Diagnosis, Clinical Course, and Treatment of Primary Amoebic Meningoencephalitis in the United States, 1937-2013
Diagnosis, Clinical Course, and Treatment of Primary Amoebic Meningoencephalitis in the United States, 1937-2013
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DOI：
10.1093/jpids/piu103
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发表时间：
2015-12-01
影响因子：
3.2
通讯作者：
Beach, Michael J.
中科院分区：
文献类型：
--
作者：
Capewell, Linda G.;Harris, Aaron M.;Beach, Michael J.
背景。原发性阿米巴脑膜脑炎 (PAM) 是一种进展迅速的水传播疾病，主要影响儿童，几乎总是致命的。 PAM 是由福氏耐格里阿米巴原虫（Naegleria fowleri）引起的，福氏耐格里阿米巴原虫是一种在世界各地温暖的淡水体中发现的自由生活的阿米巴原虫。我们回顾了 19372013 年美国诊断的 PAM 确诊病例的暴露位置、临床体征和症状、诊断方式和治疗。根据临床特征将患者分为早期组（即流感样症状）或晚期组（即中枢神经系统体征）。在这里，我们描述了幸存者和死者的特征。结果。患者的中位年龄为 12 岁（83% 年龄 = 18 岁）；男性 (76%) 主要受影响 (N = 142)。大多数感染发生在南部各州；然而，最近有 4 例感染病例发生在北部各州：明尼苏达州（2 例）、堪萨斯州（1 例）和印第安纳州（1 例）。大多数（72%）患者出现中枢神经系统受累。脑脊液分析类似于细菌性脑膜炎，具有高开放压、白细胞计数升高（以中性粒细胞为主）（中位值，2400 个细胞/μL [范围，526 000 个细胞/μL]）、低血糖水平（中位值，23 mg/dL [范围，192 mg/dL]）和蛋白质水平升高（中位值，365 mg/dL [范围， 241210 毫克/分升]）。脑脊液中发现的阿米巴原虫具有诊断意义，但只有 27% 的患者在死亡前被诊断为 PAM。大约四分之三的患者的影像学结果异常，但不能诊断阿米巴感染。美国三名患者幸存。结论。据我们所知，这是美国第一个全面的 PAM 临床病例系列。 PAM 是一种致命疾病，治疗效果有限，并且正在扩展到更多北部地区。怀疑自己患有 PAM 患者的临床医生应致电 7704887100（每周 7 天、每天 24 小时提供服务）联系美国疾病控制和预防中心，讨论诊断检测和治疗方案（请参阅 cdc.gov/naegleria）。
Background. Primary amoebic meningoencephalitis (PAM) is a rapidly progressing waterborne illness that predominately affects children and is nearly always fatal. PAM is caused by Naegleria fowleri , a free-living amoeba found in bodies of warm freshwater worldwide.Methods. We reviewed exposure location, clinical signs and symptoms, diagnostic modalities, and treatment from confirmed cases of PAM diagnosed in the United States during 19372013. Patients were categorized into the early (ie, flu-like symptoms) or late (ie, central nervous system signs) group on the basis of presenting clinical characteristics. Here, we describe characteristics of the survivors and decedents.Result. The median age of the patients was 12 years (83% aged =18 years); males (76%) were predominately affected (N = 142). Most infections occurred in southern-tier states; however, 4 recent infections were acquired in northern states: Minnesota (2), Kansas (1), and Indiana (1). Most (72%) of the patients presented with central nervous system involvement. Cerebrospinal fluid analysis resembled bacterial meningitis with high opening pressures, elevated white blood cell counts with predominantly neutrophils (median, 2400 cells/mu L [range, 526 000 cells/mu L]), low glucose levels (median, 23 mg/dL [range, 192 mg/dL]), and elevated protein levels (median, 365 mg/dL [range, 241210 mg/dL]). Amoebas found in the cerebrospinal fluid were diagnostic, but PAM was diagnosed for only 27% of the patients before death. Imaging results were abnormal in approximately three-fourths of the patients but were not diagnostic for amoebic infection. Three patients in the United States survived.Conclusions. To our knowledge, this is the first comprehensive clinical case series of PAM presented in the United States. PAM is a fatal illness with limited treatment success and is expanding into more northern regions. Clinicians who suspect that they have a patient with PAM should contact the US Centers for Disease Control and Prevention at 7704887100 (available 24 hours/day, 7 days/week) to discuss diagnostic testing and treatment options (see cdc.gov/naegleria).