Table 1.

Clinical characteristics, treatments, and outcomes of 28 Chinese patients with cutaneous Balamuthia mandrillaris infection.

Cases	Sex/Age (Years)	Causes	Skin symptoms	Brain symptoms	Imaging study with MRI examination	Treatments	Outcomes
1	Male/49	Fall to the ground and traumatized.	Red plaques on right eyebrow, temple and angle of jaw.	No brain symptoms.	Normal.	The skin lesions disappeared after treatment with lincomycin for 5 months. Thereafter, the skin lesions relapsed twice. Finally, the patient was treated with lincomycin for 1 year.	Free of disease for 18 years. The case was described in 2002 [26].
2	Male /6	Traumatized on the temple.	Red plaque on right temple, diameter 7 cm.	Developed encephalitis after 2 years. Presented with fever and headaches.	Infection of the brain stem.	Died before treatment.	Died of disease. Duration between encephalitis and death: 5 days.
3	Female /13	Dog bite on the left face.	Red plaque involving the whole left side of the face.	Developed encephalitis after 5 years. Presented with epilepsy and apathy.	Infection of right temporal lobe, right basal ganglia, bilateral frontal lobes, left hippocampus and hypothalamus.	The skin lesions regressed prominently after treatment with lincomycin and azithromycin, whereas the encephalitis evolved after treatment. Autopsy was performed.	Died of disease. Duration between encephalitis and death: 6 months.
4	Male /8	Unknown.	Red plaque on the left side of the face, diameter 7 cm.	Developed encephalitis after 3 years. Presented with fever, headache, sleepiness, and coma.	Normal during 6-months follow-up. Not performed before death.	Lincomycin, azithromycin, interferon-α, and interleukin-2 were ineffective.	Died of disease. Duration between encephalitis and death: 1 week.
5	Male /5	Unknown.	Red plaque on the nose and right side of the face, diameter 7 cm.	Developed encephalitis after 2 years. Presented with fever and headache.	Multiple infections involving left thalamus, trigone of the left lateral ventricle, left temporal lobe and cerebellum.	Died before treatment.	Died of disease. Duration between encephalitis and death: 1 week.
6	Female /18	Trauma of the face.	Red macule/plaque involving the whole left side of the face and nose.	Developed encephalitis after 9 years. Unable to walk, headache, sleepiness.	Normal during the first consultation. Not performed before death.	The skin lesion regressed after treatment with lincomycin and interferon-γ in the beginning but relapsed after 2 months.	Died of disease. Duration between encephalitis and death: 2 months.
7	Male /20	Injured by a brick.	Red plaque on the left side of the face with focal scales, diameter 9 cm.	Developed encephalitis after 2 years. Presented with apathy, anisocoria, and attenuation of light reflection.	Infections including left cerebellum, right hippocampus, bilateral temporal lobe, left semi oval center, right frontal lobe, and right parietal lobe.	Lincomycin and azithromycin were ineffective. Autopsy was performed.	Died of disease. Duration between encephalitis and death: 1.5 months.
8	Female /7	Traumatized after playing with kids.	Red plaque on the nose and the surrounding skin, diameter 5 cm.	No brain symptoms.	Focal infection of left occipital parietal lobe.	The skin lesion regressed after treatment with lincomycin and interferon-γ, while the brain infection regressed very slowly with the medicine. Thereafter, it was surgically excised and cured.	Free of disease for 13 years.
9	Female /7	Fell to the ground and was traumatized after being knocked down by a car.	Red plaque on the central face, the edge was not clear, diameter larger than 10 cm.	Developed encephalitis after 3 years. Presented with fever and headache.	Normal during the first consultation. Not performed before death.	The skin lesion showed partial regression after treatment with lincomycin and interferon γ for 4 months. After that, the treatment was terminated, and the lesion enlarged again and developed encephalitis.	Died of disease. Duration between encephalitis and death: 1 month.
10	Male /74	Trauma on the face.	Red plaque on the left side of the face, diameter 10 cm.	Developed encephalitis after 3 years. Presented with unsteady walk, tremor, somnolence, and incontinence.	Infection of left frontal lobe.	The skin lesion showed partial regression after treatment with lincomycin and interferon-γ for 2 months. After that, the treatment was terminated, and the lesion enlarged again and developed encephalitis.	Died of disease. Duration between encephalitis and death: 2 months.
11	Male /21	Unknown.	Red plaque on nose and surrounding skin, diameter 7 cm.	Developed encephalitis after 2 years. Presented with headache, somnolence, and coma.	Normal during the first consultation. Not performed before death.	Itraconazole, rifampicin, isoniazid, and ethambutol were ineffective. Lincomycin and interferon-γ were ineffective.	Died of disease. Duration between encephalitis and death: 1 month.
12	Female /61	Traumatized after fall to the ground.	Red plaque on left side of the face, diameter 10 cm.	No brain symptoms.	Normal.	The skin lesion showed regression after treatment with lincomycin, doxycycline, and interferon-γ.	Free of disease for 13 years.
13	Male /3	Traumatized after fall to the ground.	Red plaque on chin, diameter 4.5 cm.	No brain symptoms.	Normal.	The skin lesion was excised and treated with lincomycin and interferon-γ for 6 months.	Free of disease for 12 years.
