Chen Xiang-Ting, Zhang Qian, Wen Si-Yuan, Chen Fei-Fei, Zhou Chang-Qing
Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2023 Feb 9;14:1100785. doi: 10.3389/fneur.2023.1100785. eCollection 2023.
Free-living amoebae (FLA) including spp., and can become pathogenic and cause severe cerebral infections, named primary amoebic meningoencephalitis (PAM), granulomatous amoebic encephalitis (GAE), and balamuthia amoebic encephalitis (BAE), respectively. FLA encephalitis has been reported across China, but the clinical data descriptions and analytical results of these different reports vary widely. Currently, no consensus treatment has been established. We conduct a systematic review to evaluate the exposure location, clinical symptoms, diagnosis, treatment, and prognosis of three FLA encephalitis and aim to reveal the differences between three FLA encephalitis in China.
We used MEDLINE (PubMed interface), EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang database, and China Biology Medicine disc (CBMdisc) databases for literatures published and manually retrieve the hospital records of our hospital. The search time was up to August 30, 2022, with no language restrictions.
After excluding possible duplicate cases, a total of 48 patients of three FLA encephalitis were collected. One from the medical records of our hospital and 47 patients from 31 different studies. There were 11 patients of PAM, 10 patients of GAE, and 27 patients of BAE. The onset of PAM is mostly acute or subacute, and the clinical symptoms are acute and fulminant hemorrhagic meningoencephalitis. Most patients with GAE and BAE have an insidious onset and a chronic course. A total of 21 BAE patients (77.8%) had skin lesions before onset of symptoms. Additionally, 37 cases (77.1%) were diagnosed with FLA encephalitis before death. And there were 4 of PAM, 2 of GAE, and 10 of BAE diagnosed using next generation sequencing. No single agent can be proposed as the ideal therapy by itself. Only 6 cases were successfully treated.
This review provides an overview of the available data and studies of FLA encephalitis in China and identify some potential differences. FLA encephalitis is a rare but pathogenic infection, and physicians should early identify this encephalitis to improve survival.
自由生活阿米巴（FLA）包括 属、 属和 属，可致病并引发严重的脑部感染，分别称为原发性阿米巴脑膜脑炎（PAM）、肉芽肿性阿米巴脑炎（GAE）和巴拉姆希阿米巴脑炎（BAE）。中国各地均有FLA脑炎的报道，但这些不同报道中的临床数据描述和分析结果差异很大。目前，尚未确立共识性的治疗方法。我们进行了一项系统综述，以评估三种FLA脑炎的暴露部位、临床症状、诊断、治疗和预后，并旨在揭示中国三种FLA脑炎之间的差异。
我们使用MEDLINE（PubMed界面）、EMBASE、中国知网（CNKI）、万方数据库和中国生物医学光盘数据库（CBMdisc）检索已发表的文献，并人工检索我院的病历。检索时间截至2022年8月30日，无语言限制。
排除可能的重复病例后，共收集到48例三种FLA脑炎患者。其中1例来自我院病历，47例来自31项不同研究。有11例PAM患者、10例GAE患者和27例BAE患者。PAM发病多为急性或亚急性，临床症状为急性暴发性出血性脑膜脑炎。大多数GAE和BAE患者起病隐匿，病程呈慢性。共有21例BAE患者（77.8%）在症状发作前有皮肤病变。此外，37例（77.1%）在死亡前被诊断为FLA脑炎。使用下一代测序诊断出4例PAM、2例GAE和l0例BAE。没有单一药物可单独作为理想治疗方法。仅6例成功治愈。
本综述概述了中国FLA脑炎的现有数据和研究，并确定了一些潜在差异。FLA脑炎是一种罕见但具有致病性的感染，医生应尽早识别这种脑炎以提高生存率。
