Diagnosis of first case of Balamuthia amoebic encephalitis in Portugal by immunofluorescence and PCR.

We report here the first Portuguese case of acute fatal granulomatous encephalitis attributed to Balamuthia mandrillaris, initially thought to be a brain tumor, which had a progressive and fatal outcome. Balamuthia mandrillaris is a free-living amoeba recognized as an uncommon agent of granulomatous encephalitis. Infections have been identified in immunocompromised hosts and in immunocompetent pediatric patients. Balamuthia infections are very rare, with only two reported cases in Europe. The case presented here occurred in a previously healthy boy who died 5 weeks after the onset of the symptoms. No evidence of immunological deficiency was noted, and testing for human immunodeficiency virus antibodies was negative. The symptoms were initially thought to be the result of a tumor, but histopathologic examination showed evidence of amoebic infection. Immunofluorescence staining of brain tissue identified B. mandrillaris as the infectious agent. The diagnosis was confirmed with PCR by detecting Balamuthia DNA in formalin-fixed brain tissue sections. Despite initiation of empirical antimicrobial therapy for balamuthiasis, the patient died 3 weeks after being admitted to the hospital. No source of infection was readily apparent.

[Reported cases of malaria in the north of Portugal (1993-2002)]. / Malária na região norte de Portugal (1993-2002). Caracterização Epidemiológica.

The aim of this study is to provide epidemiological evidence useful to Portuguese health services dealing with prevention and treatment of malaria. Two sources of data were used: the computer database of statutory notifiable diseases and the reports of cases studied by local health authorities. The 140 cases of malaria reported between 1993 and 2002 in the North of Portugal are described. For the 26 available reports of cases occurred between 2000 and 2002 additional variables are described. The incidence rates of malaria, estimated for the period 1993-2002, respectively for Portugal and its Northern Region, were 0,74 and 0,45 per 100,000 persons-year. Incidence was stable across the studied period. Most cases were males aged 15 to 64. Most cases with laboratory confirmation were due to Plasmodium falciparum. Clinical picture, travelling details and preventive measures, namely chemoprophylaxis, were also described. All cases were imported, mostly from Portuguese speaking African countries. The usefulness of reporting cases of malaria and conducting the respective study was discussed.