II. Epidemiology
- Rare, but lethal Encephalitis (4 cases per year in U.S.)
III. Pathophysiology
- Typically occurs with swimming in fresh water lakes, rivers or hot springs
- Transmitted via the nasal cavity and secondary Sinusitis
IV. Management
- Amphoteracin B 1.5 mg/kg/day (IV and consider intrathecal) AND
- Rifampin 10 mg/kg/day AND
- Fluconazole 10 mg/kg/day IV or orally AND
- Azithromycin 500 mg IV or orally AND
-
Miltefosine (Impavido) 50 mg orally three times daily
- As of 2017, investigational, and only available from CDC (consult early and urgently if suspected case)
V. Differential Diagnosis
- See Encephalitis
- See Meningitis
- Other amebic meningoencephalitis (present as Chronic Granulomatous Meningitis)
- Balamuthia mandrillaris
- Acanthameba
VI. Prognosis
- Mortality: 90%
VII. References
- (2017) Sanford guide, accessed 5/4/2017
- Perkins (2017) Am Fam Physician 95(9): 554-60 [PubMed]