Is Balamuthia mandrillaris a public health concern worldwide?

•Balamuthia mandrillaris is an emerging pathogen that causes brain and skin infections.•Data indicate lack of diagnostic tools and unawareness of clinicians about them.•Specific diagnosis or effective therapies for B. mandrillaris are a necessity.•Understanding their biology and pathogenesis will assist in future developments.

Balamuthia mandrillaris is an opportunistic, free-living amoeba that can cause skin lesions and the typically fatal Balamuthia amoebic encephalitis (BAE) both in immunocompromised and immunocompetent individuals. Available data for BAE cases indicate that this disease is difficult to detect because knowledge of predisposing factors is lacking, causing a challenge for diagnosing BAE. The number of reported BAE cases is increasing worldwide, and this is a major concern because little is known about the pathogen, no standardized detection tools are available, and most of the treatments are almost empirical. The recently reported cases, novel diagnostics tools, and successful therapeutic approaches against BAE infections are reviewed here.