Naegleria fowleri
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Naegleria fowleri / (Redirected from Primary amoebic meningoencephalitis)
Background
Microbiology
- One of the free-living amoebae
Epidemiology
- Found in warm fresh-water, including southern US
Clinical Manifestations
- Causes acute, aggressive primary amebic meningoencephalitis (PAM)
- Infection (PAM) is rapidly-progressing and almost uniformly fatal (141/145 cases in the US)
Management
- Unclear optimal management
- CDC recommendations are:
- Amphotericin B 0.75 mg/kg IV q12h for three days followed by 1 mg/kg IV daily for 11 days, concurrent with
- Amphotericin B 1.5 mg intrathecal once daily for 2 days followed by 1 mg intrathecal q2d for 8 days, concurrent with
- Azithromycin 10 mg/kg (max 500 mg) PO/IV daily, plus fluconazole 10 mg/kg (max 600 mg) PO/IV daily, plus rifampin 10 mg/kg (max 600 mg) PO/IV daily, plus miltefosine 50 mg PO bid or tid for 28 days, concurrent with
- Dexamethasone 0.15 mg/kg IV q6h during the initial 4 days
- Note that the recommendation is specifically for conventional rather than liposomal amphotericin B
- Miltefosine dosing is bid if weight <45 kg and tid if weight ≥45 kg
