Table 2.
A systematic review of 159 reported cases of B. mandrillaris infection: demographics, initial presentation, outcome, and diagnostic methods
| Publication [References #] | Demographics (age in years, gender) | Clinical presentation | Outcome | Method of diagnosis | Diagnosed by plasma mNGS |
|---|---|---|---|---|---|
| Our case | 58 F | Progressive facial numbness, hemiparesis, imbalance, and tinnitus | Deceased | mNGS (plasma), qPCR (brain), negative on PCR & mNGS (CSF) | Yes |
| Aboubechara et al. (2024) [120] | 4 F | Facial droop, dysarthria, hemiparesis, upper respiratory tract symptoms, headache, fever | Deceased | mNGS (plasma), PCR (CSF) | Yes |
| Xiong et al. (2024) [119] | 35 M | Fever, limb convulsions, progressive quadriparesis | Deceased | mNGS (brain) | No |
| Wang et al. (2024) [90] | 49 F | Headache, dizziness, nausea, emesis, prior skin lesion(s) | Deceased | mNGS (brain) | No |
| Zheng et al. (2024) [102] | 58 M | Headache, fever | Deceased | mNGS (CSF) | No |
| Szymanski et al. (2024) [80] | 3 M | Fatigue and facial pain, previously healthy with baseline facial palsy with right lip droop | Deceased | Not specified | Not specified |
| Javed et al. (2024) [33] | 33 F | Back pain, headache, emesis | Deceased | PCR & Sanger sequencing (specimen not specified) | No |
| Qin et al. (2024) [66] | 47 M | Fever following allogenic renal transplant | Not specified | mNGS (specimen not specified) | Not specified |
| Xu et al. (2024) [94] | 66 F | Headache | Deceased | mNGS (CSF) | No |
| Qin et al. (2024) [65] | 52 M | Headache, difficulty walking, blunted affect | Deceased | mNGS (CSF), PCR (CSF) | No |
| Li et al. (2024) [46] | 77 F | Dizziness, unsteady gait | Deceased | mNGS (CSF) | No |
| Ono et al. (2023) [56] | 76 F | Headache, nausea | Deceased | PCR (brain), negative PCR (CSF) | No |
| Gramp et al. (2023) [24] | 66 M | Skin lesion(s) | Deceased | PCR (skin & brain) | No |
| Yao et al. (2023) [97] | 64 F | Headache, abdominal pain, dizziness, unsteady gait, cough, emesis, prior skin lesion(s) | Deceased | mNGS (CSF), PCR (CSF), qRT-PCR (CSF) | No |
| Spottiswoode et al. (2023) [105] | 50s M | Seizure | Survived | mNGS (brain) & Sanger sequencing (brain), negative mNGS (CSF) & PCR(CSF) | No |
| Liu et al. (2023) [47] | 61 M | Headache | Deceased | mNGS (CSF) | No |
| Sakusic et al. (2023) [71] | 61 F | Headache, prior orthotopic heart transplant | Deceased | Broad-range PCR sequencing (brain) | No |
| Fan et al. (2023) [20] | 56 M | Transient coma, nausea, emesis | Deceased | mNGS (CSF) | No |
| Xu et al. (2022) [108] | 54 M | Headache, dizziness, skin lesion(s) | Deceased | mNGS (CSF) | No |
| Saffioti et al. (2022) [109] | 17 M | Headache, weight loss, swollen nose | Deceased | qPCR (brain) | No |
| Levinson et al. (2022) [106] | 80 M | Altered mental status, dizziness, vision loss | Survived | Multiplex RT-qPCR (CSF & brain) | No |
| Tootla et al. (2022) [85] | 3(?) | Skin lesion(s) | Deceased | PCR (skin) with bidirectional Sanger sequencing | No |
| Wang et al. (2022) [89] | 14 M | Skin lesion(s) | Survived | IHC (skin) | No |
| Wang et al. (2022) [89] | 57 F | Skin lesion(s) | Deceased | IHC (skin) | No |
| Wang et al. (2022) [89] | 9 M | Skin lesion(s) | Survived | IHC (skin) | No |
| Maehara et al. (2022) [50] | 82 M | Amnesia, skin lesion(s) | Deceased | IHC (skin & brain), PCR and sequencing (skin & brain) | No |
| Zhang et al. (2021) [101] | 7 M | Skin lesion(s) | Deceased | IHC (skin), PCR (skin), negative NGS (skin) | No |
| Cuoco et al. (2022) [14] | 4 M | Seizure | Survived | multiplex RT-qPCR (brain) | No |
| Peng et al. (2022) [59] | 54 M | Numbness and weakness of extremity | Survived | mNGS (CSF, brain, & serum) | No (serum) |
| Hu et al. (2022) [30] | 37 F | Dizziness, skin lesion(s) | Deceased | mNGS (CSF) | No |
