Successful management of post-COVID-19 acanthamoebic encephalitis

Siripurapu, Govinda; Samad, Sameer Abdul; Fatima, Saman; Wig, Naveet; Srivastava, M V Padma

doi:10.1016/j.ijid.2021.07.046

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…Here, we suggest that severely ill COVID-19 patients, especially with underlying diabetes are likely susceptible hosts to contract GAE. Recent report of Acanthamoeba encephalitis in a COVID-19 patient has confirmed this suspicion ( 7 ). As the mortality rate of GAE due to Acanthamoeba is >90%, it is surprising that prognosis was successful.…”

Section: Dear Editor-in-chiefmentioning

confidence: 81%

COVID-19: Acanthamoeba Creeps into the Brain

Siddiqui

Niyyati

Abouleish

et al. 2023

IJPA

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Section: Dear Editor-in-chiefmentioning

confidence: 81%

COVID-19: Acanthamoeba Creeps into the Brain

Siddiqui

Niyyati

Abouleish

et al. 2023

IJPA

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Cotrimoxazole

2021

Reactions Weekly

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Stevens-Johnson syndrome: case reportA 32-year-old man developed Stevens-Johnson syndrome during empiric treatment with cotrimoxazole for suspected acanthamoebic encephalitis.The man was diagnosed with moderate COVID-19 and received off label treatment methylprednisolone for 5 days. He also received oxygen supplementation along with other supportive measures. He remained asymptomatic for 6 weeks. Later, he just missed an accident while driving because he was unable to estimate the distance to a nearby vehicle. Three days later, he developed facial deviation to the left and a weakness of the right side of the body. Over the following days, he additionally developed left hemiparesis, followed by severe diffuse headache, vomiting, and a sensorial decline. Urgent decompressive craniectomy was performed. Investigations raised suspicion of amoebic infection. While awaiting the confirmation for the presence of specific free-living amoeba, he started receiving empiric treatment with a six-drug regimen comprising amphotericin-B-liposomal [liposomal amphotericin B], cotrimoxazole [trimethoprim-sulfamethoxazole; route and dosage not stated] 160mg/800mg per day, fluconazole, albendazole, azithromycin and rifampicin. However, he developed Stevens-Johnson syndrome due to cotrimoxazole [duration of treatment to reaction onset not stated].Therefore, cotrimoxazole was stopped. Additionally, flucytosine was added. The man was treated with midazolam and uptitration of anti-epileptics due to the detection of features consistent with nonconvulsive status epilepticus on continuous electroencephalogram. Aspiration of the scalp swelling showed acanthamoeba cysts detected by lactophenol cotton blue staining. PCR for 18S ribosomal deoxyribonucleic acid (DNA) with the JDP primer confirmed the diagnosis of acanthamoebic encephalitis. Thereafter, amphotericin-B-liposomal was stopped and miltefosine was added to treatment regimen for 4 weeks. Later, he underwent surgical procedure to excise organizing abscess within central necrotic tissue. After debridement, the sensorium improved. After 15 weeks of hospitalisation, he was discharged in a haemodynamically stable tracheostomized state on five antiamoebic drug regimen comprising flucytosine, fluconazole, rifampicin, azithromycin and albendazole. He was doing well at home 8 weeks after the discharge [outcome of ADR not stated].

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