Pediatric Naegleria Follow-up

Updated: Oct 14, 2021
  • Author: Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab); Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Care

Further inpatient care

Survival after primary amebic meningoencephalitis (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.

Further outpatient care

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

Inpatient and outpatient medications

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

Transfer

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.

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Deterrence/Prevention

Naegleria 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.

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