| Ai et al. (2022) [1] | 15 M | Fever, altered mental status, previous skin lesion(s) | Deceased | mNGS (CSF), PCR (skin) | No |
| Hirakata et al. (2021) [29] | 60 F | Homonymous hemianopsia | Deceased | mNGS (brain), PCR (brain & skin), IHC (brain & skin) | No |
| Kalyatanda (2020) [36] | 51 M | Seizure, headache, altered mental status, disorientation, left-sided weakness, night sweats, diarrhea | Deceased | mNGS (plasma), multiplex qPCR (CSF), IHC (brain) | Yes |
| Yi et al. (2020) [98] | 9 F | Emesis, loss of appetite, fever, headache, difficulty walking, blurred vision, altered mental status | Deceased | mNGS (CSF) | No |
| Mani et al. (2021) [51] | 51 M | Blurry vision, headache, imbalance, altered mental status | Deceased | Multiplex qPCR (CSF) | No |
| Lee et al. (2021) [44] | 50 M | Headache, dizziness, dysarthria, aphasia | Deceased | qPCR (brain) | No |
| Zwillman et al. (2021) [103] | 65 M | Weakness, lethargy, lower extremity cellulitis, fever, encephalopathy | Deceased | qPCR (brain), IHC (brain) | No |
| Suyo-Prieto et al. (2020) [78] | 21 M | Seizure, skin lesion(s), nausea, headache | Deceased | PCR and sequencing (skin) | No |
| Safavi et al. (2021) [70] | 3 F | Altered mental status, emesis, dizziness, seizure, hemiparesis, ataxia | Deceased | PCR (brain) | No |
| Wu et al. (2020) [93] | 13 F | Dizziness, emesis, and blurry vision, prior skin lesion(s) | Deceased | NGS (CSF), PCR (skin), immunostaining (serum & CSF) | No |
| Aoki et al. (2020) [3] | 63 F | Dyspnea and left recurrent nerve paralysis | Deceased | PCR (brain), IHC (brain) | No |
| Pan et al. (2020) [58] | 85 F | Confusion, weakness, slurred speech | Deceased | qPCR (brain), PCR (brain) | No |
| Yang et al. (2020) [96] | 2 M | Fever | Deceased | NGS (CSF) | No |
| Suzuki et al. (2020) [79] | 68 M | Seizures, transient right hemiparesis | Deceased | IHC (brain), PCR (brain) | No |
| Lee et al. (2020) [43] | 45 M | Seizure | Deceased | qPCR (brain) | No |
| Kum et al. (2019) [110] | 71 M | Muscle spasms | Deceased | Diagnosed based on histomorphology of brain tissue, no confirmatory testing | No |
| Yohannan et al. (2019) [99] | 69 F | Altered mental status | Deceased | qPCR (brain), IHC (brain) | No |
| Hara et al. (2019) [116] | 56 M | Seizure, hemiparalysis, fever, altered level of consciousness | Deceased | IHC (brain) | No |
| Hara et al. (2019) [116] | 72 F | Lightheadedness, fever | Deceased | IHC (brain) | No |
| Hara et al. (2019) [116] | 53 M | Headache, fever | Deceased | IHC (brain) | No |
| Hara et al. (2019) [116] | 56 F | Fever, malaise | Deceased | IHC (brain) | No |
| Hara et al. (2019) [116] | 69 M | Altered level of consciousness | Deceased | IHC (brain) | No |
| Hara et al. (2019) [116] | 72 M | Loss of appetite, cognitive decline | Deceased | CSF microscopy, no confirmatory testing | No |
| Hara et al. (2019) [116] | 79 M | Skin lesion(s) | Deceased | IHC (brain), PCR (brain) | No |
| Hara et al. (2019) [116] | 67 F | Diplopia, lightheadedness | Deceased | Not specified | No |
| Hara et al. (2019) [116] | 61 F | Homonymous hemianopsia | Deceased | Whole genome sequencing (brain), PCR (brain), and IHC (brain) | No |
| Hara et al. (2019) [116] | 55 M | Unknown | Deceased | IHC (brain), PCR (brain) | No |
| Piper et al. (2018) [62] | 69 F | Skin lesion(s), seizures, prior chronic sinus infection | Deceased | qPCR (skin & brain), IFA (serum) | No |
| Tarai et al. (2018) [82] | 57 M | Altered mental status, seizures | Deceased | PCR (brain) | No |
| Shehab et al. (2018) [112] | 13 F | Hemiparesis, slurred speech | Deceased | Diagnosed based on histomorphology of brain tissue, no confirmatory testing | No |
| Joo et al. (2018) [34] | 6 M | Headache, fever, emesis | Deceased | qPCR (CSF) | No |
| Takei et al. (2018) [81] | 74 F | Somnolence | Deceased | IHC (brain), negative PCR (CSF, brain) | No |
