Successful Treatment of an Adolescent With Naegleria fowleri Primary Amebic Meningoencephalitis

Abstract

Naegleria fowleri is a thermophilic free-living ameba that causes primary amebic meningoencephalitis. Infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. Survival most likely resulted from a combination of early identification and treatment, use of a combination of antimicrobials including miltefosine and management of elevated intracranial pressure based on traumatic brain injury principles.

Biology and pathogenesis of Naegleria fowleri

“…There only are 5 documented survivors of PAM, who received combination drugs. All treatments included amphotericin B, which affects membrane integrity (Table 2) (11,(36)(37)(38)(39)(40). At present, the U.S. Centers for Disease…”

“…Control and Prevention (CDC) recommends that patients suspected of PAM should be given the following combination of drugs: deoxycholate amphotericin B intravenously (IV) and intrathecally (IT), an azole drug such as fluconazole IV or orally (PO), azithromycin IV or PO, rifampin IV or PO, miltefosine PO, and dexamethasone IV ( indicating that the combined use of these two drugs may result in successful prognosis (39,46,47).…”

“…In 2013, the U.S. CDC has been able to procure a supply of miltefosine under an expanded access IND allowing for rapid deployment to PAM patients in the U.S. In 2013, two U.S. PAM patients received miltefosine, together with amphotericin B, azithromycin, fluconazole, and rifampin, shortly after their hospital admissions, which resulted in successful treatment of PAM (39,40 …”

Summer Recreational Water Tourism: A Deadly Human Encounter with Naegleria fowleri

“…It is worth mentioning that the trophozoite infective form is seen in the brain tissue and cerebrospinal fluid. Flagellate forms of the protist are found occasionally in the cerebrospinal fluid while Cysts are not found in the brain tissue [10].…”

“…To alleviate brain swelling, the medication "Amphotericin B" continues to be PAM's most used treatment. A breast cancer medication "Miltefosine" is being investigated as a potential PAM treatment because it has saved the lives of two patients [10]. The two US PAM surviving individuals received Miltefosine in addition to other medications [2].…”