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Case Study
Amoebic Encephalitis Caused by Balamuthia mandrillaris
Su Jung Kum, Hye Won Lee, Hye Ra Jung, Misun Choe, Sang Pyo Kim
J Pathol Transl Med. 2019;53(5):327-331.   Published online May 24, 2019
DOI: https://doi.org/10.4132/jptm.2019.05.14
  • 17,308 View
  • 156 Download
  • 12 Web of Science
  • 12 Crossref
AbstractAbstract PDF
We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.

Citations

Citations to this article as recorded by  
  • Molecular identification, phylogenetic analysis and histopathological study of pathogenic free-living amoebae isolated from discus fish (Symphysodon aequifasciatus) in Iran: 2020–2022
    Hooman Rahmati-Holasoo, Maryam Niyyati, Marziye Fatemi, Fatemeh Mahdavi Abhari, Sara Shokrpoor, Alireza Nassiri, Amin Marandi
    BMC Veterinary Research.2024;[Epub]     CrossRef
  • Encephalomyelomeningitis Caused by Balamuthia mandrillaris: A Case Report and Literature Review
    XueMei Fan, TianWen Chen, Hui Yang, Yue Gao, Yan Chen
    Infection and Drug Resistance.2023; Volume 16: 727.     CrossRef
  • Diagnosing Balamuthia mandrillaris amebic meningoencephalitis in a 64-year-old woman from the Southwest of China
    Suhua Yao, Xiaoting Chen, Lian Qian, Shizheng Sun, Chunjing Zhao, Zongkai Bai, Zhaofang Chen, Youcong Wu
    Parasites, Hosts and Diseases.2023; 61(2): 183.     CrossRef
  • Diagnosis of Balamuthia mandrillaris Encephalitis by Thymine–Adenine Cloning Using Universal Eukaryotic Primers
    Ju Yeong Kim, Myung-Hee Yi, Myungjun Kim, Joon-Sup Yeom, Hyun Dong Yoo, Seong Min Kim, Tai-Soon Yong
    Annals of Laboratory Medicine.2022; 42(2): 196.     CrossRef
  • Facial Balamuthia mandrillaris infection with neurological involvement in an immunocompetent child
    Zhen Zhang, Jianying Liang, Ruoqu Wei, Xiaobo Feng, Lei Wang, Liuhui Wang, Piaoping Zhao, Hong Yu, Yan Gu, Zhirong Yao
    The Lancet Infectious Diseases.2022; 22(3): e93.     CrossRef
  • Subacute Balamuthia mandrillaris encephalitis in an immunocompetent patient diagnosed by next-generation sequencing
    Changbo Xu, Xiaoyan Wu, Miaoqin Tan, Dongmei Wang, Shengnan Wang, Yongming Wu
    Journal of International Medical Research.2022; 50(5): 030006052210932.     CrossRef
  • Distribution and Current State of Molecular Genetic Characterization in Pathogenic Free-Living Amoebae
    Alejandro Otero-Ruiz, Leobardo Daniel Gonzalez-Zuñiga, Libia Zulema Rodriguez-Anaya, Luis Fernando Lares-Jiménez, Jose Reyes Gonzalez-Galaviz, Fernando Lares-Villa
    Pathogens.2022; 11(10): 1199.     CrossRef
  • Fulminant Disseminating Fatal Granulomatous Amebic Encephalitis: The First Case Report in an Immunocompetent Patient in South Korea
    Ju Yeon Lee, In Kyu Yu, Seong Min Kim, Joo Heon Kim, Ha Youn Kim
    Yonsei Medical Journal.2021; 62(6): 563.     CrossRef
  • A Japanese case of amoebic meningoencephalitis initially diagnosed by cerebrospinal fluid cytology
    Ryogo Aoki, Toshimasa Sakakima, Asuka Ohashi, Riyoko Niwa, Masashi Matsuyama, Fumimasa Etori, Naoki Watanabe, Kenji Yagita, Takuji Tanaka
    Clinical Case Reports.2020; 8(9): 1728.     CrossRef
  • Balamuthia mandrillaris infection in China: a retrospective report of 28 cases
    Lei Wang, Wenjing Cheng, Bing Li, Zhe Jian, Xianlong Qi, Dongjie Sun, Jian Gao, Xuetao Lu, Yi Yang, Kun Lin, Chuanlong Lu, Jiaxi Chen, Chunying Li, Gang Wang, Tianwen Gao
    Emerging Microbes & Infections.2020; 9(1): 2348.     CrossRef
