Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, 701 Grove Road, Greenville, SC, 29605, USA.
Department of Pathology, Prisma Health - Upstate, Greenville, SC, 29605, USA.
Forensic Sci Med Pathol. 2020 Mar;16(1):171-176. doi: 10.1007/s12024-019-00202-6. Epub 2019 Nov 26.
Acanthamoeba spp. and Balamuthia mandrillaris are free-living amebae known to cause disseminated and fatal central nervous system dysfunction which manifests as granulomatous amebic encephalitis (GAE) with exceedingly rare frequency. We report two lethal cases of infection with free-living amebae: an acute case of Acanthamoeba spp. infection in an immunocompromised female and a subacute case of B. mandrillaris in a Hispanic male. The Acanthamoeba spp. infection presented with an atypical lesion in the thalamus that caused rapid deterioration of the patient while the case of B. mandrillaris had a prolonged clinical course with multifocal lesions beginning in the frontal lobe. Cerebrospinal fluid results were non-specific in both cases, however, post-mortem histology demonstrated the presence of trophozoites along a perivascular distribution of necrosis and infiltrate composed primarily of neutrophils. In addition to detailing the clinical presentations of these infrequent amebic infections, we offer insight into the difficulties surrounding their diagnoses in order to aid the clinician in accurate and timely identification.
棘阿米巴属和狒狒巴拉姆希阿米巴是自由生活的阿米巴原虫，已知会导致弥散性和致命性中枢神经系统功能障碍，表现为罕见的肉芽肿性阿米巴脑炎（GAE）。我们报告了两例自由生活的阿米巴感染的致死病例：一例免疫功能低下的女性急性棘阿米巴属感染病例和一例西班牙裔男性亚急性狒狒巴拉姆希阿米巴感染病例。棘阿米巴属感染表现为丘脑的非典型病变，导致患者迅速恶化，而狒狒巴拉姆希阿米巴感染的临床过程较长，额叶开始出现多灶性病变。在这两种情况下，脑脊液结果均不具特异性，但尸检组织学显示在坏死和浸润物的血管周围分布存在滋养体，浸润物主要由中性粒细胞组成。除了详细描述这些罕见的阿米巴感染的临床表现外，我们还提供了围绕这些感染诊断的困难的见解，以帮助临床医生准确和及时地识别。
