Balamuthiamandrillaris是一种变形虫,会引起罕见但致命的脑炎,称为肉芽肿性阿米巴脑炎(GAE)。全球报告的最高发病率发生在美国,在美国境内,西南地区的发病率最高,主要影响西班牙裔儿童和年轻男子。GAE的临床表现包括发热,头痛,恶心,呕吐,嗜睡,烦躁,脖子僵硬,幻觉,畏光,和癫痫发作。我们的病人是一个住在亚利桑那州的西班牙裔男童。患者在3岁时出现严重脑炎。症状包括平衡困难,步态,坐起来和类似癫痫的活动。初始CT显示右侧额叶和左侧额顶叶有一个密度降低的区域,与水肿一致。在患者住院期间的进一步成像中发现了快速进展,揭示了弥散限制,坏死/血液制品,水肿,和出血。患者在症状发作后三周和入院后一周死亡。虽然有多种生化技术可以检测曼氏芽孢杆菌,由于这种感染的罕见发生,由于多种原因,他们很少被雇用。由于这种感染的致命性质,我们建议:(1)如果患者在影像学上出现进展性脑炎,并排除其他病因,则应考虑进行检测;(2)由于感染的致命性,经验性治疗的阈值应该较低.
Balamuthia mandrillaris is an amoeba that causes an uncommon but deadly encephalitis, referred to as granulomatous amoebic encephalitis (GAE). The highest incidence reported worldwide has occurred in America, and within the United States, it has been highest in the Southwest affecting predominantly children and young men of Hispanic ethnicity. Clinical presentation of GAE includes fever, headache, nausea, vomiting, lethargy, irritability, stiff neck, hallucinations, photophobia, and seizures. Our patient was a Hispanic male child living in Arizona. The patient presented at 3 years of age for severe encephalitis. Symptoms included difficulty with balance, gait, and sitting up and seizure-like activity. Initial CT showed an area of decreased density consistent with edema in the right frontal and left frontoparietal lobes. Rapid progression was seen on further imaging over the length of the patient\'s hospital stay revealing diffusion restriction, necrosis/blood products, edema, and hemorrhage. The patient expired three weeks after onset of symptoms and one week after admission to our institution. While there are multiple biochemical techniques that can test for B. mandrillaris, they are rarely employed for multiple reasons stemming from the rare occurrence of this infection. Because of the fatal nature of this infection, we propose (1) testing should be considered if a patient presents with progressing encephalitis on imaging and other pathogenic etiologies are ruled out and (2) the threshold to treat empirically should be low due to the fatal nature of the infection.