  • Methotrexate/nonsteroidal anti-inflammatory drugs/steroids

    Reactions Weekly.2019; 1775(1): 307.     CrossRef
  • Identification of plicamycin, TG02, panobinostat, lestaurtinib, and GDC-0084 as promising compounds for the treatment of central nervous system infections caused by the free-living amebae Naegleria, Acanthamoeba and Balamuthia
    Monica M. Kangussu-Marcolino, Gretchen M. Ehrenkaufer, Emily Chen, Anjan Debnath, Upinder Singh
    International Journal for Parasitology: Drugs and Drug Resistance.2019; 11: 80.     CrossRef
Original Articles
Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease
Eun Sun Jung, Kyoungbun Lee, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
J Pathol Transl Med. 2016;50(3):190-196.   Published online April 18, 2016
DOI: https://doi.org/10.4132/jptm.2016.03.01
  • 10,474 View
  • 239 Download
  • 23 Web of Science
  • 22 Crossref
AbstractAbstract PDF
Background
The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement.
Methods
Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson’s trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics.
Results
Kappa values of the first review ranged from 0.0091–0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis.
Conclusions
More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.

Citations

Citations to this article as recorded by  
  • Non-alcoholic fatty liver disease: the pathologist’s perspective
    Wei-Qiang Leow, Anthony Wing-Hung Chan, Paulo Giovanni L. Mendoza, Regina Lo, Kihan Yap, Haeryoung Kim
    Clinical and Molecular Hepatology.2023; 29(Suppl): S302.     CrossRef
  • CT-based Hounsfield unit values reflect the degree of steatohepatitis in patients with low-grade fatty liver disease
    Ha Neul Kim, Hong Jae Jeon, Hei Gwon Choi, In Sun Kwon, Woo Sun Rou, Jeong Eun Lee, Tae Hee Lee, Seok Hyun Kim, Byung Seok Lee, Kyung Sook Shin, Hyun Jung Lee, Hyuk Soo Eun
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Artificial intelligence and deep learning: New tools for histopathological diagnosis of nonalcoholic fatty liver disease/nonalcoholic steatohepatitis
    Yoshihisa Takahashi, Erdenetsogt Dungubat, Hiroyuki Kusano, Toshio Fukusato
    Computational and Structural Biotechnology Journal.2023; 21: 2495.     CrossRef
  • An integrated gene-to-outcome multimodal database for metabolic dysfunction-associated steatotic liver disease
    Timothy J. Kendall, Maria Jimenez-Ramos, Frances Turner, Prakash Ramachandran, Jessica Minnier, Michael D. McColgan, Masood Alam, Harriet Ellis, Donald R. Dunbar, Gabriele Kohnen, Prakash Konanahalli, Karin A. Oien, Lucia Bandiera, Filippo Menolascina, An
    Nature Medicine.2023; 29(11): 2939.     CrossRef
  • Artificial intelligence scoring of liver biopsies in a phase II trial of semaglutide in nonalcoholic steatohepatitis
    Vlad Ratziu, Sven Francque, Cynthia A. Behling, Vanja Cejvanovic, Helena Cortez-Pinto, Janani S. Iyer, Niels Krarup, Quang Le, Anne-Sophie Sejling, Dina Tiniakos, Stephen A. Harrison
    Hepatology.2023;[Epub]     CrossRef
  • Improved pathology reporting in NAFLD/NASH for clinical trials
    Caitlin Rose Langford, Marc H Goldinger, Darren Treanor, Clare McGenity, Jonathan R Dillman, Daniela S Allende, Robert Goldin, Elizabeth M Brunt, Kurt Zatloukal, Helmut Denk, Kenneth A Fleming
    Journal of Clinical Pathology.2022; 75(2): 73.     CrossRef
  • Standardizing the histological assessment of late posttransplantation biopsies from pediatric liver allograft recipients
