more cures at an interval of one month, all of them associated to a long term corticotherapy. Any diminution of the dosis entailed an increase of the painful symptomatology. Because of the perennial posterior cordal painful symptom, the patient has shown a depressive reaction.(ABSTRACT TRUNCATED AT 250 WORDS)

Sarcocystis neurona-associated ataxia in horses in Brazil.

Sarcocystis neurona-like schizonts were found in sections of brain and spinal cord of two ataxic horses from Brazil. The diagnosis was supported by staining with anti-Sarcocystis serum in an immunohistochemical test. One of the affected horses was born in Argentina and raised in Brazil, and the other horse was born and raised in Brazil.