| Cope et al. (2018) [12] | 18 F | Headache, fever, lethargy | Deceased | qPCR (CSF) | No |
| Lehmer et al. (2017) [111] | 84 M | Skin lesion(s) | Survived | IFA (brain & skin) | No |
| Mittal et al. (2017) [54] | 32 M | Seizure | Not specified | IFA and PCR (specimen not specified) | No |
| Chang et al. (2016) [9] | 91 F | Skin lesion(s) | Survived | IHC (skin), PCR (skin) | No |
| Vollmer et al. (2016) [88] | 26 M | Visual disturbances, lightheadedness, headache, syncope | Survived | IFA (brain), PCR (brain) | No |
| Kobayashi et al. (2015) [40] | 57 F | Headache | Deceased | IHC (brain), PCR (brain) | No |
| Ott et al. (2015) [113] | 41 M | Encephalitis symptoms | Deceased | PCR (specimen not specified) | No |
| Roy et al. (2015) [69] | 11 M | Nausea, emesis, lethargy, clumsiness, and right-sided weakness | Deceased | IFA (brain, lung), qPCR (brain, CSF), Sanger sequencing (brain, CSF), serology | No |
| Wilson et al. (2015) [92] | 74 F | Altered mental status, fever | Deceased | mNGS (CSF), PCR (brain, CSF) Sanger sequencing (brain, CSF), serology, IHC (brain) | No |
| Schafer et al. (2015) [72] | 82 M | Fever, chills, nausea, emesis, lethargy, altered mental status, prior skin lesion(s) | Deceased | qPCR (brain), IFA (skin) | No |
| van der Beek et al. (2015) [86] | 61 F | Fever, headaches, myalgias, prior skin lesions | Deceased | qPCR (brain, CSF) with sequencing | No |
| Khurana et al. (2015) [39] | 18 M | Headache, emesis, limb weakness, slurred speech, fever, altered mental status | Deceased | PCR (brain) | No |
| Khurana et al. (2015) [39] | 18 M | Headache, diplopia, fever, emesis | Deceased | PCR (brain) with sequencing | No |
| Greninger et al. (2015) [115] | 15 F | Limb weakness, headache, emesis, ataxia, confusion | Deceased | mNGS (CSF, brain), PCR (brain) | No |
| Itoh et al. (2015) [32] | 81 M | Somnolence, disoriented, ataxic gait | Deceased | PCR (brain), IHC (brain) | No |
| Pindyck et al. (2014) [114] | 56 M | Fever, hyponatremia | Deceased | IHC (brain), PCR (specimen not specified) | No |
| Lobo et al. (2013) [48] | 48 F | Headache, neck pain, fever, diplopia, slurred speech, fever | Deceased | IFA (brain, serum) | No |
| Phillips et al. (2013) [61] | 59 M | Headache, numbness, tingling | Deceased | PCR (brain) | No |
| Krasaelap et al. (2013) [42] | 4 F | Headache, emesis | Deceased | PCR with sequencing (brain & CSF) | No |
| Moriarty et al. (2013) [117] | 4 F | Headache, abnormal gait, seizures | Survived | PCR (brain), serology and IFA (brain) | No |
| Moriarty et al. (2013) [117] | 11 F | Fever, headache, meningismus | Deceased | IFA (brain), PCR (brain) | No |
| Kato et al. (2013) [118] | 72 M | Somnolence, altered level of consciousness, hemiparesis | Survived | Diagnosed based on CSF morphology, negative PCR (CSF) & IFA (brain) | No |
| Stidd et al. (2012) [77] | 2 F | Initial fall followed by recurrent falls, ataxia, irritability, lethargy, photophobia, fever | Deceased | qPCR (brain), IFA (brain) | No |
| Hill et al. (2011) [28] | 0 y 8 mo F | Lethargy, irritability, seizures, weakness | Deceased | IFA (brain) | No |
| Doyle et al. (2010) [18] | 80 F | Skin lesion(s) | Survived | PCR (brain & skin) | No |
| Yamasaki et al. (2011) [95] | 51 F | Seizure | Deceased | IHC (brain), ELISA (brain) | No |
| Silva et al. (2010) [75] | 47 F | Headache | Deceased | IHC (brain), PCR (brain) | No |
| Centers for Disease Control and Prevention (CDC) (2010) [7] | 27 M | Organ donor, presented with presumed stroke, prior skin lesion(s) | Deceased | Not specified | No |
| Centers for Disease Control and Prevention (CDC) (2010) [7] | 56 M | Liver transplant recipient, presented with diplopia and difficulty walking | Deceased | qPCR (brain), IHC (brain & liver) | No |
