Cuevas P Mónica, Smoje P Gabriela, Jofré M Leonor, Ledermann D Walter, Noemí H Isabel, Berwart C Francisco, Latorre L Juan J, González B Sergio
Unidad de Lactantes y Nutrición, Servicio de Pediatría, Hospital Luis Calvo Mackenna, Chile.
Rev Chilena Infectol. 2006 Sep;23(3):237-42. doi: 10.4067/s0716-10182006000300007. Epub 2006 Aug 4.
The free-living amebas Naegleria and Acanthamoeba are recognized as causal agents of central nervous system infections. Recently a third free-living ameba, Balamuthia mandrillaris, was identified as the causal agent of granulomatous encephalitis in humans. We report a case of Balamuthia encephalitis in an immunocompetent school-age girl who presented cutaneous lesions that compromised the central portion of the face. The skin biopsy revealed granulomatous lesion with positive PCR for non-tuberculous Mycobacterium. We started treatment for atypical extrapulmonary mycobacteriosis. Nevertheless, the child was readmitted six months later, with progressive neurological involvement, dying about one year after the onset of cutaneous symptoms. The brain necropsy showed the presence of B. mandrillaris cysts and trophozoites. Balamuthia mandrillaris infection should be considered in the differential diagnosis of a patient with chronic granulomatous disease with neurologic symptoms.
自由生活的阿米巴原虫，如耐格里属阿米巴和棘阿米巴，被认为是中枢神经系统感染的病原体。最近，第三种自由生活的阿米巴——曼氏巴贝虫，被确定为人类肉芽肿性脑炎的病原体。我们报告了一例免疫功能正常的学龄女童患曼氏巴贝虫脑炎的病例，该女童出现了累及面部中央部分的皮肤病变。皮肤活检显示肉芽肿性病变，非结核分枝杆菌PCR检测呈阳性。我们开始针对非典型肺外分枝杆菌病进行治疗。然而，该患儿在6个月后再次入院，出现进行性神经功能受累，在皮肤症状出现约1年后死亡。脑部尸检显示存在曼氏巴贝虫囊肿和滋养体。对于患有慢性肉芽肿性疾病并伴有神经症状的患者，鉴别诊断时应考虑曼氏巴贝虫感染。
