Kodet R, Nohýnková E, Tichý M, Soukup J, Visvesvara G S
Department of Anatomic Pathology, 2nd Medical School, Prague, Czech Republic.
Pathol Res Pract. 1998;194(6):423-9. doi: 10.1016/S0344-0338(98)80033-2.
We describe a fatal case of amebic encephalitis caused by Balamuthia mandrillaris in a 3-year-old Czech boy who had never traveled abroad. This is the first such infection reported in Europe. The diagnosis was established by brain biopsy, in which abundant trophozoites and a few round amebic cysts were identified. The presence of multiple nucleoli in some trophozoites suggested the organism to be Balamuthia mandrillaris and this was confirmed by indirect immunofluorescence. The amebae invaded brain tissue, including neurons, and blood vessel walls, causing thrombovasculitis. The tissue reaction was a subacute necrotizing and granulomatous encephalitis (GAE) with an infiltrate of CD4- and CD8-positive T-lymphocytes, B-lymphocytes, plasma cells and macrophages. The child, in whom no underlying immunodeficiency was demonstrated, died after 45 days. The mode of infection was not established. Postmortem examination of the brain revealed massive areas of necrosis and microscopic findings like those in the surgical specimen. In vitro isolation of B. mandrillaris was unsuccessful.
我们描述了一例由曼氏巴贝斯虫引起的阿米巴性脑炎致死病例，患儿为一名3岁的捷克男孩，从未出过国。这是欧洲首例此类感染报告。诊断通过脑活检确定，在活检中发现了大量滋养体和一些圆形阿米巴囊肿。部分滋养体中存在多个核仁，提示该生物体为曼氏巴贝斯虫，这一点通过间接免疫荧光得到了证实。阿米巴侵入脑组织，包括神经元和血管壁，导致血栓性血管炎。组织反应为亚急性坏死性肉芽肿性脑炎（GAE），伴有CD4和CD8阳性T淋巴细胞、B淋巴细胞、浆细胞和巨噬细胞浸润。该患儿未显示有潜在免疫缺陷，45天后死亡。感染途径未明确。对大脑进行的尸检显示有大面积坏死，显微镜检查结果与手术标本相似。曼氏巴贝斯虫的体外分离未成功。