| Centers for Disease Control and Prevention (CDC) (2010) [7] | 24 M | Kidney and pancreas transplant recipient, presented with headache, nausea, emesis | Deceased | qPCR (brain), IHC (brain) | No |
| Centers for Disease Control and Prevention (CDC) (2010) [6] | 4 M | Organ donor, presented with fever, personality changes, loss of appetite, muscle twitching, headache, seizure | Deceased | IHC (brain), IFA (brain), PCR (brain) | No |
| Centers for Disease Control and Prevention (CDC) (2010) [6] | 31 F | Kidney transplant recipient, presented with paresthesias, muscle spasms, headache, nausea, altered mental status, seizure | Deceased | PCR (brain) | No |
| Centers for Disease Control and Prevention (CDC) (2010) [6] | 27 M | Kidney transplant recipient, presented with headache, nausea, altered mental status, seizure | Survived | PCR (CSF) | No |
| Cary et al. (2010) [5] | 2 M | Vomiting and diarrhea | Survived | IFA (brain) | No |
| Kansagra et al. (2009) [37] | 43 M | Fever, headache, and nausea | Deceased | IFA (brain) | No |
| Prasad et al. (2008) [107] | 22 M | Numbness, vertigo, difficulty swallowing, weakness, seizure, chronic suppurative otitis media | Deceased | PCR (brain) | No |
| Silva-Vergara et al. (2007) [76] | 32 M | Headache, blurred vision, and fever | Deceased | IFA (brain) | No |
| Perez et al. (2007) [60] | 40 M | Seizure | Deceased | IFA (brain) | No |
| Cuevas et al. (2006) [13] | 5 F | Skin lesion(s) | Deceased | Diagnosed based on histomorphology of brain tissue, no confirmatory testing | No |
| Tavares et al. (2006) [84] | 8 M | Headache, medial esotropia, diplopia, signs of intracranial hypertension | Deceased | IFA (brain), PCR (brain) | No |
| Li et al. (2005) [45] | 6 F | Headache and stiff neck | Deceased | IFA (brain) | No |
| White et al. (2004) [91] | 32 M | Confusion and focal neurological signs, prior skin lesion(s) | Deceased | IFA (serum) | No |
| Intalapaporn et al. (2004) [31] | 23 M | Skin lesion(s) | Deceased | IFA (brain) | No |
| Jung et al. (2004) [35] | 72 F | Seizure, visual loss, aphasia | Survived | IFA (brain) | No |
| Pritzker et al. (2004) [64] | 89 M | Skin lesion(s) | Deceased | IFA (skin) | No |
| Deetz et al. (2003) [15] | 64 M | Hemiparesis, speech difficulty, seizure | Survived | IFA (brain) | No |
| Deetz et al. (2003) [15] | 5 F | Seizure, fever | Survived | IFA (brain) | No |
| Bakardjiev et al. (2003) [4] & Schuster et al. (2003) [73] | 3 F | Fever, fatigue, otitis media, dehydration,seizure, emesis | Deceased | IFA (serum, brain), PCR (brain) with sequencing | No |
| Bakardjiev et al. (2003) [4] | 2 F | Fever, headache, lateral eye deviation, facial palsy, hemiparesis, otitis media | Deceased | IFA (brain) | No |
| Bakardjiev et al. (2003) [4] | 7 M | Fever, chills, seizure, wide based gait, cranial nerve palsy (VI), abdominal pain personality change | Deceased | Elevated serum titers | No |
| Bakardjiev et al. (2003) [4] | 2.5 M | Fever, emesis, ataxia | Deceased | IFA (brain), titers (serum, CSF) | No |
| Shirabe et al. (2002) [74] | 78 F | Fever | Deceased | IFA (brain) | No |
| Galarza et al. (2002) [21] | 12 M | Skin lesion(s) | Deceased | IFA (brain) | No |
| Galarza et al. (2002) [21] | 5 M | Skin lesion(s), seizure, loss of consciousness | Deceased | IFA (brain) | No |
| Galarza et al. (2002) [21] | 3 F | Seizure, loss of consciousness, hemiparesis | Deceased | IFA (brain) | No |
| Galarza et al. (2002) [21] | 6 M | Skin lesion(s), hemiparesis, loss of consciousness | Deceased | IFA (brain) | No |
| Katz et al. (2000) [38] | 52 F | Seizure, prior skin lesion(s) | Deceased | IFA (brain) | No |
