乐清家长注意！这种病近年我国确诊27例！致死率高达98%
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<strong style="font-size: 16px;letter-spacing: 0.544px;"><span style="outline: 0px;visibility: visible;">许多家长是不是喜欢带孩子去游泳？</span></strong>
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<span style="outline: 0px;visibility: visible;font-size: 16px;">近日，贵州一名孩子家长苗女士在网上持续记录自己的孩子小丁（化名）生病就医的经历。</span>
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<span style="outline: 0px;visibility: visible;font-size: 16px;">根据苗女士所发信息，6岁多的小丁去海南旅游回家后出现发烧症状，发烧十余日不见好转，辗转到几家医院就医，近日还住进了重症监护室，最终得知孩子是被一种名为“狒狒阿米巴原虫”（俗称食脑虫）感染而引发的脑膜炎，而食脑虫引发脑炎致死率高达98%。</span>
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<span style="outline: 0px;letter-spacing: 0.034em;color: #888888;font-size: 16px;">小丁被送往重症监护室救治</span>
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<span style="font-size: 16px;"><strong data-brushtype="text" style="outline: 0px;">海边游玩后<br style="outline: 0px;"/>孩子被食脑虫感染成脑膜炎</strong></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #007aaa;"><strong style="outline: 0px;"><span style="outline: 0px;">“我就带娃娃去海口玩了一趟，去海边游了一次泳，海边那么多娃娃在游泳，在玩沙，都没有事，怎么我娃娃就会着呀！这个概率是比中大奖还夸张的概率，我娃娃居然能碰上。”</span></strong></span><span style="outline: 0px;">苗女士在文章中写道。记者注意到，苗女士6月3日在海南发布了2条记录旅行的内容，她称自己的本意是“带娃娃去见世面，去认识大海，去放松开心”。</span></span>
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<span style="outline: 0px;font-size: 16px;">记者联系苗女士，截至发稿未得到回应。6月26日11时许，记者从一名知情人处获悉，小丁的确因此罕见病入院，仍在医院接受治疗，病情很严重。</span>
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<span style="outline: 0px;font-size: 16px;">苗女士所发布的内容显示，起初，小丁在6月9日晚发烧就高达39度。次日，家长带孩子去当地的县医院看病，医生开了治疗扁桃体发炎的药物，吃药后小丁退烧了，但药效一过又发烧。孩子持续多日发烧，家长辗转几家医院，给孩子检查了肝功能、血常规等，医院采取了输液等方式，孩子仍旧持续发烧、嗜睡。在转到孩子目前所在的贵阳某儿童医院时，孩子已出现昏迷的情况。</span>
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<span style="outline: 0px;letter-spacing: 0.034em;color: #888888;font-size: 16px;">医院发的病危通知书</span>
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<span style="outline: 0px;font-size: 16px;">到了贵阳某儿童医院，小丁被转到了重症监护室。6月21日，医院下达孩子病危通知书，通知书显示医院诊断孩子患有急性化脓性脑膜炎，出现持续癫痫、中枢性呼吸衰竭、支气管肺炎等症状。孩子的病情危重，血压维持不足，病情随时可能进一步恶化，危及生命。</span>
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<span style="outline: 0px;font-size: 16px;">苗女士6月25日发布消息称，小丁的脑脊液检测结果出来，“害孩子变成这样的是一种叫‘狒狒阿米巴原虫’，是一种生存于热带和亚热带的寄生虫，也叫食脑虫。<strong style="outline: 0px;">这种虫存在于温暖的水中、泳池，江河里，还有森林里，腐烂的树木、叶子里，淤泥，沙子里都有。</strong><strong style="outline: 0px;">全球70亿人，总共才200例左右，中国也才几例。”苗女士还提到，孩子的状况非常不好，拔掉呼吸机不能自主呼吸。她之所以将孩子的情况下写出来，是想让其他宝妈警惕食脑虫。</strong></span>
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<span style="outline: 0px;letter-spacing: 0.034em;color: #888888;font-size: 16px;">苗女士网上发布孩子被食脑虫感染消息</span>
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<span style="font-size: 16px;"><strong data-brushtype="text" style="outline: 0px;">食脑虫致死率高达98%<br style="outline: 0px;"/>至今仍是医疗界的一个难题</strong></span>
