一名阿米巴脑膜脑炎死亡的报告,众所周知的“吃大脑的阿米巴”,\"NaegleriaFowleri,2022年7月在爱荷华州的一个州立公园湖中收购,再次引发了关于这种病原体的季节性警报。虽然非常罕见,其几乎普遍的死亡率使公众感到恐慌,并为新闻媒体提供了良好的复制。这篇评论将解决已被确定为导致人类中枢神经系统入侵的自由生活的阿米巴,即,NaegleriaFowleri,棘阿米巴物种,Balamuthiamandrillaris,和Sappiniadiploidea(表1)。值得注意的是,几种棘阿米巴。和Balamuthiamandrillaris也可能与免疫功能低下宿主中具有免疫能力和播散性疾病的个体的局部中枢神经系统外感染有关。这些阿米巴与其他原生动物不同,因为它们是自由生活的,没有已知的昆虫媒介,不会导致人类携带者状态,通常与恶劣的卫生条件无关。表1已被确定为导致人类中枢神经系统入侵的自由生活阿米巴,即,NaegleriaFowleri,棘阿米巴物种,Balamuthiamandrillaris,和Sappiniadiploidea实体致病性阿米巴易感疾病进入潜伏期门临床特征影像学发现CSF发现诊断措施原发性阿米巴脑膜脑炎;澳大利亚奈瑟氏菌;意大利北部以前健康的儿童或年轻人嗅觉上皮2-14天(平均5天)头痛,发烧,精神状态改变,脑膜体征;癫痫发作脑水肿;脑膜强化;脑积水;基底节梗死开放压力增加;嗜中性粒细胞增多症(~1000细胞/cumm);低葡萄糖脑活检,脑脊液湿准备,IIF培养或PCR肉芽肿性阿米巴脑炎。;巴拉穆西亚曼陀罗;Sappiniadiploidea通常,免疫受损个体皮肤窦;嗅觉上皮呼吸道周至数月头痛;精神状态改变癫痫发作,局灶性神经发现局灶性实质病变伴水肿;出血性梗塞;脑膜强化一般,LP禁忌;当进行淋巴细胞性细胞增多时;蛋白质增加;低糖脑活检,CSF培养,湿准备,IIF,或PCRIIF间接免疫荧光,LP腰椎穿刺,PCR聚合酶链反应。
The report of death of a person from amebic meningoencephalitis, the proverbial \"brain-eating
ameba,\" Naegleria fowleri, acquired in a state park lake in Iowa in July 2022 has once again raised the seasonal alarms about this pathogen. While exceptionally rare, its nearly universal fatality rate has panicked the public and made for good copy for the news media. This review will address free-living
ameba that have been identified as causing CNS invasion in man, namely, Naegleria fowleri, Acanthamoeba species, Balamuthia mandrillaris, and Sappinia diploidea (Table 1). Of note, several Acanthamoeba spp. and Balamuthia mandrillaris may also be associated with localized extra-CNS infections in individuals who are immunocompetent and disseminated disease in immunocompromised hosts. These
ameba are unique from other protozoa in that they are free-living, have no known insect vector, do not result in a human carrier state, and are typically unassociated with poor sanitation. Table 1 Free-living
ameba that have been identified as causing CNS invasion in man, namely, Naegleria fowleri, Acanthamoeba species, Balamuthia mandrillaris, and Sappinia diploidea Entity Pathogenic
ameba Predisposing disorders Portal of entry Incubation period Clinical features Radiographic findings CSF finding Diagnostic measures Primary amebic meningoencephalitis Naegleria fowleri; N. australiensis; N. italica Previously healthy children or young adults Olfactory epithelium 2-14 days (average 5 days) Headache, fever, altered mental status, meningeal signs; seizures Brain edema; meningeal enhancement; hydrocephalus; basal ganglia infarctions Increased opening pressure; neutrophilic pleocytosis (~ 1000 cells/cu mm); low glucose Brain biopsy, CSF wet prep, IIF culture or PCR Granulomatous amebic encephalitis Acanthamoeba spp.; Balamuthia mandrillaris; Sappinia diploidea Typically, immunocompromised individual Skin sinuses; olfactory epithelium respiratory tract Weeks to months Headache; altered mental status seizures, focal neurological findings Focal parenchymal lesions with edema; hemorrhagic infarctions; meningeal enhancement Generally, LP contraindicated; when performed lymphocytic pleocytosis; increased protein; low glucose Brain biopsy, CSF culture, wet prep, IIF, or PCR IIF indirect immunofluorescence, LP lumbar puncture, PCR polymerase chain reaction.