Riestra-Castaneda J M, Riestra-Castaneda R, Gonzalez-Garrido A A, Pena Moreno P, Martinez A J, Visvesvara G S, Jardon Careaga F, Oropeza de Alba J L, Gonzalez Cornejo S
Departamento de Neurologia y Neurocirugia, Hospital Civil de Guadalajara, Mexico.
Am J Trop Med Hyg. 1997 Jun;56(6):603-7. doi: 10.4269/ajtmh.1997.56.603.
In this report, we describe four cases of granulomatous amebic encephalitis caused by Balamuthia (Leptomyxid ameba) in four previously healthy Mexican patients. All four cases were characterized by focal neurologic signs, increased intracranial pressure, and cerebral hyperdense lesions in computed tomography scans of the head. These patients underwent craniotomies for evaluation of mass lesions for possible brain tumors. Granulomatous chronic inflammatory reaction and amebic trophozoites were found in brain biopsies. At autopsy, areas of hemorrhagic encephalomalacia were located in both basal frontal lobes, right parieto-occipital lobes, and, less often, in the brainstem and cerebellum. Angiitis, necrotizing granulomatous encephalitis, and large numbers of amebic trophozoites in perivascular spaces were present. Amebic trophozoites were seen in the left adrenal gland in one of the cases. The amebas in all four cases were identified as Balamuthia mandrillaris (Leptomyxiidae) based on their reactivity with the anti-Balamuthia (Leptomyxiidae) serum in an immunofluorescence test.
在本报告中，我们描述了4例由巴拉姆希阿米巴（细黏菌阿米巴）引起的肉芽肿性阿米巴脑炎病例，这4例患者均为先前健康的墨西哥人。所有4例病例的特征均为局灶性神经体征、颅内压升高以及头部计算机断层扫描显示脑内高密度病变。这些患者接受了开颅手术，以评估可能为脑肿瘤的占位性病变。脑活检发现肉芽肿性慢性炎症反应和阿米巴滋养体。尸检时，出血性脑软化区域位于双侧额叶底部、右侧顶枕叶，较少见于脑干和小脑。存在血管炎、坏死性肉芽肿性脑炎以及血管周围间隙中有大量阿米巴滋养体。其中1例患者的左侧肾上腺可见阿米巴滋养体。根据免疫荧光试验中4例病例的阿米巴与抗巴拉姆希阿米巴（细黏菌科）血清的反应性，所有4例病例中的阿米巴均被鉴定为曼氏巴拉姆希阿米巴（细黏菌科）。
