Diaz James H
Environmental and Occupational Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, USA.
J La State Med Soc. 2011 Jul-Aug;163(4):197-204.
Balamuthia mandrillaris, formerly known as leptomyxid ameba, is an opportunistic, free-living ameba, related to Acanthamoeba that can cause skin lesions and granulomatous amebic encephalitis in individuals with compromised or competent immune systems. In order to make recommendations for early diagnosis, management, and prevention of typically fatal Balamuthia amebic encephalitis (BAE), this review described and analyzed laboratory-confirmed US cases of BAE for any consistent behavioral, demographic, environmental, ethnic, iatrogenic, occupational, recreational, or regional exposure factors over the study period, 1980-2010. The ages of all case-patients were stratified by age and gender and compared for statistically significant differences by two-tailed, unpaired t-tests. Potential risk factors were also stratified by age and gender, described, and compared by proportions and rates. The results of this study demonstrated that BAE occurred sporadically in patients of all ages in both immunosuppressed and immunocompetent patients. In addition, BAE exhibited only a few consistent predisposing factors that included male gender, exposure in a southern tier US state, and Hispanic ethnicity. Clinicians should suspect BAE in refractory cases of meningoencephalitis initially managed as aseptic or bacterial infections, especially in patients predisposed to BAE; confirm the diagnosis by immunodiagnostics, brain or skin biopsies, and institute conventional and, possibly, experimental, antiprotozoal therapy immediately. Brain dead victims of BAE are not suitable organ donors and have transmitted fatal BAE to organ transplant recipients.
曼氏巴贝斯虫，以前称为细粘菌阿米巴，是一种机会性自由生活阿米巴，与棘阿米巴有关，可在免疫系统受损或正常的个体中引起皮肤病变和肉芽肿性阿米巴脑炎。为了对通常致命的巴贝斯虫阿米巴脑炎（BAE）的早期诊断、管理和预防提出建议，本综述描述并分析了1980年至2010年研究期间美国实验室确诊的BAE病例，以寻找任何一致的行为、人口统计学、环境、种族、医源性、职业、娱乐或区域暴露因素。所有病例患者的年龄按年龄和性别分层，并通过双尾、不成对t检验比较统计学上的显著差异。潜在风险因素也按年龄和性别分层，进行描述，并通过比例和发生率进行比较。本研究结果表明，BAE在免疫抑制和免疫功能正常的各年龄段患者中均有散发性发生。此外，BAE仅表现出少数一致的易感因素，包括男性、在美国南部各州暴露以及西班牙裔种族。临床医生应在最初被诊断为无菌性或细菌性感染的难治性脑膜脑炎病例中怀疑BAE，特别是在易患BAE的患者中；通过免疫诊断、脑或皮肤活检确诊，并立即开始常规的、可能还有实验性的抗原生动物治疗。BAE导致脑死亡的受害者不是合适的器官捐赠者，并且已将致命的BAE传播给器官移植受者。
