Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Naegleria Treatment & Management

  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
 
Updated: Aug 27, 2013
 

Medical Care

The medical care in patients with PAM is complicated by the rarity of the disease, the difficulty in diagnosing N fowleri infection early, and the fact that N fowleri is so rapidly lethal. Once clinical symptoms begin, the patient has a very short time during which therapy might be effective. The exceedingly high mortality rate of PAM suggests that many, if not most, patients have already entered into a stage that is not responsive to currently available therapy by the time they present for medical care.

The drug of choice (DOC) is amphotericin B. Lipid preparations of amphotericin B are not superior to conventional amphotericin B, and the lipid preparations have been shown to have higher minimal inhibitory concentrations. Other drugs that have been used include miconazole IV, which is not available in the United States, as well as rifampin, sulfonamides, chloramphenicol, and tetracycline. Miconazole may be useful and even synergistic with amphotericin B, but the other drugs are of questionable value.

In conjunction with the FDA, the CDC has an expanded access investigational new drug (IND) protocol in effect to make miltefosine available directly from the CDC for treatment of free-living amebae (FLA) in the United States. These infections include primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri and granulomatous amebic encephalitis caused by Balamuthia mandrillaris and Acanthamoeba species.[6]

Next

Surgical Care

In patients who develop life-threatening elevations in intracranial pressure, ventriculostomy and drainage of CSF may be necessary to relieve intracranial pressure. In one survivor, surgical drainage of a brain abscess was performed in addition to treatment with a 6-week course of amphotericin B, rifampicin, and chloramphenicol.

Previous
Next

Consultations

When the diagnosis of PAM is considered, appropriate considerations for consultations include an infectious disease specialist and a neurosurgeon.

Previous
 
 
Contributor Information and Disclosures
Author

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP Assistant Professor of Pediatrics, Co-Director of Antimicrobial Stewardship, Medical Director, Division of Pediatric Infectious Diseases and Immunology, Connecticut Children's Medical Center

Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics

Disclosure: Received research grant from: Cubist Pharmaceuticals, Durata Therapeutics, and Biota Pharmaceutical<br/>Received income in an amount equal to or greater than $250 from: HealthyCT insurance<br/>Medico legal consulting for: Various.

Coauthor(s)

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Asad A Khan, MD Fellow, Department of Internal Medicine, Division of Infectious Diseases, Louisiana State University Health Science Center

Asad A Khan, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

J Thomas Cross, Jr, MD, MPH President, A-Cross Medicine Reviews

J Thomas Cross, Jr, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, Pediatric Infectious Diseases Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

References
  1. Fowler M, Carter RF. Acute pyogenic meningitis probably due to Acanthamoeba sp: a preliminary report. Br Med J. 1965 Sep 25. 5464:740-2. [Medline].

  2. Butt CG. Primary amebic meningoencephalitis. N Engl J Med. 1966 Jun 30. 274(26):1473-6. [Medline].

  3. Hebbar S, Bairy I, Bhaskaranand N, et al. Fatal case of Naegleria fowleri meningo-encephalitis in an infant: case report. Ann Trop Paediatr. 2005 Sep. 25(3):223-6. [Medline].

  4. Chu DM, Ferguson TJ, Marciano-Cabral F. Protein kinase activation and protein phosphorylation in Naegleria fowleri amebae in response to normal human serum. J Eukaryot Microbiol. 2000 Jan-Feb. 47(1):40-7. [Medline].

  5. Lozano-Alarcon F, Bradley GA, Houser BS, Visvesvara GS. Primary amebic meningoencephalitis due to Naegleria fowleri in a South American tapir. Vet Pathol. 1997 May. 34(3):239-43. [Medline].

  6. Investigational Drug Available Directly from CDC for the Treatment of Infections with Free-Living Amebae. MMWR Morb Mortal Wkly Rep. 2013 Aug 23. 62(33):666. [Medline]. [Full Text].

  7. Schuster FL, Visvesvara GS. Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals. International Journal for Parasitology. 2004. Vol 34, Issue 9:1001-1027. [Full Text].

  8. Barnett ND, Kaplan AM, Hopkin RJ, et al. Primary amoebic meningoencephalitis with Naegleria fowleri: clinical review. Pediatr Neurol. 1996 Oct. 15(3):230-4. [Medline].

  9. Anderson K, Jamieson A. Primary amoebic meningoencephalitis. Lancet. 1972 Apr 22. 1(7756):902-3. [Medline].

  10. Brown RL. Successful treatment of primary amebic meningoencephalitis. Arch Intern Med. 1991 Jun. 151(6):1201-2. [Medline].

  11. CDC. From the Centers for Disease Control. Primary amebic meningoencephalitis--North Carolina, 1991. JAMA. 1992 Aug 19. 268(7):862-3. [Medline].

  12. Cerva L. Laboratory diagnosis of primary amoebic meningo-encephalitis and methods for the detection of limax amoebae in the environment. Folia Parasitol (Praha). 1980. 27(1):1-9. [Medline].

  13. Committee on Infections Diseases. Amebic meningoencephalitis and keratitis. 2006 Report of the Committee on Infections Diseases. 2006. 206-8.

  14. DeNapoli TS, Rutman JY, Robinson JR, Rhodes MM. Primary amoebic meningoencephalitis after swimming in the Rio Grande. Tex Med. 1996 Oct. 92(10):59-63. [Medline].

  15. Dingley D. Safe water practices can lower risk of contracting primary amoebic meningoencephalitis. Tex Med. 1996 Oct. 92(10):28-9. [Medline].

  16. Dubray BL, Wilhelm WE, Jennings BR. Serology of Naegleria fowleri and Naegleria lovaniensis in a hospital survey. J Protozool. 1987 Aug. 34(3):322-7. [Medline].

