II. Epidemiology

  1. Rare, but lethal Encephalitis (4 cases per year in U.S.)

III. Pathophysiology

  1. Typically occurs with swimming in fresh water lakes, rivers or hot springs
  2. Transmitted via the nasal cavity and secondary Sinusitis

IV. Management

  1. Amphoteracin B 1.5 mg/kg/day (IV and consider intrathecal) AND
  2. Rifampin 10 mg/kg/day AND
  3. Fluconazole 10 mg/kg/day IV or orally AND
  4. Azithromycin 500 mg IV or orally AND
  5. Miltefosine (Impavido) 50 mg orally three times daily
    1. As of 2017, investigational, and only available from CDC (consult early and urgently if suspected case)

V. Differential Diagnosis

  1. See Encephalitis
  2. See Meningitis
  3. Other amebic meningoencephalitis (present as Chronic Granulomatous Meningitis)
    1. Balamuthia mandrillaris
    2. Acanthameba

VI. Prognosis

  1. Mortality: 90%

VII. References

  1. (2017) Sanford guide, accessed 5/4/2017
  2. Perkins (2017) Am Fam Physician 95(9): 554-60 [PubMed]

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