granulomatous amoebic encephalitis granulomatous amoebic encephalitis granulomatous amoebic encephalitis (gae) is a rare, usually fatal, subacute-to-chronic central nervous system disease caused by certain species of free-living amoebae of the genera acanthamoeba, balamuthia and sappinia. the term is most commonly used with acanthamoeba. in more modern references, the term "balamuthia amoebic encephalitis" (bae) is commonly used when balamuthia mandrillaris is the cause. granulomatous amoebic encephalitist2-weighted mri showing liquefied, necrotic brain tissue as a result of gae caused by an infection of acanthamoeba, genotype t18specialtyinfectious diseases symptomsfever, headaches, personality changescomplicationsseizures, comacausesacanthamoeba, balamuthia mandrillaris, and sappinia pedata a: t2-weighted mri showing liquefied, necrotic brain tissue as a result of gae caused by balamuthia mandrillarisb: t1-weighted mri showing expansion and addition of necrotic areas 4 days later symptoms and signs gae starts slowly, with symptoms like headache, nausea, dizziness, irritability and a low-grade fever. the cns symptoms depend on the part of the brain that is infected. changes in behavior are an important sign. other cns signs may include seizures, focal neurologic signs, diplopia (double vision), cranial nerve palsies, ataxia, confusion, and personality changes. some of the symptoms may mimic glioma (especially brainstem glioma), or other brain diseases, which may hamper timely diagnosis. the symptoms are caused by inflammatory necrosis of brain tissue brought on by compounds released from the organisms. diagnosis the condition can be difficult for doctors to diagnose, because it is a rare disease. a brain biopsy will reveal the presence of infection by pathogenic amoebas. in gae, these present as general inflammation and sparse granules. on microscopic examination, infiltrates of amoebic cysts and/or trophozoites will be visible. treatment acanthamoeba antifungal drugs including ketoconazole, miconazole, 5-flucytosine and pentamidine have been shown to be effective against acanthamoeba in vitro. balamuthia