Evidence map›Paper›PMID 40082992›Full record

ArticleActa neuropathologica communications2025

The role of plasma metagenomic sequencing in identification of Balamuthia mandrillaris encephalitis.

Sarah Y Edminster, Ryan W Rebbe, Christopher Khatchadourian, Kyle M Hurth, Anna J Mathew, Julie Huss-Bawab, Mark S Shiroishi, Devin Clark, Andrew P Norgan, Susan M Butler-Wu and 1 more

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta neuropathologica communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. The first reported case ofFrontiers in medicine · 2026
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Sarah Y EdminsterDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Ryan W RebbeDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Christopher KhatchadourianDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Kyle M HurthDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Anna J MathewDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Julie Huss-BawabDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Mark S ShiroishiDepartment of Neuroradiology, Los Angeles Medical Center, Los Angeles, CA, 90033, USA.
Devin ClarkDepartment of Infectious Diseases, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Andrew P NorganDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
Susan M Butler-WuDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA.
Annie HinikerDepartment of Pathology, Los Angeles General Medical Center, Los Angeles, CA, 90033, USA. ahiniker@usc.edu.

Funding

Vascular Contributions to Dementia and Genetic Risk Factors for Alzheimer's DiseaseP01AG052350 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI Daniel A Nation, ARTHUR W TOGA · 2016 to 2026
$28.4M
USCADRC Diversity Supplement PachicanoP30AG066530 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI HELENA Chang CHUI, ARTHUR W TOGA · 2020 to 2026
$27.8M
NIA NIH HHS P01 AG052350NIA NIH HHS P30 AG066530
6 · The paper itself

Abstract

Balamuthia mandrillaris is a rare, free-living amoeba (FLA) that causes granulomatous amoebic encephalitis, a disease with close to 90% mortality. The geographical ranges of many FLA are expanding, potentially increasing human exposure to B. mandrillaris. Here, we report a case of a 58-year-old woman with progressive neurological symptoms, ultimately diagnosed postmortem with B. mandrillaris encephalitis through plasma metagenomic next-generation sequencing (mNGS) despite negative results on both cerebrospinal fluid (CSF) mNGS and CSF PCR testing. Histologic analysis and real-time PCR (qPCR) studies on postmortem brain tissue confirmed B. mandrillaris infection with significant vascular clustering of trophozoites. Retrospective analysis of CSF mNGS data demonstrated subthreshold reads for B. mandrillaris, emphasizing the challenges of interpreting low-level pathogen signals. A systematic review of 159 published B. mandrillaris cases revealed only two reports of B. mandrillaris diagnosed using plasma mNGS, both of which also had diagnostic CSF studies. This case demonstrates the diagnostic challenges of B. mandrillaris infections, highlights its vascular tropism, and suggests that plasma mNGS may warrant evaluation as a diagnostic tool for B. mandrillaris.

Indexed as

AmebiasisBalamuthia mandrillarisEncephalitisInfectious EncephalitisMetagenomicsBrainFemaleHigh-Throughput Nucleotide SequencingHumansMiddle AgedAmoebaAmoebic encephalitisBalamuthiaBalamuthia mandrillarisFree living amoebaGranulomatous amoebic encephalitisPlasma metagenomic sequencing

Identifiers

PMID40082992
PMCPMC11908043

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.