phenylephrine-hydrochloride and Amebiasis

In view of the devastating nature of primary amoebic meningoencephalitis caused by Naegleria fowleri and the problems associated with diagnostic delays and chemotherapeutic failures, here we propose a noninvasive diagnostic method using the 'reverse transcribrial route device', a novel strategy in the management of this life-threatening infection with a case fatality rate of more than 90%. The proposed rationale should stimulate interest in this emerging infection that almost always proves fatal.

Topics: Amebiasis; Animals; Catheters; Central Nervous System Protozoal Infections; Equipment Design; Humans; Naegleria fowleri; Nose

We describe five cases of parasitic sinusitis and otitis in patients infected with human immunodeficiency virus (HIV) and review 14 reported cases. The pathogens identified in our group of patients included agents such as Microsporidium, Cryptosporidium, and Acanthamoeba species. The clinical features common to these patients included a long history of HIV seropositivity associated with advanced immunosuppression and multiple opportunistic infections as well as long-standing local symptoms refractory to multiple courses of antibacterial agents. Symptoms often included fever and chills in addition to local tenderness and discharge. Invasive diagnostic procedures were necessary to obtain the final diagnosis and to initiate appropriate therapy. Although most patients responded at least partially to specific therapy, relapses and recurrences were frequent in patients who did not receive long-term suppressive therapy. The general outcome for HIV-infected patients with parasitic sinusitis and otitis was poor; however, deaths were generally associated with other complications of the underlying HIV infection.

Topics: Adult; AIDS-Related Opportunistic Infections; Albendazole; Amebiasis; Animals; Anthelmintics; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Antifungal Agents; Antiprotozoal Agents; Cryptosporidiosis; Ear, Middle; HIV Seropositivity; Homosexuality, Male; Humans; Male; Microsporida; Microsporidiosis; Nose; Otitis; Protozoan Infections; Recurrence; Sinusitis

Granulomatous amebic encephalitis is an uncommon central nervous system (CNS) infection, usually caused by Acanthamoeba spp., which generally occurs in immunocompromised individuals. Balamuthia mandrillaris is a recently described free-living ameba that occasionally causes fatal CNS disease. The infection might start from a minor, slowly progressive, skin ulceration that can be present for weeks to months before neurologic changes occur. The clinical and histologic presentation is easily confused with many other diseases. Accurate diagnosis requires an awareness of this unusual presentation of amebiasis and identification of the amebic trophozoites in tissue and culture. Special stains are helpful, but immunofluorescence assays or electron microscopy is required to identify the organism as B mandrillaris. We present a fatal case of granulomatous amebic encephalitis that began as a cutaneous infection in an immunocompetent host.

Topics: Aged; Aged, 80 and over; Amebiasis; Amoeba; Animals; Diagnosis, Differential; Encephalitis; Fatal Outcome; Granuloma; Humans; Magnetic Resonance Imaging; Male; Necrosis; Nose; Skin Diseases, Parasitic

We present a case of 23-year-old man with acute meningoencephalitis, accompanied by inflammation of a nasal ulcer. He had been healthy until six months prior to admission to the hospital when he had a motorcycle accident. A star-shaped wound at his nose was incurred after falling into a swamp. A computed tomogram of the brain showed two nonenhancing hypodense lesions at the left caudate nucleus and the right parietal lobe, ependymitis and leptomeningeal enhancement. A skin biopsy showed chronic noncaseous granulomatous inflammation without demonstrated microorganisms. The patient did not respond to the empirical treatment with cloxacillin, ceftriaxone, and amphotericin B, and eventually died on the thirteenth day of hospitalization. At autopsy, hematoxylin and eosin-stained brain sections showed a chronic necrotizing inflammation with numerous amebic trophozoites and rare cysts. Definitive identification of Balamuthia mandrillaris was made by fluorescent immunohistochemical analysis. There were 10 Naegleria fowleri primary amebic meningoencephalitis, eight Acanthamoeba granulomatous amebic encephalitis, and three Acanthamoeba meningitis in Thailand. To our knowledge, this case is the first reported case of B. mandrillaris in Southeast Asia.

Topics: Adult; Amebiasis; Animals; Asia, Southeastern; Brain; Central Nervous System Protozoal Infections; Humans; Lobosea; Male; Meningoencephalitis; Nose; Tomography, X-Ray Computed; Ulcer

Following the observation of cases of primary amoebic meningoencephalitis (PAME) during the dusty harmattan period in Zaria, a survey was carried out in randomly selected local populations of Zaria, to find out the incidence of free-living amoebae in the nasal passages. The times of sampling were spaced so as to cover both the rainy (non-harmattan) abd dry (harmattan) seasons. In all 1250 individuals were sampled, and were grouped in the three age groups of above 18 years, between 4 and 18 years and below 4 years. The overall incidence was 4.2% (52 out of 1250). There was no marked difference in the three age groups studied. The incidence rate in males was 4.8% (30 of 630) and that in females was 3.5% (22 of 620). Nine different species of free-living amoebae were isolated. Six belonged to the Genus Hartmannella, two to the genus Naegleria, and one to the genus Schizopyrenus. Three species were found to be pathogenic for mice: H. culbertsoni, H. rhysodes and N. fowleri. It was observed from this study that a significant percentage of the Zaria population carry free-living amoebae in the nasal passages. The monthly incidence rate in population ranged from 1.8 to 3.1% during the rainy (non-harmattan) season whereas in the dry (harmattan) season it ranged from 4.2 to 7.9%. The highest incidence rate coincided with the peak of the dry (harmattan) season. The possible role of harmattan winds on the nasal carriage as well as the necessity to investigate fully the disease PAME in this environment is discussed.

Topics: Adolescent; Adult; Amebiasis; Amoeba; Carrier State; Child; Child, Preschool; Female; Hartmannella; Humans; Male; Nigeria; Nose; Seasons; Wind

Topics: Amebiasis; Amoeba; Czechoslovakia; Military Medicine; Nose; Otorhinolaryngologic Diseases; Palatine Tonsil; Paranasal Sinuses; Pharynx