Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clin Infect Dis. 2021 Jul 1;73(1):e19-e27. doi: 10.1093/cid/ciaa520.
Primary amebic meningoencephalitis (PAM) is a rapidly progressive and often fatal condition caused by the free-living ameba Naegleria fowleri. To estimate the global occurrence, characterize the epidemiology, and describe the clinical features of PAM, we report a series of PAM cases published in the international literature and reported to the Centers for Disease Control and Prevention (CDC).
We performed a literature search of PAM case reports published through 2018. Additionally, we included cases reported through the CDC's Free-Living Ameba surveillance or diagnosed via CDC's Free-Living and Intestinal Amebas Laboratory. Cases were classified as confirmed, probable, or suspect on the basis of confirmatory testing, presentation, exposure, and disease course.
A total of 381 PAM cases were identified. Seven reported survivors were classified as confirmed. The most commonly reported exposure associated with PAM was swimming/diving, and the most common class of water source was lakes/ponds/reservoirs. Patients were predominantly male (75%), with a median age of 14 years. Confirmed and probable cases were similar in their survival, course of illness, and cerebrospinal fluid (CSF) findings.
PAM is a rare but deadly disease with worldwide occurrence. Improved clinician awareness, resulting in earlier diagnosis and treatment, may contribute to increased survival among PAM patients. The case definition of probable used in this study appears to capture cases of PAM, as evidenced by similarities in outcomes, clinical course, and CSF profile to confirmed cases. In the absence of confirmatory testing, clinicians could use this case definition to identify cases of PAM.
原发性阿米巴脑膜脑炎（PAM）是一种迅速进展且常致命的疾病，由自由生活的阿米巴原虫 Naegleria fowleri 引起。为了估计全球发病率，描述其流行病学特征并描述 PAM 的临床特征，我们报告了一系列在国际文献中发表的 PAM 病例以及向疾病预防控制中心（CDC）报告的病例。
我们对截至 2018 年发表的 PAM 病例报告进行了文献检索。此外，我们还包括了通过 CDC 的自由生活阿米巴监测报告或通过 CDC 的自由生活和肠道阿米巴实验室诊断的病例。根据确证性检测、表现、暴露和疾病过程，将病例分类为确诊、可能或疑似。
共确定了 381 例 PAM 病例。报告的 7 例幸存者被归类为确诊病例。与 PAM 最常报告的暴露相关的是游泳/潜水，最常见的水源是湖泊/池塘/水库。患者主要为男性（75%），中位年龄为 14 岁。确诊和可能病例在存活、疾病过程和脑脊液（CSF）发现方面相似。
PAM 是一种罕见但致命的疾病，全球均有发生。提高临床医生的认识，从而更早地进行诊断和治疗，可能有助于提高 PAM 患者的生存率。本研究中使用的可能病例的病例定义似乎可以捕获 PAM 病例，这一点从确诊病例的结果、临床过程和 CSF 特征相似得到证明。在没有确证性检测的情况下，临床医生可以使用此病例定义来识别 PAM 病例。
