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Abstract：
BACKGROUND: Balamuthia mandrillaris, a free-living amoeba, causes an uncommon infection that is characterized by cutaneous and neurological involvement, which carries a poor prognosis.
METHODS: This is a retrospective observational study including patients with clinical suspicion of cutaneous balamuthiasis, their skin biopsies, and/or a positive direct immunofluorescence test. The data were collected from the Dermatology and Pathology service of the Hospital Cayetano Heredia and the Instituto Tropical Alexander von Humboldt, Lima, Peru, from January 1985 to June 2007. We identified 60 biopsies from 35 patients, from which clinical data were available in 30.
RESULTS: Twenty-two (73%) patients had centrofacial lesions, mostly located on the nose. The classical lesion was an asymptomatic, erythematous, or violaceous infiltrated plaque. Twenty-two (73%) patients had neurologic involvement. Fifty (83%) biopsies showed granulomatous dermatitis and 75% showed ill-defined tuberculoid granulomas without caseous necrosis. Multinucleated giant cells were observed in 52 (87%) biopsies. Trophozoite forms were identified in the biopsies of 25 (71%) patients. Direct immunofluorescence was positive in 25 (71%) patients.
CONCLUSIONS: B. mandrillaris is a pathogen that is capable of inducing a characteristic skin lesion with a reaction pattern of ill-defined tuberculoid granulomas and many giant cells.
METHODS: This is a retrospective observational study including patients with clinical suspicion of cutaneous balamuthiasis, their skin biopsies, and/or a positive direct immunofluorescence test. The data were collected from the Dermatology and Pathology service of the Hospital Cayetano Heredia and the Instituto Tropical Alexander von Humboldt, Lima, Peru, from January 1985 to June 2007. We identified 60 biopsies from 35 patients, from which clinical data were available in 30.
RESULTS: Twenty-two (73%) patients had centrofacial lesions, mostly located on the nose. The classical lesion was an asymptomatic, erythematous, or violaceous infiltrated plaque. Twenty-two (73%) patients had neurologic involvement. Fifty (83%) biopsies showed granulomatous dermatitis and 75% showed ill-defined tuberculoid granulomas without caseous necrosis. Multinucleated giant cells were observed in 52 (87%) biopsies. Trophozoite forms were identified in the biopsies of 25 (71%) patients. Direct immunofluorescence was positive in 25 (71%) patients.
CONCLUSIONS: B. mandrillaris is a pathogen that is capable of inducing a characteristic skin lesion with a reaction pattern of ill-defined tuberculoid granulomas and many giant cells.
摘要：
背景：Balamuthiamandrillaris，一个自由生活的变形虫,导致一种罕见的感染，其特征是皮肤和神经系统受累，预后不良。
方法：这是一项回顾性观察性研究，包括临床怀疑患有皮肤龟裂症的患者，他们的皮肤活检，和/或阳性直接免疫荧光测试。数据是从卡耶塔诺·埃雷迪亚医院和热带亚历山大·冯·洪堡研究所的皮肤病学和病理学服务中收集的，利马,秘鲁,从1985年1月到2007年6月。我们从35例患者中鉴定出60例活检,30年可获得临床数据。
结果：22例（73%）患者有中心面病变，主要位于鼻子上。典型的病变是无症状的，红斑,或者是暴力浸润的斑块.22例（73％）患者有神经系统受累。50例（83％）活检显示肉芽肿性皮炎，75％显示不明确的结核性肉芽肿，无干酪样坏死。在52例（87％）活检中观察到多核巨细胞。在25例（71％）患者的活检中发现了滋养体形式。直接免疫荧光阳性25例(71%)。
结论：B.mandrillaris是一种病原体，能够诱导特征性皮肤病变，具有不明确的结核性肉芽肿和许多巨细胞的反应模式。
方法：这是一项回顾性观察性研究，包括临床怀疑患有皮肤龟裂症的患者，他们的皮肤活检，和/或阳性直接免疫荧光测试。数据是从卡耶塔诺·埃雷迪亚医院和热带亚历山大·冯·洪堡研究所的皮肤病学和病理学服务中收集的，利马,秘鲁,从1985年1月到2007年6月。我们从35例患者中鉴定出60例活检,30年可获得临床数据。
结果：22例（73%）患者有中心面病变，主要位于鼻子上。典型的病变是无症状的，红斑,或者是暴力浸润的斑块.22例（73％）患者有神经系统受累。50例（83％）活检显示肉芽肿性皮炎，75％显示不明确的结核性肉芽肿，无干酪样坏死。在52例（87％）活检中观察到多核巨细胞。在25例（71％）患者的活检中发现了滋养体形式。直接免疫荧光阳性25例(71%)。
结论：B.mandrillaris是一种病原体，能够诱导特征性皮肤病变，具有不明确的结核性肉芽肿和许多巨细胞的反应模式。