| Deol et al. (2000) [17] | 38 M | Skin lesion(s), weight loss, seizures | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 22 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 5 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 9 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 10 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 12 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 50 F | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 34 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 14 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Recavarren-Arce et al. (1999) [122] | 28 M | Skin lesion(s), neurological symptoms | Deceased | IFA (brain) | No |
| Kodet et al. (1998) [41] | 3 M | Lethargy, seizure | Deceased | IFA (brain) | No |
| Denney et al. (1997) [16] | 32 M | Nausea, emesis, headache | Deceased | IFA (brain) | No |
| Reed et al. (1997) [67] | 5 M | Skin lesion(s) | Deceased | IFA (brain) | No |
| Duke et al. (1997) [19] | 3 M | Pharyngitis, fever, chills, emesis, irritability, somnolence | Deceased | Not specified | No |
| Rowen et al. (1995) [68] | 5 M | Extremity weakness, slurred speech | Deceased | IFA (brain) | No |
| Rowen et al. (1995) [68] | 15 M | Headache, emesis, abdominal pain | Deceased | IFA (brain) | No |
| Martinez et al. (1994) [52] | 14 M | Seizure, limb weakness, headache | Deceased | IFA (brain) | No |
| Zagardo et al. (1997) [100] | 34 F | Seizure, fever, cranial nerve palsy, pronator drift | Deceased | IFA (brain) | No |
| Lowichik et al. (1995) [49] | 0 y 11 mo F | Internal strabismus, unsteady crawling, difficulty grasping objects, cranial nerve palsy | Deceased | IFA (brain) | No |
| Griesemer et al. (1994) [26] | 2 M | Otitis media, hemiparesis, aphasia, emesis, lethargy, fever, instability | Deceased | IFA (brain) | No |
| Griesemer et al. (1994) [26] | 13 F | Headache, diplopia, hemiparesis, left facial weakness, emesis | Deceased | IFA (brain) | No |
| Neafie et al. (1993) [55] | 1 M | Hemiplegia, lethargy | Deceased | IFA (brain) | No |
| Gordon et al. (1992) [23] | 52 M | Skin lesion(s), headache, fever, chills | Deceased | IFA (brain & skin) | No |
| Popek et al. (1992) [63] | 0 y 5 mo F | Sore throat, otitis media, seizures, fever | Deceased | IFA (brain) | No |
| Chimelli et al. (1992) [10] | 47 F | Weakness, myalgia, fever, weight loss, headache | Deceased | IFA (brain) | No |
| González-Alfonzo et al. (1991) [22] | 7 M | Pain, swelling, serous eye discharge | Deceased | IFA (brain) | No |
| Taratuto et al. (1991) [83] | 12 M | Skin lesion(s), hyperthermia, headache, conjugate gaze deviation, facial palsy, dysarthria, hemiparesis | Deceased | IFA (brain) | No |
| Anzil et al. (1991) [2] | 36 M | Headache, fever | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 2 F | Headache | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 0 y 3 mo M | Diarrhea, dehydration, fever, pneumonia | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 2.5 M | Neurologic dysfunction, headache, emesis | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 72 M | Chronic renal failure | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 0 y 9 mo F | Diarrhea, cough, fever, cranial nerve palsy | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 61 M | Altered mental status, prior skin lesion(s) | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 22 M | Head injury, headache, seizure | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 11 F | Seizure, headache, fever vomiting | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 39 M | Seizure, cranial nerve deficits, coma | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 22 M | Headache, seizure, nasal mass | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 30 M | Headache, nausea, emesis, dizziness, diplopia | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 60 M | Skin lesion(s) | Deceased | IFA (brain) | No |
| Visvesvara et al. (1990) [87] | 60 M | Seizure, hemiparesis | Deceased | IFA (brain) | No |