Naegleria fowleri: Difference between revisions
From IDWiki
Naegleria fowleri
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* Unclear optimal management |
* Unclear optimal management |
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* CDC recommendations are: |
* CDC recommendations are: |
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| − | ** [[Is treated by::Amphotericin B]] 0.75 mg/kg IV q12h for three days followed by 1 mg/kg IV daily for 11 days, |
+ | ** [[Is treated by::Amphotericin B]] 0.75 mg/kg IV q12h for three days followed by 1 mg/kg IV daily for 11 days, concurrent with |
| − | ** [[Is treated by::Amphotericin B]] 1.5 mg intrathecal once daily for 2 days followed by 1 mg intrathecal q2d for 8 days, |
+ | ** [[Is treated by::Amphotericin B]] 1.5 mg intrathecal once daily for 2 days followed by 1 mg intrathecal q2d for 8 days, concurrent with |
| − | ** [[Is treated by::Azithromycin]] 10 mg/kg (max 500 mg) PO/IV daily, plus [[Is treated by::fluconazole]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::rifampin]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::miltefosine]] 50 mg PO bid or tid for 28 days, with |
+ | ** [[Is treated by::Azithromycin]] 10 mg/kg (max 500 mg) PO/IV daily, plus [[Is treated by::fluconazole]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::rifampin]] 10 mg/kg (max 600 mg) PO/IV daily, plus [[Is treated by::miltefosine]] 50 mg PO bid or tid for 28 days, concurrent with |
| + | ** [[Is treated by::dexamethasone]] 0.15 mg/kg IV q6h during the initial 4 days |
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{{DISPLAYTITLE:''Naegleria fowleri''}} |
{{DISPLAYTITLE:''Naegleria fowleri''}} |
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* Note that the recommendation is specifically for conventional rather than liposomal [[amphotericin B]] |
* Note that the recommendation is specifically for conventional rather than liposomal [[amphotericin B]] |
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Revision as of 22:36, 3 June 2020
Background
Microbiology
- One of the free-living amoebae
Epidemiology
- Found in warm fresh-water, including southern US
Clinical Presentation
- 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
