一例狒狒巴拉姆希阿米巴脑炎报告及文献复习

doi:10.3877/cma.j.issn.2095-5820.2024.04.007

目的

加深对狒狒巴拉姆希阿米巴脑炎（BAE）的认识，提高临床对该种疾病的早期诊治和护理水平。

方法

回顾分析1 例BAE 患者的诊疗及护理过程，包括临床资料、体格检查、实验室检查、影像检查、诊治护理经过及临床转归等病例资料。

结果

患者，女，9 岁，因咳嗽、发热与神志不清就诊于外院，对症治疗无效后转入广东三九脑科医院治疗。入院查体、影像学检查结果均无特征性。行2 次脑脊液病原宏基因组（mNGS）检测，均提示狒狒巴拉姆希阿米巴感染，与脑脊液常规、生物化学及细胞学检查结果相符。患者接受对症治疗与特殊护理，但因病情进展过快，于入院7 d 后死亡。

结论

BAE 临床表现缺乏特异性，脑脊液mNGS 检测有助于疾病的诊断。由于该疾病尚无特效治疗方法，需要为患者定制专属的治疗与护理方案。

关键词: 狒狒巴拉姆希阿米巴, 阿米巴脑炎, 实验诊断, 脑脊液检查, 诊疗护理

Objective

To deepen public understanding of Balamuthia amebic encephalitis(BAE) and improve early diagnosis, treatment, and care of this disease in clinical practice.

Methods

The diagnosis, treatment and care process of a patient with BAE were analyzed, including clinical data, physical examination, laboratory examination, imaging examination, diagnosis, treatment, care process and clinical regression.

Results

The 9-year-old female patient was admitted to another hospital with cough, fever and confusion, and was transferred to our hospital after ineffective symptomatic treatment. Admission physical examination and imaging findings were uncharacteristic. Two cerebrospinal fluid (CSF) metagenomic nextgeneration sequencing (mNGS) tests were performed. Both tests suggested Balamuthia mandrillaris amoeba infection, which was consistent with the results of routine, biochemical and cytological examination of the CSF. The patient died seven days after admission due to rapid progression of the disease despite symptomatic treatment and specialized care.

Conclusion

The clinical presentation of BAE lacks specificity, and CSF examination helps to diagnose the disease. Since there is no specific treatment for this disease, an exclusive treatment and care plan needs to be tailed to the individual patient.

Key words: Balamuthia mandrillaris amoeba, amoebic encephalitis, experimental diagnosis, cerebrospinal fluid examination, treatment and care

表1 患儿脑脊液常规与生物化学指标检测

检测项目	第1次检查（2023年12月24日）	第2次检查（2023年12月26日）	第3次检查（2023年12月29日）
颜色	无色	淡红	微黄
透明度	透明	微浑	微浑
球蛋白半定量	++	+	+++
细胞总数/（10⁶/L）	389	2460	960
有核细胞数/（10⁶/L）	389	460	360
RBC/（10⁶/L）	0	2000	600
有核细胞分类*	单个核85.7%；多个核14.3%	单个核97.3%；多个核2.7%	淋巴细胞79%；单核细胞7%；浆细胞7%；中性粒细胞4%；含铁血黄素吞噬细胞3%
总蛋白/（g/L）	1.41	0.95	2.70
葡萄糖/（mmo1/L）	1.34	2.14	4.90
氯化物/（mmo1/L）	106.10	114.40	85.90

表1 患儿脑脊液常规与生物化学指标检测

检测项目	第1次检查（2023年12月24日）	第2次检查（2023年12月26日）	第3次检查（2023年12月29日）
颜色	无色	淡红	微黄
透明度	透明	微浑	微浑
球蛋白半定量	++	+	+++
细胞总数/（10⁶/L）	389	2460	960
有核细胞数/（10⁶/L）	389	460	360
RBC/（10⁶/L）	0	2000	600
有核细胞分类*	单个核85.7%；多个核14.3%	单个核97.3%；多个核2.7%	淋巴细胞79%；单核细胞7%；浆细胞7%；中性粒细胞4%；含铁血黄素吞噬细胞3%
总蛋白/（g/L）	1.41	0.95	2.70
葡萄糖/（mmo1/L）	1.34	2.14	4.90
氯化物/（mmo1/L）	106.10	114.40	85.90

图1 患儿的脑脊液细胞学检查注：1A. 患儿脑脊液细胞学呈淋巴细胞为主的混合细胞反应；1B. 可见患儿脑脊液中含有多种细胞，包括淋巴细胞、单核细胞、中性粒细胞与RBC。

图2 患儿的头颅MRI 检查注：2A. T1 加权像；2B. T2 加权像；2C. 增强后T1 加权成像；2D. T2-FLAIR 增强序列。

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