An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan
An autopsy case of Balamuthia mandrillaris amoebic encephalitis, a rare emerging infectious disease, with a brief review of the cases reported in Japan
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DOI：
10.1111/neup.12151
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发表时间：
2015-02-01
期刊：
影响因子：
2.3
通讯作者：
Fushiki, Shinji
中科院分区：
文献类型：
--
作者：
Itoh, Kyoko;Yagita, Kenji;Fushiki, Shinji
Balamuthia mandrillaris是一种在淡水和土壤中发现的阿米巴，可引起肉芽肿性阿米巴脑炎。本文报告一例B的尸检。PCR确诊为扁桃体阿米巴脑炎。一名81岁的男子，谁有干燥综合征，表现嗜睡2个月前，他的死亡与进行性恶化。神经影像学显示大脑半球、丘脑和中脑的T2和液体衰减反转恢复高信号和T1低信号病灶，伴不规则的增强后环形增强。病理学上，在大脑、丘脑、中脑、脑桥、髓质和小脑中发现多处出血和坏死性病变，其特征为坏死性坏死、显著水肿、出血和坏死性血管炎，伴有阿米巴滋养体血管周围积聚、少数囊肿以及大量中性粒细胞和小胶质细胞/巨噬细胞浸润。滋养体卵圆形或圆形，直径10- 60 μ m，胞质呈泡沫状，核圆形，中央有小的核小体。石蜡包埋脑组织标本的PCR和免疫组化显示为B所致的血管浸润性脑炎。曼迪拉里斯。人类感染B病毒的病例mandrillaris脑感染在日本很少见，文献中只有少数简短的报道。
Balamuthia mandrillaris is an amoeba found in fresh water and soil that causes granulomatous amoebic encephalitis. We report herein an autopsy case of B. mandrillaris amoebic encephalitis, which was definitely diagnosed by PCR. An 81-year-old man, who had Sjogren's syndrome, manifested drowsiness 2 months before his death with progressive deterioration. Neuroimaging demonstrated foci of T2- and fluid-attenuated inversion recovery high and T1 low-intensity with irregular post-contrast ring enhancement in the cerebral hemisphere, thalamus and midbrain. Pathologically, multiple hemorrhagic and necrotic lesions were found in the cerebrum, thalamus, midbrain, pons, medulla and cerebellum, which were characterized by liquefactive necrosis, marked edema, hemorrhage and necrotizing vasculitis associated with the perivascular accumulation of amoebic trophozoites, a few cysts, and the infiltration of numerous neutrophils and microglia/macrophages. The trophozoites were ovoid or round, 10-60m in diameter, and they showed foamy cytoplasm and a round nucleus with small karyosome in the center. The PCR and immunohistochemistry from paraffin-embedded brain specimens revealed angioinvasive encephalitis due to B. mandrillaris. Human cases of B. mandrillaris brain infection are rare in Japan, with only a few brief reports in the literature.