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amoebic meningoencephalitis
Etiology:
- Acanthamoeba* (immunosuppressed hosts)
- Naegleria fowleri* (may occur in immunocompetent hosts)
- Balamuthia mandrillaris
- Sappinia pedata
* most common in U.S.
Epidemiology:
- fresh water exposure, including Neti pot [2]
Clinical manifestations:
- rapidly progressive meningoencephalitis
- brain edema
- intracerebral hemorrhage
- death within days
Laboratory:
- CSF analysis:
- diminished glucose
- elevated CSF leukocytes, may be lymphocyte predominant
- brain biopsy
- foci of necrosis
- numerous free-floating amoebas, some encysted
- amoebas may cluster around blood vessels
- multinucleated giant cells may be seen
- Acanthamoeba antibody in CSF
- Naegleria fowleri antibody in CSF
- Acanthamoeba DNA
- Naegleria fowleri DNA
- Balamuthia mandrillaris DNA
Radiology:
- neuroimaging (brain CT or brain MRI)
- cerebral edema, intracerebral hemorrhage
Management:
Acanthamoeba
- trimethoprim-sulfamethoxazole in combination with rifampin & ketoconazole
- combination therapy with fluconazole plus sulfadiazine & pyrimethamine
- miltefosine is used as part of combination therapy
- surgical resection of lesions, when possible
General
meningoencephalitis
amebiasis
References
- Samuels MA, Gonzalez RG, Makadzange AT, Hedley-Whyte ET
Case 3-2017 - A 62-Year-Old Man with Cardiac Sarcoidosis
and New Diplopia and Weakness.
N Engl J Med 2017; 376:368-379. January 26, 2017
PMID: 28121502
http://www.nejm.org/doi/full/10.1056/NEJMcpc1610713
- Medical Knowledge Self Assessment Program (MKSAP) 18,
American College of Physicians, Philadelphia 2018