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Volume 30, Number 4—April 2024
Research Letter

Successful Treatment of Confirmed Naegleria fowleri Primary Amebic Meningoencephalitis

Ahmed Mujadid Khan Burki, Luqman SattiComments to Author , Saira Mahboob, Syed Onaiz Zulfiqar Anwar, Mahwash Bizanjo, Muhammad Rafique, and Najia Karim Ghanchi
Author affiliations: PNS Shifa Hospital, Karachi, Pakistan (A.M.K. Burki, L. Satti, S. Mahboob, S.O.Z. Anwar, M. Bizanjo, M. Rafique); Aga Khan University, Karachi (N.K. Ghanchi)

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Table

Demographic profiles, time from symptom onset to diagnosis, and management of 8 confirmed survivors of Naegleria fowleri infection, 1971–2023*

Country, year of infection (reference) Age, y/sex Time from symptom onset to diagnosis Therapy given Adjuvant therapy
Australia, 1971 (5)
 14/M
 Unknown
 Unknown
 Unknown
United States, 1978 (6)
 9/M
 3 d
 Intravenous and intrathecal amphotericin b, intravenous and intrathecal miconazole, oral rifampin, intravenous sulfisoxazole
 Intravenous dexamethasone, intravenous phenytoin
Mexico, 2003 (7)
 10/M
 9 h
 Intravenous amphotericin, intravenous fluconazole, intravenous dexamethasone, oral rifampin
 ETT, intravenous dexamethasone
United States, 2013 (8)
 12/F
 2 d
 Intravenous amphotericin, intravenous fluconazole, oral rifampin, intravenous azithromycin, oral miltefosine after 3 d, intrathecal amphotericin on second day for 10 d
 Intravenous dexamethasone, extraventricular drain, intravenous 20% mannitol with hypertonic saline, hypothermia
United States, 2013 (9)
 8/M
 5 d
 Intravenous amphotericin, oral rifampin, intravenous fluconazole, intravenous azithromycin, oral miltefosine
 ETT, EVD, dexamethasone, mannitol
Pakistan, 2015 (10)
 25/M
 3 d
 Intravenous amphotericin, oral rifampin, intravenous fluconazole
 Intravenous chlorpromazine
United States, 2016 (NA)
 16/M
 1 d
 Intravenous amphotericin, intravenous fluconazole, oral rifampin, intravenous azithromycin, oral miltefosine after 3 d, intrathecal amphotericin on second day for 10 d
 Mechanical ventilation, hypothermia
Pakistan, 2023 (this case) 22/M 2 d Intravenous amphotericin, intravenous fluconazole, oral rifampin, intravenous azithromycin, oral miltefosine, intrathecal amphotericin for 2 d Mechanical ventilation, intravenous sodium valproate, intravenous 20% mannitol

*ETT, endotracheal tube intubation; EVD, external ventricular drain; NA, not applicable (only news reports).

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References
  1. Gharpure  R, Bliton  J, Goodman  A, Ali  IKM, Yoder  J, Cope  JR. Epidemiology and clinical characteristics of primary amebic meningoencephalitis caused by Naegleria fowleri: a global review. Clin Infect Dis. 2021;73:e19–27. DOIPubMedGoogle Scholar
  2. Centers for Disease Control and Prevention. Naegleria fowleri—primary amebic meningoencephalitis (PAM)—amebic encephalitis. Information for public health and medical professionals [cited 2023 May 3]. https://www.cdc.gov/parasites/naegleria/health_professionals.html
  3. Ali  M, Jamal  SB, Farhat  SM. Naegleria fowleri in Pakistan. Lancet Infect Dis. 2020;20:27–8. DOIPubMedGoogle Scholar
  4. Ghanchi  NK, Khan  E, Khan  A, Muhammad  W, Malik  FR, Zafar  A. Naegleria fowleri meningoencephalitis associated with public water supply, Pakistan, 2014. Emerg Infect Dis. 2016;22:1835–7. DOIPubMedGoogle Scholar
  5. Anderson  K, Jamieson  A. Primary amoebic meningoencephalitis. Lancet. 1972;2:379. DOIPubMedGoogle Scholar
  6. Seidel  JS, Harmatz  P, Visvesvera  GS. Successful treatment of PAM. N Engl J Med. 1982;306:346–8. DOIPubMedGoogle Scholar
  7. Vargas-Zepeda  J, Gómez-Alcalá  AV, Vásquez-Morales  JA, Licea-Amaya  L, De Jonckheere  JF, Lares-Villa  F. Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin. Arch Med Res. 2005;36:83–6. DOIPubMedGoogle Scholar
  8. Linam  WM, Ahmed  M, Cope  JR, Chu  C, Visvesvara  GS, da Silva  AJ, et al. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics. 2015;135:e744–8. DOIPubMedGoogle Scholar
  9. Cope  JR, Conrad  DA, Cohen  N, Cotilla  M, DaSilva  A, Jackson  J, et al. Use of the novel therapeutic agent miltefosine for the treatment of primary amebic meningoencephalitis: report of 1 fatal and 1 surviving case. Clin Infect Dis. 2016;62:774–6. DOIPubMedGoogle Scholar
  10. Ghanchi  NK, Jamil  B, Khan  E, Ansar  Z, Samreen  A, Zafar  A, et al. Case series of Naegleria fowleri primary ameobic meningoencephalitis from Karachi, Pakistan. Am J Trop Med Hyg. 2017;97:1600–2. DOIPubMedGoogle Scholar

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Page created: February 22, 2024
Page updated: March 25, 2024
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