rifampin and miltefosine

Primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is a rare and deadly disease that requires prompt treatment with multiple therapies. Although N. fowleri previously was only found in warmer areas, climate change appears to be contributing to its geographic spread. Clinicians should consider PAM when faced with a patient with meningitis, especially if the patient participates in outdoor water activities or practices nasal rinsing.

Topics: Amebicides; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Antiparasitic Agents; Azithromycin; Central Nervous System Protozoal Infections; Climate Change; Dexamethasone; Early Diagnosis; Early Medical Intervention; Fluconazole; Geography; Glucocorticoids; Humans; Hypothermia, Induced; Macrolides; Naegleria fowleri; Phosphorylcholine; Rifampin; United States; Ventriculostomy

Case management in children with cutaneous leishmaniasis (CL) is mainly based on studies performed in adults. We aimed to determine the efficacy and harms of interventions to treat CL in children.. We conducted a systematic review of clinical trials and cohort studies, assessing treatments of CL in children (≤12 years old). We performed structured searches in PubMed, CENTRAL, LILACS, SciELO, Scopus, the International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and Google Scholar. No restrictions regarding ethnicity, country, sex or year of publication were applied. Languages were limited to English, Spanish and Portuguese. Two reviewers screened articles, completed the data extraction and assessment of risk of bias. A qualitative summary of the included studies was performed.. We identified 1092 records, and included 8 manuscripts (6 Randomized Clinical Trials [RCT] and 2 non-randomized studies). Most of the articles excluded in full-text review did not report outcomes separately for children. In American CL (ACL), 5 studies evaluated miltefosine and/or meglumine antimoniate (MA). Their efficacy varied from 68-83% and 17-69%, respectively. In Old-World CL (OWCL), two studies evaluated systemic therapies: rifampicin and MA; and one study assessed efficacy of cryotherapy (42%, Per Protocol [PP]) vs intralesional MA (72%, PP). Few studies (4) provided information on adverse events (AEs) for children, and no serious AEs were reported in participants. Risk of bias was generally low to unclear in ACL studies, and unclear to high in OWCL studies.. Information on efficacy of treatment for CL in children is scarce. There is an unmet need to develop specific formulations, surveillance of AEs, and guidelines both for the management of CL and clinical trials involving the pediatric population.. The protocol of this review was registered in the PROSPERO International register of systematic reviews, number CRD42017062164.

Topics: Antiprotozoal Agents; Clinical Trials as Topic; Humans; Leishmania; Leishmaniasis, Cutaneous; Meglumine Antimoniate; Phosphorylcholine; Rifampin

Primary amoebic meningoencephalitis (PAM) is a rare and almost always fatal disease that is caused by Naegleria fowleri, a freshwater thermophilic amoeba. Our case involves an adolescent female who presented with fever of unknown origin. A lumbar puncture was performed, and the Wright-Giemsa and Gram stained cerebrospinal fluid (CSF) cytospin slides showed numerous organisms. Experienced medical technologists in the microbiology and hematology laboratories identified the organisms as morphologically consistent with Naegleria species. The laboratory made a rapid diagnosis and alerted emergency department care providers within 75 minutes. The patient was treated for PAM with amphotericin, rifampin, azithromycin, fluconazole and aggressive supportive therapy including dexamethasone. The Centers for Disease Control and Prevention (CDC) was contacted, and miltefosine, an investigational medication, was started. Additional treatment included an intraventricular shunt and controlled hypothermia in order to mitigate potential cerebral edema. Our patient is a rare success story, as she was diagnosed swiftly, successfully treated, and survived PAM.

Topics: Amebiasis; Amphotericin B; Antiprotozoal Agents; Azithromycin; Central Nervous System Protozoal Infections; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Child; Early Diagnosis; Female; Fluconazole; Humans; Hypothermia, Induced; Meningoencephalitis; Naegleria fowleri; Phosphorylcholine; Rifampin