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<span style="outline: 0px;font-size: 16px;">记者注意到，国家传染病医学中心、复旦大学附属华山医院感染科曾通过官方公众号“华山感染”，发布过另外一个15岁的孩子阿文因感染狒狒巴拉姆希阿米巴脑炎去世的情况。<br style="outline: 0px;"/><br style="outline: 0px;"/></span>
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<span style="outline: 0px;font-size: 16px;">狒狒巴拉姆希阿米巴脑炎的治疗在当今医疗界仍是一个难题。<strong style="outline: 0px;">该病的总体预后很差，死亡率高达98％，全球仅报道了很少成功治疗的案例。</strong>并且所有成功治疗案例均需要数月甚至数年的药物治疗，治疗药物包括喷他脒、磺胺嘧啶、米替福新、吩噻嗪化合物，大环内酯类抗生素、阿苯达唑、氟康唑和氟胞嘧啶等。由于成功治疗的患者数目非常有限，目前尚未建立标准的治疗方案。</span>
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<span style="outline: 0px;font-size: 16px;">阿文生于贵州，平时经常于家乡河塘中游泳，2018年12月出现鼻部破损，组织病理提示肉芽肿性病变。在2019年5月23日出现发烧，6月2日，阿文求医到华山医院，阿文的脑脊液经宏基因组二代测序检测显示：阿文脑脊液中检测到150条B.mandrillaris序列片段，相对丰度87.13％。这个名字对于临床医生也是相对陌生的病原，叫作“狒狒巴拉姆希阿米巴”（即上文的“狒狒阿米巴原虫”）。同年6月9日，阿文经抢救无效去世。</span>
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<span style="font-size: 16px;"><strong data-brushtype="text" style="outline: 0px;">临床上很罕见，但后果严重，<br style="outline: 0px;"/>近三年在我国确诊过27例</strong></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">狒狒阿米巴原虫为什么被叫做“食脑虫”？这种寄生虫脑病多见吗？它的感染途径到底是什么？</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">南方医科大学珠江医院检验医学部副主任陈定强向记者介绍，狒狒阿米巴原虫是三种可以感染脑部的阿米巴原虫之一，<span style="letter-spacing: 1px;outline: 0px;color: #ab1942;"><strong style="outline: 0px;">在淡水湖泊与土壤等中广泛存在，可能通过鼻腔和皮肤伤口进入人体，引起脑部感染。</strong></span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;letter-spacing: 1px;">狒狒阿米巴原虫导致的脑病</span><span style="outline: 0px;color: #ab1942;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">临床上很罕见，但后果严重</span></strong></span><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;color: #ab1942;">，近三年在我国确诊过27例。</span></strong></span>
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<span style="font-size: 16px;"><span style="outline: 0px;letter-spacing: 1px;">暑期旅游高峰期即将到来，陈定强建议大家</span><span style="outline: 0px;color: #ab1942;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">出外游玩时尽量避开温暖的死水、流动性差的水域</span></strong></span><span style="outline: 0px;color: #000000;letter-spacing: 1px;">，</span><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;color: #ab1942;">必要时使用鼻夹，身体有伤口时也尽量避免与水相关的活动。</span></strong></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">01 / 问：这个孩子所遇到的狒狒阿米巴原虫，是一种怎样的寄生虫？临床上常见吗？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">狒狒阿米巴原虫的学名是“狒狒巴拉姆希阿米巴”（Balamuthia mandrillaris），是一种“**生活”阿米巴（free-living ameba，FLA）寄生虫，广泛存在于自然环境中，<strong style="outline: 0px;">如土壤和淡水湖泊</strong>等。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">为什么叫“**生活”阿米巴？因为很多的寄生虫是需要在宿主体内才能生活的，而这种狒狒阿米巴原虫可以不依赖于宿主，是可以在自然环境中**生活、通过捕食和分解有机物来获取营养的阿米巴。</span>
