17/2/2015

Successful Treatment of Naegleria fowleri Meningoencephalitis by Using Intravenous Amphotericin B, Fluconazole and Rifampicin

 

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Article outline

Background
Methods
Results
Conclusions
Key words
Introduction
Patients and Methods
Results
Discussion
Acknowledgments
References

Archives of Medical Research
Volume 36, Issue 1, January 2005, Pages 83–86

Case report

Successful Treatment of Naegleria fowleri Meningoencephalitis by
Using Intravenous Amphotericin B, Fluconazole and Rifampicin
Jesús Vargas-Zepedaa, Alejandro V. Gómez-Alcaláb,
c

,

, José Alfonso Vázquez-Moralesa, Leonardo

Licea-Amaya , Johan F. De Jonckheere , Fernando Lares-Villae
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doi:10.1016/j.arcmed.2004.11.003

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Background
Primary amebic meningoencephalitis (PAM) is an emerging disease with a rapidly fatal outcome. Only
eight reports of cured cases have appeared in the medical literature to date.

Methods
A 10-year-old boy developed PAM caused by Naegleria fowleri 1 week after swimming in an irrigation
canal. He was admitted to our hospital after 9 h of severe headache and vomiting, fever, ataxic gait, mild
confusion, and seizures were evident. Trophozoites were identified in the cerebrospinal fluid (CSF).
Treatment with intravenous (i.v.) dexamethasone, amphotericin B, fluconaloze, and oral rifampicin was
started. After several hours of conflicting clinical signs, recovery began, and on the third day he was
conscious again. Hospital discharge occurred on day 23, after a normal brain CT scan. There was no
sequel to the disease during the following 12 months.

Results
The amebas present in the CSF were identified and confirmed as N. fowleri after observation of wet mounts
and of cultures seeded on 1.5% non-nutrient agar plates covered with Escherichia coli, vegetative and
cystic forms, enflagellation experiments in distilled water at 98°F, temperature tolerance testing and by
indirect immunofluorescence using N. fowleri LEE antibody. The genotype was determined by PCR
amplification and sequencing of the internal transcribed spacers (ITS) including the 5.8S rDNA.

Conclusions
Early treatment of PAM by i.v. administration of amphotericin B and fluconazole, and oral administration of
rifampicin can offer some hope of cure for this devastating disease.

Key words
Naegleria fowleri; Free-living ameba; Primary amebic meningoencephalitis; Meningoencephalitis; Waterborne infections
Address reprint requests to: Dr. Alejandro V. Gómez-Alcalá, Coordinación Delegacional de
Investigación en Salud, Delegación Estatal del IMSS, Sonora, 5 de Febrero 205, Centro, Ciudad
Obregón, Sonora, México CP 85000.
Copyright © 2005 Published by Elsevier Inc. All rights reserved.

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Pediatric Neurology more Diagnosis of the primary amoebic meningoencepha… 2005.17/2/2015   Successful Treatment of Naegleria fowleri Meningoencephalitis by Using Intravenous Amphotericin B. Medical Hypotheses more View more articles »     Citing articles (44) Related book content http://www. Fluconazole and Rifampicin Recommended articles Primary amoebic meningoencephalitis with Naegler… 1996.com/science/article/pii/S0188440904001225 2/2 . Parasitology International more Survival of Naegleria fowleri primary amebic menin… 2008.sciencedirect.