  17. Duma RJ, Rosenblum WI, McGehee RF, et al. Primary amoebic meningoencephalitis caused by Naegleria. Two new cases, response to amphotericin B, and a review. Ann Intern Med. 1971 Jun. 74(6):923-31. [Medline].

  18. Gustavo dos Santos Neto. Fatal primary amebic meningoencephalitis. A retrospective study in Richmond, Virginia. Am J Clin Pathol. 1970 Nov. 54(5):737-42. [Medline].

  19. Jarolim KL, McCosh JK, Howard MJ, John DT. A light microscopy study of the migration of Naegleria fowleri from the nasal submucosa to the central nervous system during the early stage of primary amebic meningoencephalitis in mice. J Parasitol. 2000 Feb. 86(1):50-5. [Medline].

  20. John DT. Primary amebic meningoencephalitis and the biology of Naegleria fowleri. Annu Rev Microbiol. 1982. 36:101-23. [Medline].

  21. Kidney DD, Kim SH. CNS infections with free-living amebas: neuroimaging findings. AJR Am J Roentgenol. 1998 Sep. 171(3):809-12. [Medline].

  22. Lawande RV, Macfarlane JT, Weir WR, Awunor-Renner C. A case of primary amebic meningoencephalitis in a Nigerian farmer. Am J Trop Med Hyg. 1980 Jan. 29(1):21-5. [Medline].

  23. Levy DA, Bens MS, Craun GF, et al. Surveillance for waterborne-disease outbreaks--United States, 1995-1996. Mor Mortal Wkly Rep CDC Surveill Summ. 1998 Dec 11. 47(5):1-34. [Medline].

  24. Loschiavo F, Ventura-Spagnolo T, Sessa E, Bramanti P. Acute primary meningoencephalitis from entamoeba Naegleria Fowleri. Report of a clinical case with a favourable outcome. Acta Neurol (Napoli). 1993 Oct. 15(5):333-40. [Medline].

  25. Ma P, Visvesvara GS, Martinez AJ, et al. Naegleria and Acanthamoeba infections: review. Rev Infect Dis. 1990 May-Jun. 12(3):490-513. [Medline].

  26. Markowitz SM, Martinez AJ, Duma RJ, Shiel FO. Myocarditis associated with primary amebic (Naegleria) meningoencephalitis. Am J Clin Pathol. 1974 Nov. 62(5):619-28. [Medline].

  27. Martinez AJ, Visvesvara GS. Free-living, amphizoic and opportunistic amebas. Brain Pathol. 1997 Jan. 7(1):583-98. [Medline].

  28. Primary amebic meningoencephalitis--Arizona, Florida, and Texas, 2007. MMWR Morb Mortal Wkly Rep. 2008 May 30. 57(21):573-7. [Medline].

  29. Reilly MF, Marciano-Cabral F, Bradley DW, Bradley SG. Agglutination of Naegleria fowleri and Naegleria gruberi by antibodies in human serum. J Clin Microbiol. 1983 Apr. 17(4):576-81. [Medline].

  30. Scaglia M, Gatti S, Bernuzzi AM. An in vitro comparative study on the effect of amphotericin B, econazole, and 5-fluorocytosine on Naegleria fowleri, Naegleria australiensis, and Naegleria australiensis s.sp. italica. Microbiologica. 1988 Oct. 11(4):279-88. [Medline].

  31. Schuster FL, Guglielmo BJ, Visvesvara GS. In-vitro activity of miltefosine and voriconazole on clinical isolates of free-living amebas: Balamuthia mandrillaris, Acanthamoeba spp., and Naegleria fowleri. J Eukaryot Microbiol. 2006 Mar-Apr. 53(2):121-6. [Medline].

  32. Seidel JS, Harmatz P, Visvesvara GS, et al. Successful treatment of primary amebic meningoencephalitis. N Engl J Med. 1982 Feb 11. 306(6):346-8. [Medline].

  33. Shenoy S, Wilson G, Prashanth HV, et al. Primary meningoencephalitis by Naegleria fowleri: first reported case from Mangalore, South India. J Clin Microbiol. 2002 Jan. 40(1):309-10. [Medline]. [Full Text].

  34. Stevens AR, Shulman ST, Lansen TA, et al. Primary amoebic meningoencephalitis: a report of two cases and antibiotic and immunologic studies. J Infect Dis. 1981 Feb. 143(2):193-9. [Medline].

  35. Sugita Y, Fujii T, Hayashi I, et al. Primary amebic meningoencephalitis due to Naegleria fowleri: an autopsy case in Japan. Pathol Int. 1999 May. 49(5):468-70. [Medline].

  36. Szenasi Z, Endo T, Yagita K, Nagy E. Isolation, identification and increasing importance of ''free-living'' amoebae causing human disease. J Med Microbiol. 1998 Jan. 47(1):5-16. [Medline].

  37. Valenzuela G, Lopez-Corella E, De Jonckheere JF. Primary amoebic meningoencephalitis in a young male from northwestern Mexico. Trans R Soc Trop Med Hyg. 1984. 78(4):558-9. [Medline].

  38. Vargas-Zepeda J, Gómez-Alcalá AV, Vásquez-Morales JA, Licea-Amaya L, De Jonckheere JF, Lares-Villa F. Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin. Arch Med Res. 2005 Jan-Feb. 36(1):83-6. [Medline].

  39. Visvesvara GS, Stehr-Green JK. Epidemiology of free-living ameba infections. J Protozool. 1990 Jul-Aug. 37(4):25S-33S. [Medline].

 
Previous
Next
 
Number of identified cases of primary amoebic meningoencephalitis (PAM), 1937-2007.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.