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<span style="font-size: 16px;"><span style="outline: 0px;letter-spacing: 1px;">这种“狒狒阿米巴原虫”</span><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">是目前已知的三种可以引起严重脑部感染的**生活阿米巴之一</span></strong><span style="outline: 0px;letter-spacing: 1px;">，其他两种为福氏耐格里阿米巴原虫（Naegleria fowleri）和棘阿米巴原虫（Acanthamoebaspp.）。</span></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">福氏耐格里阿米巴原虫</span></strong><span style="outline: 0px;letter-spacing: 1px;">会引起原发性阿米巴脑膜脑炎，这是一种<strong style="outline: 0px;">快速急性感染</strong>，其特征是大脑中出现坏死和出血斑块，从出现症状到死亡病程可能小于1-2周。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">相比之下，<strong style="outline: 0px;">狒狒阿米巴原虫</strong>和<strong style="outline: 0px;">棘阿米巴原虫</strong>通常导致<strong style="outline: 0px;">慢性但致命</strong>的肉芽肿性阿米巴脑炎，其发病和疾病进展较慢，病程可持续1-2月。狒狒阿米巴原虫引起的感染也被称为狒狒阿米巴原虫脑炎（Balamuthia amoebic encephalitis，BAE）。</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">这三者引起的感染在临床都非常<strong style="outline: 0px;">罕见</strong>，<span style="letter-spacing: 1px;outline: 0px;color: #ab1942;"><strong style="outline: 0px;">但</strong><strong style="outline: 0px;">致死率都高达90%以上</strong></span>。 </span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">02 / 问：有多罕见？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">由狒狒阿米巴原虫引起的BAE（狒狒阿米巴原虫脑炎）在临床上很少见，也没有确切的发病率。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">全世界已经报告了大约<strong style="outline: 0px;">300例</strong>的狒狒阿米巴原虫感染脑炎病例。狒狒阿米巴原虫在世界上第一次被发现是在1986年，从一只死于脑炎的狒狒的脑组织中鉴定得到，也是由此得名的。</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">我们国家其实是在<strong style="outline: 0px;">2018年才第一次确认</strong>这种感染，因为要检测到这种狒狒阿米巴的病原体比较难，需要提取脑脊液或脑组织，来检测可能存在的阿米巴DNA，近几年有了宏基因组测序的检测办法后，才陆陆续续有了这种病例的报道。</span>
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<span style="font-size: 16px;"><span style="outline: 0px;letter-spacing: 1px;">2023年的一篇综述统计了<strong style="outline: 0px;">中国</strong>报道的三种食脑虫引起的脑炎病例，截至2022年8月30日，<strong style="outline: 0px;">共有48例报道，<span style="outline: 0px;color: #ab1942;">其中27例检测到狒狒阿米巴原虫</span>，</strong></span><span style="outline: 0px;letter-spacing: 1px;color: #000000;">11例检测到福氏耐格里阿米巴原虫, 10例检测到棘阿米巴原虫。这些感染区域也没有特别明显的地域性，南方、北方很多省份都有涉及，毕竟水体的分布是非常广泛的。</span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">03 / 问：它的感染途径是什么？目前很多公开资料显示它常通过鼻腔进入人体。</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #000000;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">由于病例较少，目前具体的传播途径尚不完全清楚。目前来看，脑部感染主要通过接触</span></span><span style="outline: 0px;letter-spacing: 1px;"><strong style="outline: 0px;"><span style="outline: 0px;color: #ab1942;">含有致病性**生活阿米巴的水源（例如游泳池或温泉）</span></strong></span><span style="outline: 0px;letter-spacing: 1px;color: #000000;">或</span><span style="outline: 0px;letter-spacing: 1px;"><strong style="outline: 0px;"><span style="outline: 0px;color: #ab1942;">土壤中的寄生虫</span></strong></span><span style="outline: 0px;letter-spacing: 1px;color: #000000;">等，通过鼻腔、伤口、呼吸道等直接进入人体。