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Case Reports
. 2015 Mar;135(3):e744-8.
doi: 10.1542/peds.2014-2292. Epub 2015 Feb 9.

Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis

W Matthew Linam  1 , Mubbasheer Ahmed  2 , Jennifer R Cope  3 , Craig Chu  2 , Govinda S Visvesvara  3 , Alexandre J da Silva  3 , Yvonne Qvarnstrom  3 , Jerril Green  2
Affiliations
Case Reports

Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis

W Matthew Linam et al. Pediatrics. 2015 Mar.

Abstract

Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury.

Keywords: Naegleria fowleri; hypothermia; miltefosine; primary amebic meningoencephalitis.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have indicated they have no potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1. The Relationship Between Mean Arterial Pressure, Cerebral Perfusion Pressure, Intracranial Pressure and Core Body Temperature During the Management of a Twelve-Year-Old Female with Naegleria fowleri Primary Amebic Meningoencephalitis
MAP is mean arterial pressure. ICP is intracranial pressure. CPP is cerebral perfusion pressure. Temp is temperature. The graph above illustrates our management strategy of maintaining CPP above 60mmHg and ICP below 20mmHg. With induction of hypothermia (7/22 22:00), ICPs were sustained under 20mmHg. Please note early attempts to rewarm the patient on 7/24 and 7/26 led to elevations of ICP. After 5 days of cooling, rewarming the patient was met with minimal ICP elevations.
Figure 2
Figure 2. Noncontrast Axial Magnetic Resonance Images of the Brain of a Patient with Naegleria fowleri Primary Amebic Meningoencephalitis
Figure 2a: The axial fluid attenuated inversion recovery (FLAIR) image shows focal edema in the left frontal lobe (arrow). Figure 2b: Axial susceptibility-weighted image shows hemorrhage within the left frontal edematous lesion (arrow). Figure 2c: Axial FLAIR image demonstrates multiple areas of edema in the cerebellum bilaterally (arrows). Figure 2d: Axial diffusion-weighted image shows areas of restricted diffusion consistent with acute cerebellitis (arrows).
Figure 2
Figure 2. Noncontrast Axial Magnetic Resonance Images of the Brain of a Patient with Naegleria fowleri Primary Amebic Meningoencephalitis
Figure 2a: The axial fluid attenuated inversion recovery (FLAIR) image shows focal edema in the left frontal lobe (arrow). Figure 2b: Axial susceptibility-weighted image shows hemorrhage within the left frontal edematous lesion (arrow). Figure 2c: Axial FLAIR image demonstrates multiple areas of edema in the cerebellum bilaterally (arrows). Figure 2d: Axial diffusion-weighted image shows areas of restricted diffusion consistent with acute cerebellitis (arrows).
See this image and copyright information in PMC

References

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