14	Female /68	Unknown.	Three plaques around a surgical scar. The largest diameter about 2 cm.	No brain symptoms.	Not performed.	The patient underwent surgery but relapsed; hence, the patient was treated with rifampicin, isoniazid, and ethambutol.	Lost to follow-up.
15	Male /13	Trauma of right earlobe.	Plaque on the right ear and the surrounding skin, diameter 8 cm.	Developed encephalitis after 5 years. Presented with sleepiness, reduced speech, and diplopia.	Infection of left parietal, occipital, and frontal lobes.	The skin lesion regressed after treatment with lincomycin, azithromycin and interferon-γ, whereas encephalitis evolved after treatment. Autopsy was performed.	Died of disease. Duration between encephalitis and death: 1 month.
16	Male /5	Unknown.	Red plaque on nose and surrounding skin, diameter of 10 cm.	Developed encephalitis after 3.5 years. Presented with left eye movement restriction, blurred vision, right arm muscle weakness, and inability to stand and walk.	Normal during the first consultation. Not performed before death.	The skin lesion did not regress after treatment with lincomycin, interferon-γ, doxycycline, and rifampin. Azithromycin showed improvement at first but was ineffective after 2 months.	Died of disease. Duration between encephalitis and death: 15 days.
17	Male /39	Fall to the ground when riding a bicycle.	Red plaque on right side of the face and two solitary lesions on arm and waist.	No brain symptoms.	Normal.	The skin lesion was cured after 6 months of treatment with lincomycin and interferon-γ.	Free of disease for 10 years.
18	Male /9	Unknown.	Red plaque on nose, diameter 3 cm.	No brain symptoms.	Normal.	The skin lesion was cured with clindamycin and topical mupirocin for 3 months.	Free of disease for 9 years.
19	Female /22	Nasal congestion after catching a cold.	Red plaque on left nasolabial fold and nose, diameter 4 cm.	Developed encephalitis after 6 months. Presented with headache, dizziness, vomiting and epilepsy.	Infection of left frontal and temporal lobe.	Lincomycin, azithromycin and interferon-α were ineffective.	Died of disease. Duration between encephalitis and death: 2 months.
20	Female /58	Traumatized after fall to the ground.	Dark red plaque on the right ear and the surrounding skin, diameter 8 cm. The helix showed focal absence.	No brain symptoms.	Normal.	The lesion was cured with 1-year treatment with anti-tuberculosis drugs including rifampicin, isoniazid and ethambutol.	Free of disease for 8 years.
21	Male /7	Traumatized after fall to the ground.	Red plaque on the nose and face, diameter 8 cm.	Developed encephalitis after 8 years. Unable to walk, evolved into sleepiness and coma.	Normal during 2-years follow-up. Not performed before death.	The skin lesion showed partial regression after treatment with lincomycin, interferon γ and azithromycin in the beginning, but showed relapse after 3 months.	Died of disease. Duration between encephalitis and death: 2 weeks.
22	Male /48	Traumatized after fall to the ground.	Red plaque on the nose and surrounding skin, diameter 10 cm.	No brain symptoms.	Normal.	The skin lesion was cured after treatment with lincomycin, interferon-γ, and azithromycin for 5 months.	Free of disease for 5 years.
23	Female /4	Traumatized after fall to the ground.	Red plaque on left zygomatic region, diameter 5 cm.	No brain symptoms.	Normal.	The skin lesion was excised, and the patient was treated with lincomycin and interferon-γ.	Free of disease for 5 years.
24	Male /4	Developed after hitting an iron gate.	Red plaque on left side of the face, diameter 12 cm.	Developed encephalitis after 4.5 years. Presenting with sleepiness and coma.	Normal during 2-years follow-up. Not performed before death.	The skin lesion showed partial regression after treatment with lincomycin and interferon-γ but was ineffective after 6 months.	Died of disease. Duration between encephalitis and death: 1 month.
25	Female /57	Unknown.	Red plaque on right side of the face, diameter 10 cm.	No brain symptoms.	Normal.	The skin lesion was cured after treatment with lincomycin and interferon-γ for 3 months.	Free of disease for 4 years.
26	Male /51	Fell to the ground and was traumatized after drinking.	Red plaque on the forehead, diameter 7 cm.	No brain symptoms	Normal.	The skin lesion did not regress with lincomycin, interferon-γ, and azithromycin. Thereafter, it was excised and treated with lincomycin, interferon-γ, and azithromycin for 6 months.	Free of disease for 4 years.
27	Male /15	Unknown.	Red plaque around the nose, diameter 6 cm.	No brain symptoms	Normal.	Skin lesions showed partial regression after treatment with lincomycin, interferon-γ and azithromycin. Six months later it was excised and treated with lincomycin, interferon-γ, and azithromycin for 8 months.	Free of disease for 3 years.
28	Male /69	Unknown.	Red plaque on the forehead, diameter 7 cm.	Developed encephalitis after 4 years. Presenting with sleepiness, coma, and inability to stand and walk.	Normal during the first consultation. Not performed before death.	The skin lesion showed slight regress after treatment with lincomycin and interferon-γ and relapsed after treatment withdrawal.	Died of disease. Duration between encephalitis and death: 2 months.