    Stefan G. Hübscher, Sandy Feng, Annette S. H. Gouw, Hironori Haga, Hyo Jeong Kang, Deirdre A. Kelly, Mina Komuta, Andrew Lesniak, Benjamin A. Popp, Henkjan J. Verkade, Eunsil Yu, Anthony J. Demetris
    Liver Transplantation.2022; 28(9): 1475.     CrossRef
  • Discordant pathological diagnosis of non‐alcoholic fatty liver disease: A prospective multicenter study
    Takuya Kuwashiro, Hirokazu Takahashi, Hideyuki Hyogo, Yuji Ogawa, Kento Imajo, Masato Yoneda, Takashi Nakahara, Satoshi Oeda, Kenichi Tanaka, Yuichiro Amano, Shinji Ogawa, Atsushi Kawaguchi, Shinichi Aishima, Masayoshi Kage, Kazuaki Chayama, Atsushi Nakaj
    JGH Open.2020; 4(3): 497.     CrossRef
  • Obeticholic acid for the treatment of nonalcoholic steatohepatitis: Expectations and concerns
    Stergios A. Polyzos, Jannis Kountouras, Christos S. Mantzoros
    Metabolism.2020; 104: 154144.     CrossRef
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    Kyoungbun Lee, Eun Sun Jung, Eunsil Yu, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Woo Sung Moon, Jin Sook Jeong, Cheol Keun Park, Jae-Bok Park, Dae Young Kang, Jin Hee Sohn, So-Young Jin
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  • An Improved qFibrosis Algorithm for Precise Screening and Enrollment into Non-Alcoholic Steatohepatitis (NASH) Clinical Trials
    Wei-Qiang Leow, Pierre Bedossa, Feng Liu, Lai Wei, Kiat-Hon Lim, Wei-Keat Wan, Yayun Ren, Jason Pik-Eu Chang, Chee-Kiat Tan, Aileen Wee, George Boon-Bee Goh
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  • Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease
    Juan S. Calle-Toro, Suraj D. Serai, Erum A. Hartung, David J. Goldberg, Bradley D. Bolster, Kassa Darge, Sudha A. Anupindi
    Abdominal Radiology.2019; 44(3): 894.     CrossRef
  • R2 relaxometry based MR imaging for estimation of liver iron content: A comparison between two methods
    Juan S. Calle-Toro, Christian A. Barrera, Dmitry Khrichenko, Hansel J. Otero, Suraj D. Serai
    Abdominal Radiology.2019; 44(9): 3058.     CrossRef
  • Inhibition of mitochondrial fatty acid oxidation in drug-induced hepatic steatosis
    Bernard Fromenty
    Liver Research.2019; 3(3-4): 157.     CrossRef
  • Standardising the interpretation of liver biopsies in non‐alcoholic fatty liver disease clinical trials
    Rish K. Pai, David E. Kleiner, John Hart, Oyedele A. Adeyi, Andrew D. Clouston, Cynthia A. Behling, Dhanpat Jain, Sanjay Kakar, Mayur Brahmania, Lawrence Burgart, Kenneth P. Batts, Mark A. Valasek, Michael S. Torbenson, Maha Guindi, Hanlin L. Wang, Veeral
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    Rish K. Pai
    Current Hepatology Reports.2019; 18(4): 473.     CrossRef
  • Hepatic sonic hedgehog protein expression measured by computer assisted morphometry significantly correlates with features of non-alcoholic steatohepatitis
    Michael Estep, Rohini Mehta, Gary Bratthauer, Lakshmi Alaparthi, Fanny Monge, Simon Ali, Dinan Abdelatif, Zahra Younoszai, Maria Stepanova, Zachary D. Goodman, Zobair M. Younossi
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  • Validation of intimate correlation between visceral fat and hepatic steatosis: Quantitative measurement techniques using CT for area of fat and MR for hepatic steatosis
    Moon Hyung Choi, Joon-Il Choi, Michael Yong Park, Sung Eun Rha, Soon Nam Oh, Seung Eun Jung, Jae Young Byun, Stephan Kannengiesser, Yohan Son
    Clinical Nutrition.2018; 37(1): 214.     CrossRef
  • Ultrasound or MR elastography of liver: which one shall I use?
