Murakawa G J, McCalmont T, Altman J, Telang G H, Hoffman M D, Kantor G R, Berger T G
Department of Dermatology, University of California at San Francisco, USA.
Arch Dermatol. 1995 Nov;131(11):1291-6.
Acanthamoeba and Leptomyxida are free-living amebae that cause granulomatous amebic encephalitis, a rare, slowly progressive, fatal neurologic process seen in immunosuppressed hosts. In addition, these organisms produce disseminated cutaneous lesions and involve other organs, particularly in patients with the acquired immunodeficiency syndrome (AIDS).
We report five cases of disseminated acanthamebiasis in patients with AIDS, each with cutaneous manifestations but lacking central nervous system involvement. The medial CD4+ T-cell count was 0.024 x 10(9)/L. Skin lesions included pustules, subcutaneous and deep dermal nodules, and ulcers, most often seen on the extremities and face. Histopathologically, both pustular and vasculitic changes were observed; in all cases, the microscopic identification of organisms was difficult because of the macrophagelike appearance of the microbes in routine sections.
Skin lesions are the most common reported presentation of infections caused by Acanthamoeba and Leptomyxida organisms in patients with AIDS, a minority of whom have central nervous system manifestations. A high index of suspicion is necessary for both the dermatologist and the dermatopathologist. Prognosis is guarded, but early treatment using a combination of intravenous pentamidine and oral fluconazole, sulfadiazine, and flucytosine may be beneficial.
棘阿米巴属和瘦粘菌目是自由生活的阿米巴，可引起肉芽肿性阿米巴脑炎，这是一种在免疫抑制宿主中出现的罕见、进展缓慢且致命的神经病变过程。此外，这些病原体还会引发播散性皮肤病变并累及其他器官，尤其是在获得性免疫缺陷综合征（AIDS）患者中。
我们报告了5例艾滋病患者的播散性棘阿米巴病病例，每例均有皮肤表现但无中枢神经系统受累。CD4 + T细胞的中位计数为0.024×10⁹/L。皮肤病变包括脓疱、皮下和真皮深层结节以及溃疡，最常出现在四肢和面部。组织病理学检查发现了脓疱和血管炎改变；在所有病例中，由于常规切片中微生物呈现巨噬样外观，因此在显微镜下难以识别病原体。
皮肤病变是艾滋病患者中由棘阿米巴属和瘦粘菌目病原体引起的感染最常见的报告表现，其中少数患者有中枢神经系统表现。皮肤科医生和皮肤病理学家都需要高度怀疑。预后不佳，但早期联合使用静脉注射喷他脒和口服氟康唑、磺胺嘧啶及氟胞嘧啶进行治疗可能有益。
