Primary Amebic Meningoencephalitis: Difference between revisions
Fredvarone (talk | contribs) No edit summary |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 10: | Line 10: | ||
*[[Fever]] | *[[Fever]] | ||
*[[Headache]] | *[[Headache]] | ||
*[[Meningismus]] | *[[meningitis|Meningismus]] | ||
*[[AMS]] | *[[AMS]] | ||
*[[Nausea]] | *[[Nausea]] | ||
| Line 32: | Line 32: | ||
**Culture | **Culture | ||
*PCR of CSF or tissue sample are newer modalities | *PCR of CSF or tissue sample are newer modalities | ||
* | *[[CT brain]] - should be to evaluate for abscess/mass/hemorrhage and prior to LP | ||
==Management<ref>Linam et al. Successful Treatment of an Adolescent With ''Naegleria fowleri'' Primary Amebic Meningoencephalitis. Pediatrics. 2015;135(3):e744-e748.</ref><ref>Cope et al. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. CID. 2016;62(6):774-776.</ref>== | ==Management<ref>Linam et al. Successful Treatment of an Adolescent With ''Naegleria fowleri'' Primary Amebic Meningoencephalitis. Pediatrics. 2015;135(3):e744-e748.</ref><ref>Cope et al. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. CID. 2016;62(6):774-776.</ref>== | ||
| Line 43: | Line 43: | ||
**[[Miltefosine]]: 50mg PO BID (<45kg) or TID (>45kg) for 28 days | **[[Miltefosine]]: 50mg PO BID (<45kg) or TID (>45kg) for 28 days | ||
*[[Dexamethasone]]: 0.6mg/kg/day IV for 4 days | *[[Dexamethasone]]: 0.6mg/kg/day IV for 4 days | ||
*Therapeutic hypothermia | *[[Therapeutic hypothermia]] | ||
*Elevated ICP management | *[[Elevated ICP]] management | ||
**Hyperosmolar therapy ([[hypertonic saline]], [[mannitol]]) | **Hyperosmolar therapy ([[hypertonic saline]], [[mannitol]]) | ||
**EVD placement | **EVD placement | ||
| Line 64: | Line 64: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | |||
[[Category:Neurology]] | |||
Latest revision as of 17:47, 25 October 2020
Background
- Primary amebic meningoencephalitis is a rare central nervous system disease caused by the thermophilic free-living amoeba Naegleria fowleri
- The amoeba lives in freshwater and can enter the brain through the cribriform plate after water containing it enters the nose; the amoeba causes direct tissue damage with hemorrhage and necrosis of brain tissue [1]
- Exposure can occur from natural water sources (lakes, ponds, puddles) as well as man-made sources (swimming pools)
- Cases nearly always result in death - in the USA 141/145 known cases were fatal
- >50% cases in the USA occur in Texas and Florida[2][3]
Clinical Features
Differential Diagnosis
Evaluation
- Often diagnosed post-mortem given general low clinical suspicion and rapid death of patients
- Lumbar puncture - basic studies may be consistent with meningitis with a negative Gram stain
- Wet mount may see free moving trophozoites
- Giemsa-Wright, H+E, PAS, trichrome staining may show amoebae
- Immunohistochemical staining
- Culture
- PCR of CSF or tissue sample are newer modalities
- CT brain - should be to evaluate for abscess/mass/hemorrhage and prior to LP
Management[4][5]
- Anti-amoeba therapy (CDC recommendations at: https://www.cdc.gov/parasites/naegleria/treatment-hcp.html)
- Amphotericin B: 1.5mg/kg/day divided in 2 doses for 3 days followed by 1mg/kg/day IV as one dose for 11 days
- Intrathecal Amphotericin B: 1.5mg once daily for 2 days followed by 1mg/day every other day for 8 days
- Azithromycin: 10mg/kg/day once daily IV/PO for 28 days, max dose 500mg/day
- Fluconazole: 10mg/kg/day once daily IV/PO for 28 days, max dose 600mg/day
- Rifampin: 10mg/kg/day once daily IV/PO for 28 days, max dose 500mg/day
- Miltefosine: 50mg PO BID (<45kg) or TID (>45kg) for 28 days
- Dexamethasone: 0.6mg/kg/day IV for 4 days
- Therapeutic hypothermia
- Elevated ICP management
- Hyperosmolar therapy (hypertonic saline, mannitol)
- EVD placement
- CSF removal
- Infectious disease consultation
Disposition
- Admission to ICU
- Very few patients have made a full neurologic recovery; key factors are high clinical suspicion and prompt diagnosis, aggressive anti-amoeba therapy, and management of elevated ICP
See Also
External Links
- https://www.cdc.gov/parasites/naegleria/health_professionals.html#one
- https://www.cdc.gov/parasites/naegleria/treatment-hcp.html
References
- ↑ Marciano-Cabral F et al. The immune response to Naegleria fowleri amebae and pathogenesis of infection. FEMS Immunol Med Microbiol. 2007;51(2):243-259.
- ↑ Yoder JS et al. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962–2008. Epidemiol Infect. 2010;138:968-975.
- ↑ Gharpure R et al. Epidemiology and Clinical Characteristics of Primary Amebic Meningoencephalitis Caused by Naegleria fowleri: A Global Review. CID. 2019. https://doi.org/10.1093/cid/ciaa520.
- ↑ Linam et al. Successful Treatment of an Adolescent With Naegleria fowleri Primary Amebic Meningoencephalitis. Pediatrics. 2015;135(3):e744-e748.
- ↑ Cope et al. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. CID. 2016;62(6):774-776.