    Meng Yin, Sudhakar K. Venkatesh
    Abdominal Radiology.2018; 43(7): 1546.     CrossRef
  • Feasibility and agreement of stiffness measurements using gradient-echo and spin-echo MR elastography sequences in unselected patients undergoing liver MRI
    Guilherme Moura Cunha, Kevin J Glaser, Anke Bergman, Rodrigo P Luz, Eduardo H de Figueiredo, Flavia Paiva Proença Lobo Lopes
    The British Journal of Radiology.2018; : 20180126.     CrossRef
  • Second harmonic generation microscopy provides accurate automated staging of liver fibrosis in patients with non-alcoholic fatty liver disease
    Pik Eu Chang, George Boon Bee Goh, Wei Qiang Leow, Liang Shen, Kiat Hon Lim, Chee Kiat Tan, Manlio Vinciguerra
    PLOS ONE.2018; 13(6): e0199166.     CrossRef
An Analysis of Histopathologic Evaluation of Lung Carcinomas in Last Ten Years.
Ji Min Jeon, Sun Young Kwon, Eun Sook Chang, Young Jun Jeon, Kun Young Kwon
Korean J Pathol. 1999;33(7):483-489.
  • 1,649 View
  • 17 Download
AbstractAbstract PDF
Lung cancer is one of the most common types of malignancy in western nations with serious health problem, and it has become the leading cause of cancer death of males, second only to stomach cancer, in Korea. A review of the histopathology of 1363 cases (1231 patients) of lung carcinoma, diagnosed at the Keimyung University Medical center from 1987 to 1996, was performed to reclassify the type of carcinomas and to investigate the change in the distribution of histologic types of lung carcinoma according to age, sex and year. Among the 1363 cases, 132 patients underwent a surgical operation after biopsy. The diagnosis of each case was proven by histopathologic analysis of surgical specimens (13.2%) and biopsy materials (86.8%). The histologic types in our study were basically based on modified WHO classification (1982) and on new WHO classification (1999). The classification of small cell carcinoma was based on International Association for the Small Cell Lung Cancer (IASLC, 1988). Of the 1231 patients with lung carcinoma, 1012 were male and 219 were female (male to female ratio was 3.6:1). According to the analysis of age distribution, the most prevalent age group was 60~69 years in both sex as (n=516, 42.0%). Changing trends in sex distribution of lung carcinoma patients showed that the proportion of men had decreased throughout the years, whereas the proportion of women had significantly increased. Histologically, squamous cell carcinoma was the most common (n=624, 50.7%), followed by small cell carcinoma (21.1%), adenocarcinoma (18.1%), large cell undifferentiated carcinoma (2.1%), adenosquamous carcinoma (0.4%), and large cell neuroendocrine carcinoma (0.4%), in order of frequency. In men, squamous cell carcinoma was the most frequent type (55.1%). In women, adenocarcinoma was the most frequent type (39.7%). In both sexes, adenocarcinoma was the most common type in patients under the age of 40 (n=12, 41.4%), while squamous cell carcinoma proved the most frequent type in patients over the age of 40 (n=617, 51.3%). Changing trends of histologic types of lung cancer showed that the incidences of squamous cell carcinoma had significantly decreased throughout the years, whereas those of adenocarcinoma and small cell carcinoma had increased. In conclusion, the results showing increases in the percentage of female patients and in the number of cases of adenocarcinoma were noteworthy, and well correlated with other related reports.

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