Akpek G, Uslu A, Huebner T, Taner A, Rapoport A P, Gojo I, Akpolat Y T, Ioffe O, Kleinberg M, Baer M R
Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland 21201, USA.
Transpl Infect Dis. 2011 Aug;13(4):366-73. doi: 10.1111/j.1399-3062.2011.00612.x. Epub 2011 Feb 21.
Granulomatous amebic encephalitis (GAE) is a rare, nearly always fatal form of encephalitis that occurs mostly in the setting of immune compromise or chronic disease. The prevalence and clinical characteristics of this Acanthamoeba infection in hematopoietic stem cell transplant (HSCT) recipients are not well described. We present an HSCT patient in whom the diagnosis of GAE was made at autopsy. A systematic review of previously reported cases is provided to highlight the clinical presentation and early diagnostic features of GAE in HSCT recipients. Amebic infection usually initially involves the skin or lungs over a period of months, and becomes rapidly fatal once it crosses the blood-brain barrier. GAE is usually discovered postmortem owing to lack of awareness of this deadly infection and delay in diagnosis. Subacute presentation of multiple recurrent panniculitis-like subcutaneous nodules associated with eosinophilia and a history of chronic rhinitis or sinusitis warrant investigation for a possible amebic infection. Prolonged corticosteroid use and a recent exposure to unhygienic water are potential risk factors for GAE. Successful outcomes may be achieved with early intensive treatment using a combination of effective drugs.
肉芽肿性阿米巴脑炎（GAE）是一种罕见的、几乎总是致命的脑炎形式，主要发生在免疫功能低下或患有慢性疾病的情况下。造血干细胞移植（HSCT）受者中这种棘阿米巴感染的患病率和临床特征尚未得到充分描述。我们报告了一名在尸检时确诊为GAE的HSCT患者。本文对先前报道的病例进行了系统回顾，以突出HSCT受者中GAE的临床表现和早期诊断特征。阿米巴感染通常最初在数月内累及皮肤或肺部，一旦穿过血脑屏障就会迅速致命。由于对这种致命感染缺乏认识和诊断延迟，GAE通常在死后才被发现。伴有嗜酸性粒细胞增多以及慢性鼻炎或鼻窦炎病史的亚急性复发性脂膜炎样皮下结节表现值得对可能的阿米巴感染进行调查。长期使用皮质类固醇以及近期接触不卫生的水是GAE的潜在危险因素。早期使用有效药物联合强化治疗可能会取得成功的治疗效果。
