1Pathology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
2Neurosurgery Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Am J Trop Med Hyg. 2021 Mar 15;104(5):1836-1840. doi: 10.4269/ajtmh.20-1257.
It is about half a century since free-living amoebae were recognized as pathogenic organisms, but there is still much we should learn about these rare fatal human infectious agents. A recently introduced causative agent of granulomatous amoebic encephalitis, Balamuthia mandrillaris, has been reported in a limited number of countries around the world. A 3-year-old girl was referred to our tertiary hospital because of inability to establish a proper diagnosis. She had been experiencing neurologic complaints including ataxia, altered level of consciousness, dizziness, seizure, and left-sided hemiparesis. The patient's history, physical examination results, and laboratory investigations had led to a wide differential diagnosis. Computed tomography (CT) scan and magnetic resonance imaging analyses revealed multiple mass lesions. As a result, the patient underwent an intraoperative frozen section biopsy of the brain lesion. The frozen section study showed numerous cells with amoeba-like appearances in the background of mixed inflammatory cells. Medications for free-living amoebic meningoencephalitis were administered. PCR assay demonstrated B. mandrillaris as the pathogenic amoeba. Unfortunately, the patient died 14 days after her admission. To our knowledge, this is the first report of B. mandrillaris meningoencephalitis in the Middle East and the first time we have captured the organism during a frozen-section study.
自从自由生活的阿米巴原虫被确认为病原体以来，已经过去了大约半个世纪，但我们仍然有很多关于这些罕见的致命人类感染因子的知识需要了解。一种最近被发现的肉芽肿性阿米巴脑炎的病原体——曼氏巴贝西虫，已在世界范围内的少数几个国家报告过。一名 3 岁女孩因无法明确诊断而被转至我们的三级医院。她出现了包括共济失调、意识改变、头晕、癫痫发作和左侧偏瘫在内的神经系统症状。患者的病史、体格检查结果和实验室检查导致了广泛的鉴别诊断。计算机断层扫描（CT）和磁共振成像分析显示了多个肿块病变。因此，患者接受了脑病变的术中冷冻切片活检。冷冻切片研究显示，在混合炎症细胞的背景下存在许多具有阿米巴样外观的细胞。针对自由生活阿米巴脑膜脑炎的药物治疗被给予。PCR 检测显示为曼氏巴贝西虫。不幸的是，患者在入院后 14 天死亡。据我们所知，这是中东地区首例曼氏巴贝西虫脑膜脑炎的报告，也是我们首次在冷冻切片研究中捕获该病原体。
