Amebic Meningoencephalitis Treatment & Management

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Medical Care

Primary amebic meningoencephalitis (PAM)

Amebic meningitis is seldom diagnosed before an individual's death. Difficulties in diagnosis and rapid progression make this condition extremely difficult to treat. For this reason, aggressively pursue the diagnosis in the patient with CSF findings consistent with bacterial meningitis, with a history of water exposure, and in whom the CSF Gram stain is negative.

Typically, PAM infection proceeds as an overwhelming acute bacterial meningitis that is unresponsive to routine antibacterials.

The treatment of choice is amphotericin B, at maximally tolerated doses, with adjunctive rifampin and doxycycline. Successful treatment may also require intrathecal amphotericin B. Sulfisoxazole, phenothiazine, and qinghaosu may have some benefit. Studies have suggested some role for azithromycin as an adjunct to amphotericin B.[16, 17] More recently, in vitro studies and mouse models of PAM treatment have suggested that miltefosine, chlorpromazine, and rokitamycin may have activity; however, the effectiveness of these treatments remains unproven.

Granulomatous amebic encephalitis (GAE)

Ketoconazole and amphotericin B (alone or in combination) as well as sulfadiazine may be indicated. A recent case report described successful treatment of Balamuthia GAE with miltefosine, fluconazole, and albendazole.[18] Another case report described successful treatment of Acanthamoeba GAE with trimethoprim-sulfamethoxazole (TMP-SMZ), fluconazole, pentamidine, miltefosine, and hyperbaric oxygen.[19]

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Surgical Care

PAM

PAM may require the placement of a reservoir for intrathecal amphotericin B or miconazole.

Hydrocephalus may necessitate shunting.

GAE

Biopsy findings may permit diagnosis.

Excision of solitary or isolated lesions may benefit the individual with GAE.

Hydrocephalus may necessitate shunting.

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Consultations

Emergent consultations with infectious diseases specialists, neurologists, and neurosurgeons are recommended if PAM or GAE is suspected.

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Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Michael D Nissen, MBBS, FRACP, FRCPA  Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society, Royal Australasian College of Physicians, and Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

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.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

David Pallares, MD  Clinical Assistant Professor, Department of Pediatrics, Division of Allergy and Immunology, University of Louisville School of Medicine

David Pallares, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

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, and Southern Medical Association

Disclosure: Nothing to disclose.

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