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ARTICLES

Vol. 14 No. 2 (2025): Rev. Arg. Parasitol.

Central nervous system infection with Balamuthia mandrillaris and Toxoplasma gondii and possible role of the amoeba as a Trojan horse

  • Juliana M. Perazzo  ▸
  • María Fernanda Degese
  • Bibiana A. Ledesma
  • Mónica Nigro
  • María Belén Palma
  • Joana B. Nappe
  • Viviana Randazzo
  • Carolina Epelbaum
  • Fabiana Lubieniecki
  • Gabriela Lamas
  • E. Correa Louzao
  • Mariana Denoi
  • Andrea Vizzo
  • María Victoria Braica
  • Marcelo Batalla
  • Ana Buchovsky
  • Christian Palacios
  • Carlos Rugilo
  • Josmar Flores Arnez
  • Florencia Medina
  • Facundo Cuba
  • Tomás Poklépovich
  • Magalí B. Pérez Garófalo
Submitted
October 31, 2025
Published
2025-10-31

Abstract

Balamuthia mandrillaris and Toxoplasma gondii central nervous system infections (SNC) are rare. Early diagnosis of these infections is vital for proper treatment onset. The study describes a clinical case of an immunocompetent patient with B. mandrillaris and T. gondii cerebral infection, who had a persistently non-reactive toxoplasmosis serology, attended in a tertiary care children’s hospital. There are reports that these free-living amoebas and T. gondii can co-habit the same places in nature, and that free-living amoebas can phagocytize T. gondii oocysts, allowing them to retain their infectivity inside the amoeba. Because of this, we consider the possibility that T. gondii may have entered into the patient’s central nervous system inside the amoeba, avoiding contact with the host immune system. The patient improved after surgical resection of the cerebral lesion and antimicrobial treatment.

References

  1. Akturk, H. K., Sotello, D., Ameri, A., Abuzaid, A. S., Rivas, A. M. y Vashisht, P. (2017). Toxoplasma infection in an immunocompetent host: Possible risk of living with multiple cats. Cureus, 9(3), e1103. https://doi.org/10.7759/cureus.1103
  2. Burg, J. L., Grover, C. M., Pouletty, P. y Boothroyd, J. C. (1989). Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. Journal of Clinical Microbiology, 27(8), 1787–1792. https://doi.org/10.1128/jcm.27.8.1787-1792.1989
  3. Kofman, A. y Guarner, J. (2022). Infections caused by free-living amoebae. Journal of Clinical Microbiology, 60(1), e0022821. https://doi.org/10.1128/JCM.00228-21
  4. Król-Turmińska, K. y Olender, A. (2017). Human infections caused by free-living amoebae. Annals of Agricultural and Environmental Medicine, 24(2), 254–260. https://doi.org/10.5604/12321966.1233568
  5. Khalid, S., Memon, S. F., Jumani, L., Memon, S. A. y Siddiqui, M. S. (2023). Neurotoxoplasmosis in the immunocompetent: A rare occurrence. Cureus, 15(3), e36782. https://doi.org/10.7759/cureus.36782
  6. Layton, J., Theiopoulou, D. C., Rutenberg, D., Elshereye, A., Zhang, Y., Sinnott, J., Kim, K., Montoya, J. G. y Contopoulos-Ioannidis, D. G. (2023). Clinical spectrum, radiological findings, and outcomes of severe toxoplasmosis in immunocompetent hosts: A systematic review. Pathogens, 12(4), 543. https://doi.org/10.3390/pathogens12040543
  7. Lima, K. D. F., Queiroz, A. L. G., Teixeira, H. S., Bonsi, V. M., Inada, B. S. Y., Lancellotti, C. L. P. y Baêta, A. M. (2021). An atypical case of neurotoxoplasmosis in immunocompetent patients. Radiology Case Reports, 16(7), 1766–1769. https://doi.org/10.1016/j.radcr.2021.04.013
  8. Mahmoudi, M. R., Kazemi, B., Haghighi, A. y Karanis, P. (2015). Detection of Acanthamoeba and Toxoplasma in river water samples by molecular methods in Iran. Iranian Journal of Parasitology, 10(2), 250–257. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522301/
  9. Pietrucha-Dilanchian, P., Chan, J. C., Castellano-Sanchez, A., Hirzel, A., Laowansiri, P., Tuda, C., Visvesvara, G. S., Qvarnstrom, Y. y Ratzan, K. R. (2012). Balamuthia mandrillaris and Acanthamoeba amebic encephali-tis with neurotoxoplasmosis coinfection in a patient with advanced HIV infection. Journal of Clinical Microbiology, 50(3), 1128–1131. https://doi.org/10.1128/JCM.06252-11
  10. Pustorino, G., Ferlazzo, E., Carpentieri, M. S., Cianci, V., Gasparini, S., Campello, M., Milardi, G. L., Gangemi, A. y Aguglia, U. (2017). Cerebral toxoplasmosis diagnosed by brain tissue PCR analysis in an immunocompetent patient. Neurology: Clinical Practice, 7(5), 436–438. https://doi.org/10.1212/CPJ.0000000000000364
  11. Qvarnstrom, Y., Visvesvara, G. S., Sriram, R. y da Silva, A. J. (2006). Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. Journal of Clinical Microbiology, 44(10), 3589–3595. https://doi.org/10.1128/JCM.00875-06
  12. Robert-Gangneux, F. y Dardé, M. L. (2012). Epidemiology of and diagnostic strategies for toxoplasmosis. Clinical Microbiology Reviews, 25(2), 264–296. https://doi.org/10.1128/CMR.05013-11
  13. Tapia, J. L., Torres, B. N. y Visvesvara, G. S. (2013). Balamuthia mandrillaris: In vitro interactions with selected protozoa and algae. Journal of Eukaryotic Microbiology, 60(5), 448–454. https://doi.org/10.1111/jeu.12052
  14. Winiecka-Krusnell, J., Dellacasa-Lindberg, I., Dubey, J. P. y Barragan, A. (2009). Toxoplasma gondii: Uptake and survival of oocysts in free-living amoebae. Experimental Parasitology, 121(2), 124–131. https://doi.org/10.1016/j.exppara.2008.09.022