</span></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">通过鼻腔是最常见的方式</span></strong><span style="outline: 0px;letter-spacing: 1px;">，但根据已有的病例来看，狒狒阿米巴原虫感染脑部并不一定需要通过鼻腔。</span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;letter-spacing: 1px;">个别情况下，如果人体皮肤存在切口、溃疡或其他<strong style="outline: 0px;">开放性损伤</strong>，狒狒阿米巴原虫<strong style="outline: 0px;">可能</strong><strong style="outline: 0px;">通过这些损伤</strong>进入人体；也有报道显示，狒狒阿米巴原虫</span><strong style="outline: 0px;font-size: 16px;letter-spacing: 1px;">可通过呼吸道</strong><span style="outline: 0px;letter-spacing: 1px;">进入人体，这可能发生在</span><strong style="outline: 0px;font-size: 16px;letter-spacing: 1px;">吸入寄生虫污染的灰尘或液滴</strong><span style="outline: 0px;letter-spacing: 1px;">时。</span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #000000;letter-spacing: 1px;">我国报道的27例BAE（狒狒阿米巴原虫脑炎）患者中，</span><span style="outline: 0px;letter-spacing: 1px;"><strong style="outline: 0px;">有21例（77.8%）在出现症状前有皮肤损伤</strong></span><span style="outline: 0px;color: #000000;letter-spacing: 1px;">，</span><span style="outline: 0px;letter-spacing: 1px;">可能是一种重要的感染途径。 </span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">04 / 问：除了脑部，狒狒阿米巴原虫还会感染身体的其他部位吗？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">因病例较少，感染脑部的比例目前无法准确估计，<strong style="outline: 0px;">目前报道的病例都是脑部感染</strong>，但不排除有非脑部感染但没有被报道的病例。</span></span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">05 / 问：公开资料显示，阿米巴感染引起的肠道感染并不罕见，肠道感染与脑部感染有什么不同？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">脑部感染与肠道感染是两种不同类型的阿米巴感染。</span></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">脑部感染是由上述三种“**生活”阿米巴引起</span></strong><span style="outline: 0px;letter-spacing: 1px;">，这些寄生虫在环境中**存在，并通过皮肤伤口、呼吸道等途径进入人体，引起的症状主要涉及神经系统，如头痛、发热、颈部僵硬、抽搐、意识障碍等。</span></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">引起肠道感染的是阿米巴寄生虫（Entamoeba histolytica）</span></strong><span style="outline: 0px;letter-spacing: 1px;">，在人体摄取被寄生虫囊泡污染的水源或食物时，寄生虫囊泡或滋养体进入肠道，并在结肠内繁殖。肠道感染的症状通常包括腹痛、腹泻、贫血等，严重情况下可能有便血和脓血便。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">对于肠道感染，<strong style="outline: 0px;">口服抗阿米巴药物（如甲硝唑等）</strong>通常是有效的治疗方法，而对于脑部感染，目前还没有明确有效的治疗方法，治疗更为复杂和困难。 </span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">06 / 问：暑期临近，去海边、山溪等自然环境中玩耍时要注意什么？怎样预防阿米巴感染？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">目前还不存在用于预防阿米巴原虫感染的疫苗等，主要依靠阻断已知感染途径的方式进行预防。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">野外玩耍或旅游时可以采取以下措施预防阿米巴原虫感染：</span>
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<span style="outline: 0px;letter-spacing: 1px;color: #000000;font-size: 16px;">1.<strong style="outline: 0px;">不要在温暖的死水附近</strong>从事水上活动，特别是如果水浅、低、流速弱；</span>
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<span style="outline: 0px;letter-spacing: 1px;color: #000000;font-size: 16px;">2.在可能被污染的水中参与活动时，<strong style="outline: 0px;">捏住鼻子或使用鼻夹</strong>；</span>
