Successful Treatment of Primary Amebic Meningoencephalitis

Seidel, James S.; Harmatz, Paul; Visvesvara, G. S.; Cohen, Arthur H.; Edwards, Jack; Turner, Jerrold A.

doi:10.1056/nejm198202113060607

Cited by 212 publications

(109 citation statements)

References 13 publications

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“…In a well-documented recovery, the patient was treated with intravenous and intrathecal amphotericin B, miconazol and oral rifampicin. In vitro testing of the isolate from the patient showed no efficacy for rifampicin [14]. Amphotericin B was reported to be more effective against Naegleria than amphotericin methyl ester, a water-soluble form of the drug.…”

Section: Primary Amoebic Encephalitis (Pam)mentioning

confidence: 96%

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Human infections caused by free-living amoebae

Król-Turmińska¹,

Olender²

2017

Ann Agric Environ Med.

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Introduction. Among free-living amoebae that are widely distributed in nature only four genera/species are known as agents of human infections: Acanthamoeba spp., Naegleriafowleri, Balamuthia mandrillaris and Sappiniapedata. These amoebae are not well adapted to parasitism, and could exist in the human environment without the need for a host. Infections due to these amoebae, despite low morbidity, are characterized by relatively high mortality rate and pose serious clinical problems. Objectve. This review study presents and summarizes current knowledge about infections due to pathogenic and opportunistic free-living amoebae focused on epidemiology, clinical manifestations, diagnosis and treatment based on global literature. State of knowledge. All four genera have been recognized as etiologic factors of fatal central nervous system infections and other serious diseases in humans. N. fowleri causes an acute fulminating meningoencephalitis in children and young adults. Acanthamoeba spp. and B.mandrillaris are opportunistic pathogens causing granulomatous amoebic encephalitis and disseminated or localized infections which could affect the skin, sinuses, lungs, adrenals and/or bones. Acanthamoeba spp. is also the main agent of acute eye infection -Acanthamoeba keratitis, mostly in contact lens wearers. However, there is only one recognized case of encephalitis caused by S. pedata. Conclusions. Amoebic diseases are difficult to diagnose which leads to delayed treatment, and result in a high mortality rate. Considering those issues, there is an urgent need to draw more attention to this type of diseases.

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Section: Primary Amoebic Encephalitis (Pam)mentioning

confidence: 96%

“…Because of rapid onset and progression of PAM in humans, there is meager chance of effective humoral response to develop against the amoebae. Seidel et al [14] described a case of 9-year-old who survived PAM. In this patient, anti-Naegleria antibodies of the IgM class were found [5].…”

Section: Primary Amoebic Encephalitis (Pam)mentioning

confidence: 99%

Human infections caused by free-living amoebae

Król-Turmińska¹,

Olender²

2017

Ann Agric Environ Med.

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“…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…”

Section: Chemotherapeutic Strategiesmentioning

confidence: 99%

Biology and pathogenesis of Naegleria fowleri

et al. 2016

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2 SummaryNaegleria fowleri is a protist pathogen that can cause lethal brain infection. Despite decades of research, the mortality rate related with primary amoebic meningoencephalitis owing to N. fowleri remains more than 90%. The amoebae pass through the nose to enter the central nervous system killing the host within days, making it one of the deadliest opportunistic parasites. Accordingly, we present an up to date review of the biology and pathogenesis of N.fowleri and discuss needs for future research against this fatal infection.

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“…While infections with Balamuthia mandrillaris are clinically very similar to infections with Acanthamoeba, Naegleria fowleri causes primary amebic meningoencephalitis, usually in immunocompetent individuals and children. Treatment is based on the administration of amphotericin B in combination with other drugs (9,14), but results are generally poor. GAE in immunocompetent persons is extremely rare (16).…”

mentioning

confidence: 99%

Granulomatous Amebic Encephalitis in a Child with Acute Lymphoblastic Leukemia Successfully Treated with Multimodal Antimicrobial Therapy and Hyperbaric Oxygen

et al. 2011

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Acanthamoeba is the causative agent of granulomatous amebic encephalitis, a rare and usually fatal disease. We report a child with acute lymphoblastic leukemia who developed brain abscesses caused by Acanthamoeba during induction therapy. Multimodal antimicrobial chemotherapy and hyperbaric oxygen therapy resulted in complete resolution of symptoms and of pathology as seen by magnetic resonance imaging. CASE REPORTA 25-month-old boy was treated at our institution for acute lymphoblastic leukemia (ALL). The induction therapy consisted of prednisone, dexamethasone, vincristine, daunorubicin, l-asparaginase, methotrexate, cyclophosphamide, and mercaptopurine. Infection prophylaxis included oral amphotericin B and trimethoprim-sulfamethoxazole (4 mg/kg of body weight/day 4 days/week). Complete remission of ALL was achieved by day 15 of ALL treatment.Forty-three days after the diagnosis was established and therapy started, the boy developed fever followed by an increase of C-reactive protein (CRP) (maximum, 87.8 mg/liter [normal range, 0 to 8 mg/liter]). Therapy with meropenem and liposomal amphotericin B resulted in defervescence. The patient suffered from mild headache, and 5 days later he experienced left-sided hemiparesis and a second elevation of CRP level (maximum, 37 mg/dl). No other symptoms besides fever and hemiparesis were noted.Magnetic resonance imaging (MRI) revealed multifocal lesions up to 20 mm in diameter, partially necrotic as seen by increased contrast medium enhancement, and extended edema. The largest lesion was located in the right front parietal lobe. The morphology of these lesions was indicative for abscess formations (Fig. 1).Analysis of the initially acquired cerebrospinal fluid (CSF) showed 0 erythrocytes/l, 2 leukocytes/l, increased protein (62 mg/dl), normal glucose, and no bacteria. An extensive diagnostic workup on fungi, bacteria, and parasites known to cause brain abscesses in children (7) revealed positive PCR results for Acanthamoeba 2 days after the first signs of hemiparesis. An Acanthamoeba-specific PCR amplifying a fragment of the 18S ribosomal DNA (rDNA) was performed using the primers JDP1 and JDP2 (12) and Acanthamoeba strain ATCC PRA-105, genotype T4, as a positive control. For genotyping, amplicons were sequenced using a 310 ABI Prism automated sequencer (Applied Biosystems, Langen, Germany), and the genotype was assessed with the model assumption of a Ͻ5% sequence dissimilarity within one genotype (3). Further specification revealed Acanthamoeba group II, genotype T4, known to be the predominant type that causes granulomatous amebic encephalitis (GAE) in humans (13).Cultures and PCR of the CSF were negative for fungi and bacteria. The results of Acanthamoeba PCR of nasal and respiratory discharge and sputum were negative.ALL therapy was stopped on treatment day 44, and empirical antimicrobial therapy was initiated, consisting of meropenem, teicoplanin, fosfomycin, metronidazole, and liposomal amphotericin B. Hyperbaric oxygen therapy (HBO) was started empirically for its...

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Successful Treatment of Primary Amebic Meningoencephalitis

Cited by 212 publications

References 13 publications

Human infections caused by free-living amoebae

Human infections caused by free-living amoebae

Biology and pathogenesis of Naegleria fowleri

Granulomatous Amebic Encephalitis in a Child with Acute Lymphoblastic Leukemia Successfully Treated with Multimodal Antimicrobial Therapy and Hyperbaric Oxygen

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