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  Indian J Med Microbiol
 

Figure 3: Microscopic laboratory diagnosis of Balamuthia mandrillaris. (a) ×20 and ×100 fields of view (inset) of a brain biopsy specimen from a patient demonstrating numerously viable, large amebae (black arrows), with abundant basophilic vacuolated cytoplasm, round central nuclei, and prominent nucleoli, consistent with Balamuthia mandrillaris. Areas of extensive hemorrhagic necrosis accompanied by a polymorphic inflammatory cell infiltrate including neutrophils and eosinophils are observed. (b) Periodic acid–Schiff-stained section of brain parenchyma shows necrotizing vasculitis with mixed inflammation including macrophages and numerous eosinophils and a population of amebic trophozoites that closely resemble macrophages (yellow arrows), bar = 20 μm. (c) Typical trophozoites (H and E) under high power (×1000) are indicated by yellow arrows. (d) High-power photomicrograph of a cyst (H and E) in brain tissue. (e) Immunohistochemistry highlights numerous B. mandrillaris trophozoites, bar = 20 μm. (f) Indirect immunofluorescence using anti-Balamuthia antibodies under ultraviolet microscopy. (Image courtesy – [a] – Ref. 39, [b and e] – Ref. 67, [c] – Ref. 33, [d and f] – Centers for Disease Control and Prevention, Atlanta, USA)

Figure 3: Microscopic laboratory diagnosis of <i>Balamuthia mandrillaris</i>. (a) ×20 and ×100 fields of  view (inset) of a brain biopsy specimen from a patient demonstrating numerously viable, large amebae (black arrows), with abundant basophilic vacuolated cytoplasm, round central nuclei, and prominent nucleoli, consistent with Balamuthia mandrillaris. Areas of extensive hemorrhagic necrosis accompanied by a polymorphic inflammatory cell infiltrate including neutrophils and eosinophils are observed. (b) Periodic acid–Schiff-stained section of brain parenchyma shows necrotizing vasculitis with mixed inflammation including macrophages and numerous eosinophils and a population of amebic trophozoites that closely resemble macrophages (yellow arrows), bar = 20 μm. (c) Typical trophozoites (H and E) under high power (×1000) are indicated by yellow arrows. (d) High-power photomicrograph of a cyst (H and E) in brain tissue. (e) Immunohistochemistry highlights numerous <i>B. mandrillaris</i> trophozoites, bar = 20 μm. (f) Indirect immunofluorescence using anti-<i>Balamuthia</i> antibodies under ultraviolet microscopy. (Image courtesy – [a] – Ref. 39, [b and e] – Ref. 67, [c] – Ref. 33, [d and f] – Centers for Disease Control and Prevention, Atlanta, USA)