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<span style="outline: 0px;letter-spacing: 1px;color: #000000;font-size: 16px;" >3.在淡水、温泉和其他未经处理的热水体中游泳时，<strong style="outline: 0px;">保持头部在水面以上</strong>；</span>
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<span style="outline: 0px;letter-spacing: 1px;color: #000000;font-size: 16px;">4.避免潜水和跳入停滞的淡水中，<strong style="outline: 0px;">不要挖掘或搅动水体底部的沉积物</strong>；</span>
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<span style="outline: 0px;letter-spacing: 1px;color: #000000;font-size: 16px;">5.<strong style="outline: 0px;">如果身体上有任何开放性伤口，尽量避免与水相关的活动</strong>。</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">其他包括注意个人卫生，<strong style="outline: 0px;">谨慎食用食物，注意饮水水源选择</strong>等，对于旅游过程中避免其它寄生虫感染也是有必要的。</span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">07 / 问：出现哪些症状时可以怀疑阿米巴感染？需要做哪些检测？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">在临床上，狒狒阿米巴原虫感染非常罕见，往往一开始会被误诊为其他神经系统疾病，如病毒性脑炎或其他细菌感染，确诊需要进行组织活检或通过分子检测方法检测到原虫的DNA。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">如果存在<strong style="outline: 0px;">脑膜炎和脑炎症状</strong>（包括头痛、脑膜刺激征象如颈项强直、恶心、呕吐等），或<strong style="outline: 0px;">神经系统症状、视觉改变、皮肤病变、呼吸道症状</strong>等，同时有可能的野外游泳、冲洗鼻孔、皮肤破损等阿米巴原虫<strong style="outline: 0px;">污染暴露史</strong>，可以考虑做一些检测来确定是不是阿米巴原虫感染。</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">对于诊断阿米巴性脑炎, 最重要的是<strong style="outline: 0px;">鉴定组织或脑脊液中的阿米巴病原体</strong>, 并进行病理涂片检查或脑脊液的培养。目前最常用的诊断方法是脑组织和皮肤活检, 可对受损病灶进行直接活检和组织学检查。</span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">另外还有免疫组化检测, 使用针对阿米巴原虫的特异性抗体来检测阿米巴虫；或间接免疫荧光分析法，用于检测受感染患者血清中针对阿米巴原虫产生的抗体；前边提到的mNGS宏基因组测序对于阿米巴性脑炎的病原体确认也有较好的辅助作用。 </span>
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<span style="font-size: 16px;"><span style="outline: 0px;color: #0080ff;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">08 / 问：治疗阿米巴原虫感染现在有特效药物吗？</span></strong></span><strong style="outline: 0px;"></strong></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">陈定强：</span></strong><span style="outline: 0px;letter-spacing: 1px;">阿米巴原虫感染脑炎特点是发病率非常低、死亡率非常高，这两个因素使治疗的发展变得复杂。</span></span>
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<span style="font-size: 16px;"><strong style="outline: 0px;"><span style="outline: 0px;letter-spacing: 1px;">目前针对肉芽肿性阿米巴脑炎潜在有效用药方案都是根据少数病例报告中总结得到</span></strong><span style="outline: 0px;letter-spacing: 1px;">，几乎很难通过开展临床试验来测试其有效性和安全性。</span></span>
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<span style="outline: 0px;letter-spacing: 1px;font-size: 16px;">美国疾病控制和预防中心推荐喷他脒（Pentamidine）、乙磺酸酯（Ethosulfonate）、米替福新（Miltefosine）、氟康唑（Fluconazole）、氟胞嘧啶（Flucytosine）、磺胺嘧啶（Sulfadiazine）和克拉霉素（Clarithromycin）等作为治疗肉芽肿性阿米巴脑炎（GAE）的核心药物，一般建议联合用药。</span>
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