Introduction: Balamuthia mandrillaris is known to cause a fatal infection of the central nervous system termed granulomatous amoebic encephalitis (GAE). Cases of GAE by B. mandrillaris are usually fatal indicating the inefficacy of currently available regimens used to treat the disease and the virulent nature of the amoebae.

Areas covered: This review discusses the current treatment options, diagnosis, and pathogenesis of Balamuthia mandrillaris. In this regard, a PubMed search using pathogenesis, treatment, and diagnosis, combined with B. mandrillaris as keywords, was performed. In addition, conference proceedings, and discussions in Free-Living-Amoebae meetings over the past 20 years were reviewed.

Expert opinion: Despite the current treatment and diagnostic options, the mortality rates due to B. mandrillaris infections remain alarmingly high. The actual number of GAE cases due to B. mandrillaris are much higher than the currently reported number. Information on the pathogenesis of the amoebae is limited, highlighting the need for further studies on the pathogenesis of B. mandrillaris. This would provide useful information to improve both diagnostic and treatment options. Similarly, new molecules that are targeted toward B. mandrillaris and can penetrate the blood-brain barrier should be established. Theranostics may be the way forward for the treatment of B. mandrillaris.

简介：众所周知，Balamuthia mandrillaris会引起致命的中枢神经系统感染，称为肉芽肿性阿米巴性脑炎（GAE）。曼氏芽孢杆菌的GAE病例通常是致命的，表明目前用于治疗该疾病的方案无效，且变形虫的毒性性质很大。

涵盖的领域：本篇文章讨论了Balamuthia mandrillaris的当前治疗方案，诊断和发病机理。在这方面，进行了使用发病机理，治疗和诊断并结合B. mandrillaris作为关键词的PubMed搜索。此外，还审查了会议记录和过去20年来在自由活动的变形虫属会议中的讨论。

专家意见：尽管有当前的治疗和诊断选择，但曼氏芽孢杆菌感染导致的死亡率仍然高得惊人。曼氏芽孢杆菌引起的GAE病例的实际数量远高于当前报道的数量。关于变形虫的发病机理的信息是有限的，这突出了需要进一步研究曼氏芽孢杆菌的发病机理。这将提供有用的信息，以改善诊断和治疗选择。类似地，应该建立针对曼氏芽孢杆菌并可以穿透血脑屏障的新分子。治疗诊断可能是向前用于治疗的方法B. mandrillaris。