Pediatric Naegleria Follow-up

Updated: Sep 12, 2016
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
  • Print
Follow-up

Further Outpatient Care

See the list below:

  • In survivors, outpatient care should include assessment of neurologic function and control of seizures, if present.

Next:

Further Inpatient Care

See the list below:

  • Survival after PAM has been uncommon, and death occurs in 95% or more of patients. In patients who do survive, careful attention to the prevention of seizures and control of intracranial pressure is critical. Other measures include prevention of secondary bacterial infections (especially intravenous catheter–related infections and urinary tract infections in patients with Foley catheters), prevention of decubitus ulcers, and prevention of aspiration in patients with coma or seizures.

Previous
Next:

Inpatient & Outpatient Medications

See the list below:

  • Therapy for PAM requires hospitalization. Survivors may need seizure medications.

Previous
Next:

Transfer

See the list below:

  • The rapidity of progression in PAM usually precludes transferring the patient long distances; however, treating patients in a medical facility with an intensive care unit and neurosurgical and infectious disease support is best whenever possible.

Previous
Next:

Deterrence/Prevention

See the list below:

  • N fowleri is ubiquitous and is present in warm freshwater and soil. The widespread presence of anti– N fowleri antibodies in the population indicates that exposure to this ameba is common and usually not associated with disease. Thus, general prevention of exposure to N fowleri is difficult if not impossible; however, most cases of clinical disease (ie, PAM) follow swimming or diving in warm freshwater. In swimming pools, proper chlorination is effective in significantly reducing risk; in open waterways, eradication of N fowleri is not a reasonable expectation.

Previous
Next:

Complications

See the list below:

  • Most survivors have improved and fared well. A risk of persistent seizures is observed.

Previous
Next:

Prognosis

See the list below:

  • The overall prognosis of PAM is very poor. Many reported cases have been diagnosed only postmortem. The overall mortality rate exceeds 95%.

Previous
Next:

Patient Education

See the list below:

  • As part of general public health information, people should be aware that swimming or diving in warm freshwater (ie, not saltwater) poses risks of bacterial, parasitic, and protozoal infections. Patients' families should be aware that they should provide complete histories to physicians trying to care for critically ill patients.

  • Physicians, especially in emergency departments, should be aware of the possibility that a child or young adult who presents with what appears to be acute pyogenic meningitis could have PAM. [10] A history of recent swimming or diving in warm freshwater should suggest the diagnostic possibility of N fowleri infection.

Previous