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Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature.
Pediatr Neurol 2017; 70:75-79PN

Abstract

BACKGROUND

Primary amebic meningoencephalitis is a rare, almost uniformly fatal disease of cerebral invasion by Naegleria fowleri, occurring most commonly after swimming in warm fresh water in summer months. Treatment using the experimental medication miltefosine demonstrated improved survival and favorable neurocognitive outcome in a 2013 North American patient. There is little information about the electroencephalographic findings of such patients, and our understanding of factors predicting survival is limited.

METHODS AND RESULTS

We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures. With evidence of pyogenic meningitis and examination of cerebrospinal fluid demonstrating motile trophozoites on wet mount, N. fowleri meningoencephalitis was diagnosed. Amebicidal antibiotic regimens with miltefosine were administered. Continuous electroencephalography monitoring demonstrated evolution from diffuse slowing to seizures, status epilepticus, and eventually global attenuation and absence of activity. Both patients ultimately died after complications of progressive increasing intracranial pressure and hemodynamic compromise.

CONCLUSIONS

Primary amebic meningoencephalitis is a serious, sporadic infection. We describe two fatal pediatric patients, the evolution of their electroencephalography findings, and compare their findings with the 13 reported pediatric survivors.

Authors+Show Affiliations

Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas. Electronic address: stowe@bcm.edu.Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

28389055

Citation

Stowe, Robert C., et al. "Primary Amebic Meningoencephalitis in Children: a Report of Two Fatal Cases and Review of the Literature." Pediatric Neurology, vol. 70, 2017, pp. 75-79.
Stowe RC, Pehlivan D, Friederich KE, et al. Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature. Pediatr Neurol. 2017;70:75-79.
Stowe, R. C., Pehlivan, D., Friederich, K. E., Lopez, M. A., DiCarlo, S. M., & Boerwinkle, V. L. (2017). Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature. Pediatric Neurology, 70, pp. 75-79. doi:10.1016/j.pediatrneurol.2017.02.004.
Stowe RC, et al. Primary Amebic Meningoencephalitis in Children: a Report of Two Fatal Cases and Review of the Literature. Pediatr Neurol. 2017;70:75-79. PubMed PMID: 28389055.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature. AU - Stowe,Robert C, AU - Pehlivan,Davut, AU - Friederich,Katie E, AU - Lopez,Michael A, AU - DiCarlo,Shannon M, AU - Boerwinkle,Varina L, Y1 - 2017/02/22/ PY - 2016/10/04/received PY - 2017/02/06/revised PY - 2017/02/08/accepted PY - 2017/4/9/pubmed PY - 2018/2/28/medline PY - 2017/4/9/entrez KW - Naegleria fowleri KW - continuous EEG KW - miltefosine KW - status epilepticus SP - 75 EP - 79 JF - Pediatric neurology JO - Pediatr. Neurol. VL - 70 N2 - BACKGROUND: Primary amebic meningoencephalitis is a rare, almost uniformly fatal disease of cerebral invasion by Naegleria fowleri, occurring most commonly after swimming in warm fresh water in summer months. Treatment using the experimental medication miltefosine demonstrated improved survival and favorable neurocognitive outcome in a 2013 North American patient. There is little information about the electroencephalographic findings of such patients, and our understanding of factors predicting survival is limited. METHODS AND RESULTS: We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures. With evidence of pyogenic meningitis and examination of cerebrospinal fluid demonstrating motile trophozoites on wet mount, N. fowleri meningoencephalitis was diagnosed. Amebicidal antibiotic regimens with miltefosine were administered. Continuous electroencephalography monitoring demonstrated evolution from diffuse slowing to seizures, status epilepticus, and eventually global attenuation and absence of activity. Both patients ultimately died after complications of progressive increasing intracranial pressure and hemodynamic compromise. CONCLUSIONS: Primary amebic meningoencephalitis is a serious, sporadic infection. We describe two fatal pediatric patients, the evolution of their electroencephalography findings, and compare their findings with the 13 reported pediatric survivors. SN - 1873-5150 UR - https://www.unboundmedicine.com/medline/citation/28389055/Primary_Amebic_Meningoencephalitis_in_Children:_A_Report_of Two_Fatal_Cases_and_Review_of_the_Literature L2 - https://linkinghub.elsevier.com/retrieve/pii/S0887-8994(16)30760-3 DB - PRIME DP - Unbound Medicine ER -