Stubhaug Tore Taksdal, Reiakvam Olaug Marie, Stensvold Christen Rune, Hermansen Nils Olav, Holberg-Petersen Mona, Antal Ellen-Ann, Gaustad Knut, Førde Ingrid Schage, Heger Bernt
Department of Microbiology, Oslo University Hospital - Ullevaal, Oslo, Norway.
Department of Infectious Diseases, Oslo University Hospital - Ullevaal, Oslo, Norway.
JMM Case Rep. 2016 Jun 25;3(3):e005042. doi: 10.1099/jmmcr.0.005042. eCollection 2016 Jun.
Primary amoebic meningoencephalitis (PAM) is a rare disease caused by the free-living amoeba . Infection occurs by insufflation of water containing amoebae into the nasal cavity, and is usually associated with bathing in freshwater. Nasal irrigation is a more rarely reported route of infection.
A fatal case of PAM in a previously healthy Norwegian woman, acquired during a holiday trip to Thailand, is described. Clinical findings were consistent with rapidly progressing meningoencephalitis. The cause of infection was discovered by chance, owing to the unexpected detection of DNA by a PCR assay targeting fungi. A conclusive diagnosis was established based on sequencing of DNA from brain biopsies, supported by histopathological findings. Nasal irrigation using contaminated tap water is suspected as the source of infection.
The clinical presentation of PAM is very similar to severe bacterial meningitis. This case is a reminder that when standard investigations fail to identify a cause of infection in severe meningoencephalitis, it is of crucial importance to continue a broad search for a conclusive diagnosis. PAM should be considered as a diagnosis in patients with symptoms of severe meningoencephalitis returning from endemic areas.
原发性阿米巴脑膜脑炎（PAM）是一种由自由生活的阿米巴引起的罕见疾病。感染是通过将含有阿米巴的水吸入鼻腔发生的，通常与在淡水中沐浴有关。鼻腔冲洗是一种较少报道的感染途径。
描述了一名此前健康的挪威女性在泰国度假期间感染致死性PAM的病例。临床症状与快速进展的脑膜脑炎一致。由于针对真菌的聚合酶链反应（PCR）检测意外检测到DNA，感染原因得以偶然发现。基于脑活检DNA测序并结合组织病理学结果，确立了确诊诊断。怀疑使用受污染的自来水进行鼻腔冲洗是感染源。
PAM的临床表现与严重细菌性脑膜炎非常相似。该病例提醒我们，当标准检查未能确定严重脑膜脑炎的感染原因时，继续广泛寻找确诊诊断至关重要。对于来自流行地区且有严重脑膜脑炎症状的患者，应考虑PAM作为诊断。
