Naegleria fowleri: Difference between revisions

Latest revision as of 16:29, 18 February 2022

Causes acute, aggressive primary amebic meningoencephalitis (PAM)
Infection (PAM) is rapidly-progressing and almost uniformly fatal (141/145 cases in the US)

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

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+==Background==
-* Protozoan parasite that causes '''primary amebic meningoencephalitis (PAM)'''
+===Microbiology===
+* One of the [[free-living amoebae]]
+===Epidemiology===
 * Found in warm fresh-water, including southern US
-* Infection (PAM) is rapidly-progressing and almost uniformly fatal
+==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:
+** [[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, 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, concurrent with
+** [[Is treated by::Dexamethasone]] 0.15 mg/kg IV q6h during the initial 4 days
 {{DISPLAYTITLE:''Naegleria fowleri''}}
+* 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
 [[Category:Protozoa]]