CAJ | 학술논문

目的研究微孢子虫脑炎的临床与病理形态学表现.方法对1例微孢子虫脑炎患者的临床、脑活体组织检查组织病理特点进行研究.结果此病呈亚急性或慢性起病,体温大多正常或37.5℃以下,升高见于病情加重出现昏迷时;患者不伴有人类免疫缺陷病毒感染但免疫力低下;全脑多发病灶,有脑膜刺激征;骨髓检查呈感染骨髓象;发病初期类风湿因子升高;中期以后出现间接胆红素升高现象;脑脊液蛋白、免疫球蛋白IgG、IgA升高,细胞学检查示淋巴细胞反应.患者伴有胸膜炎、腹膜炎及膀胱炎.脑MRI表现为双侧大、小脑半球脑白质区见斑片状等长T1、长T2信号影,压水扫描(FLAIR)呈高信号,无明显占位效应,强化扫描病灶呈斑点状及环形强化;神经系统损害症状呈永久性,治疗无效.脑组织病理显示神经元变性、核固缩,有血管周围炎现象,神经元内胞质内可见病原体.Wister大鼠腹腔内注射患者脑脊液2周后出现多脏器内炎症反应,腹腔灌洗液内发现大量病原体.结论患者伴有多脏器病变,脑内多发病灶,脑组织病理呈炎症反应,Klüver-Barrer-PAS染色法可显示神经元内病原体.动物腹腔注射培养可增加病原体的检出率.
목적 연구미포자충뇌염적림상여병리형태학표현.방법 대1례미포자충뇌염환자적림상、뇌활체조직검사조직병리특점진행연구.결과 차병정아급성혹만성기병,체온대다정상혹37.5℃이하,승고견우병정가중출현혼미시;환자불반유인류면역결함병독감염단면역력저하;전뇌다발병조,유뇌막자격정;골수검사정감염골수상;발병초기류풍습인자승고;중기이후출현간접담홍소승고현상;뇌척액단백、면역구단백IgG、IgA승고,세포학검사시림파세포반응.환자반유흉막염、복막염급방광염.뇌MRI표현위쌍측대、소뇌반구뇌백질구견반편상등장T1、장T2신호영,압수소묘(FLAIR)정고신호,무명현점위효응,강화소묘병조정반점상급배형강화;신경계통손해증상정영구성,치료무효.뇌조직병리현시신경원변성、핵고축,유혈관주위염현상,신경원내포질내가견병원체.Wister대서복강내주사환자뇌척액2주후출현다장기내염증반응,복강관세액내발현대량병원체.결론 환자반유다장기병변,뇌내다발병조,뇌조직병리정염증반응,Klüver-Barrer-PAS염색법가현시신경원내병원체.동물복강주사배양가증가병원체적검출솔.
Objective To study the clinical and pathological manifestations of microsporidian encephalitis.Methods The clinical findings and the brain pathological features of a patient with microsporidian encephalitis hospitalized in 2004 were studied.Results The onset was subacute or chronic. The body temperature was usually normal or below 37.5℃,but it rose when patient's condition deteriorated and coma appeaxed.The patient had hypoimmunity but without human immunodeficiency virus infection. Multifocal lesions in the whole brain,signs of meningeal irritation and infective myelogram were observed. Rheumatoid factor increased in the early stage and indirect bilirubin,proteins in cerebrospinal fluid(CSF), and immunoglobulin IgG,IgA increased in the middle stage.Cytological examination of CSF showed lymphocyte reaction.Blood routine test showed normal eosinophil granulocyte count.The patient was found to have pleurisy,peritonitis and cystitis.Brain magnetic resonance image(MRI)manifested plaque-like isometric T1 weight image and long T2 weight image signal in white matter of bilateral cerebral hemisphere and cerebella where FLAIR sequence showed hyperintensity.No apparent mass was identified.Contrast- enhanced MRI scan showed patchy and ring-like intensification.The neural system impairments were permanent and not improved after treatment.The pathology of brain tissue showed neuronal degeneration, karyopycnosis and Derivasculitis.The infectious agents were observed in the cytoplasm of neurons.Wister rats had muhiple organ inflammatory reaction 2 weeks after intraperitoneal inoculation of the patient's CSF and a large quantity of pathogens were found in the peritoneal lavage fluid.Conclusions The patient was PAS staining method is useful for detecting the pathogen in neurons and the rate can be raised by animal intraperitoneal cultivation