Granulomatous amoebic encephalitis: pathogenesis, diagnostic advances, therapeutic challenges, and emerging treatment strategies.

IF 3.1 3区医学 Q1 IMMUNOLOGY

Medical Microbiology and Immunology Pub Date : 2026-08-06 DOI:10.1007/s00430-026-00885-z

Megha Gautham, Poluri Koteswari

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引用次数: 0

Abstract

Granulomatous amoebic encephalitis (GAE) is a rare but highly fatal central nervous system infection caused primarily by Acanthamoeba spp. and Balamuthia mandrillaris. Delayed diagnosis and the absence of standardized treatment protocols contribute to mortality exceeding 90%. This review summarizes current knowledge regarding GAE pathogenesis, diagnosis, therapeutic challenges, and emerging treatment strategies. The pathogenesis involves amoebic adhesion, secretion of proteases and phospholipases, host inflammatory responses, and blood-brain barrier disruption. Recent advances in molecular diagnostics improve early pathogen detection, while drug repurposing, nanotechnology-based delivery systems, and cyst-targeted approaches represent promising therapeutic strategies. Nevertheless, treatment remains challenging because of poor blood-brain barrier penetration, cyst-associated resistance, and limited clinical evidence. Continued integration of molecular diagnostics, mechanistic studies, translational research, and multicentre clinical investigations is essential for improving outcomes in this devastating disease.

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肉芽肿性阿米巴脑炎：发病机制、诊断进展、治疗挑战和新出现的治疗策略。

肉芽肿性阿米巴脑炎（GAE）是一种罕见但高度致命的中枢神经系统感染，主要由棘阿米巴和山棘阿米巴引起。延迟诊断和缺乏标准化治疗方案导致死亡率超过90%。本文综述了目前关于GAE发病机制、诊断、治疗挑战和新兴治疗策略的知识。发病机制涉及阿米巴黏附、蛋白酶和磷脂酶分泌、宿主炎症反应和血脑屏障破坏。分子诊断的最新进展改善了早期病原体检测，而药物再利用、基于纳米技术的递送系统和囊肿靶向方法代表了有希望的治疗策略。然而，由于血脑屏障穿透性差、囊肿相关耐药性和临床证据有限，治疗仍然具有挑战性。分子诊断、机制研究、转化研究和多中心临床研究的持续整合对于改善这一毁灭性疾病的预后至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Microbiology and Immunology 医学-免疫学

CiteScore

10.60

自引率

0.00%

发文量

审稿时长

1 months

期刊介绍： Medical Microbiology and Immunology (MMIM) publishes key findings on all aspects of the interrelationship between infectious agents and the immune system of their hosts. The journal´s main focus is original research work on intrinsic, innate or adaptive immune responses to viral, bacterial, fungal and parasitic (protozoan and helminthic) infections and on the virulence of the respective infectious pathogens. MMIM covers basic, translational as well as clinical research in infectious diseases and infectious disease immunology. Basic research using cell cultures, organoid, and animal models are welcome, provided that the models have a clinical correlate and address a relevant medical question. The journal also considers manuscripts on the epidemiology of infectious diseases, including the emergence and epidemic spreading of pathogens and the development of resistance to anti-infective therapies, and on novel vaccines and other innovative measurements of prevention. The following categories of manuscripts will not be considered for publication in MMIM: submissions of preliminary work, of merely descriptive data sets without investigation of mechanisms or of limited global interest, manuscripts on existing or novel anti-infective compounds, which focus on pharmaceutical or pharmacological aspects of the drugs, manuscripts on existing or modified vaccines, unless they report on experimental or clinical efficacy studies or provide new immunological information on their mode of action, manuscripts on the diagnostics of infectious diseases, unless they offer a novel concept to solve a pending diagnostic problem, case reports or case series, unless they are embedded in a study that focuses on the anti-infectious immune response and/or on the virulence of a pathogen.