自由生活阿米巴引起的感染。
Infections Caused by Free-Living Amoebae.
机构信息
Division of Infectious Diseases, Department of Medicine, Emory Universitygrid.189967.8, Atlanta, Georgia, USA.
Department of Pathology and Laboratory Medicine, Emory Universitygrid.189967.8, Atlanta, Georgia, USA.
出版信息
J Clin Microbiol. 2022 Jan 19;60(1):e0022821. doi: 10.1128/JCM.00228-21. Epub 2021 Jun 16.
Infections caused by Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris result in a variety of clinical manifestations in humans. These amoebae are found in water and soil worldwide. spp. and B. mandrillaris cause granulomatous amoebic encephalitis (GAE), which usually presents as a mass, while N. fowleri causes primary amoebic meningoencephalitis (PAM). spp. can also cause keratitis, and both spp. and can cause lesions in skin and respiratory mucosa. These amoebae can be difficult to diagnose clinically as these infections are rare and, if not suspected, can be misdiagnosed with other more common diseases. Microscopy continues to be the key first step in diagnosis, but the amoeba can be confused with macrophages or other infectious agents if an expert in infectious disease pathology or clinical microbiology is not consulted. Although molecular methods can be helpful in establishing the diagnosis, these are only available in referral centers. Treatment requires combination of antibiotics and antifungals and, even with prompt diagnosis and treatment, the mortality for neurological disease is extremely high.
福氏耐格里阿米巴、棘阿米巴属和狒狒巴拉姆希阿米巴引起的感染会导致人类出现多种临床表现。这些阿米巴在世界各地的水和土壤中都有发现。棘阿米巴属和狒狒巴拉姆希阿米巴会引起肉芽肿性阿米巴脑炎(GAE),通常表现为肿块,而福氏耐格里阿米巴会引起原发性阿米巴脑膜脑炎(PAM)。棘阿米巴属也会引起角膜炎,棘阿米巴属和狒狒巴拉姆希阿米巴都会导致皮肤和呼吸道黏膜损伤。由于这些感染较为罕见,如果没有被怀疑,临床诊断可能会误诊为其他更为常见的疾病,因此这些阿米巴类病原体可能难以临床诊断。显微镜检查仍然是诊断的关键第一步,但如果没有传染病病理学或临床微生物学专家的咨询,阿米巴可能会与巨噬细胞或其他病原体混淆。虽然分子方法有助于确立诊断,但这些方法仅在转诊中心可用。治疗需要联合使用抗生素和抗真菌药物,即使及时诊断和治疗,神经疾病的死亡率也极高。
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