Mixed CNS Infection by a Balamuthia Ameba and a Mycobacterium: Two Cases from Peru

Balamuthia mandrillaris are free-living amoebae (FLA) which are parasites within both humans and animals causing a wide range of sicknesses and acting as vehicles for many microorganisms such as mycobacterium. We present two young male patients, who died with highly unusual mixed infections involving Balamuthia or Balamuthia-like amoebae in the brain tissues plus Mycobacteria, one tuberculous encephalitis and the other cutaneous. Case 1 was a 21-year-old Hispanic male with 1 month of global headache, nausea, vomiting, fever (39 °C), confusion, and garbled speech, as well as pulmonary tuberculosis 1 year ago with possible meningeal TB at the time of admission to the hospital. The patient never developed skin injuries, and he died after 65 days of hospitalization, in August 2006. Case 2 was a 28-year-old male patient with mild parietal headache of 3-week evolution, associated at the beginning with light dizziness, with neurological examination at his normal admission. Twenty-five days later, he presented mental confusion and psychomotor agitation, and in the next 3 h, he suffered from cardiorespiratory arrest, being referred to intensive care; brain death was verified, and he died on January 8, 2005. To the best of our knowledge, these two cases are the first case reports of Balamuthia-like and Mycobacterium tuberculosis/Balamuthia mandrillaris and Mycobacterium sp. from Peru and are presented for academic interest.