rifampin and Amebiasis

Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri was detected in a 36-year-old, Indian countryman who had a history of taking bath in the village pond. He was admitted in a semi comatosed condition with severe frontal headache, neck stiffness, intermittent fever, nausea, vomiting, left hemiparesis and seizures. Computerized tomography (CT) scan of brain showed a soft tissue non-enhancing mass with erosion of sphenoid sinus. However CSF findings showed no fungal or bacterial pathogen. Trophozoites of Naegleria fowleri were detected in the direct microscopic examination of CSF and these were grown in culture on non-nutrient agar. The patient was put on amphotericin-B, rifampicin and ceftazidime but his condition deteriorated and was taken home by his relatives in a moribund condition against medical advice and subsequently died. A literature review of 7 previous reports of PAM in India is also presented. Four of theses eight cases were non lethal. The mean age was 13.06 years with male: female ratio of 7:1. History of contact with water was present in four cases. Trophozoites could be identified in all 8 cases in this series.

Topics: Adult; Amebiasis; Amphotericin B; Animals; Ceftazidime; Central Nervous System Protozoal Infections; Cerebrospinal Fluid; Drug Therapy, Combination; Fatal Outcome; Humans; Male; Naegleria fowleri; Rifampin; Tomography, X-Ray Computed; Treatment Refusal

Acanthamoeba-related cerebral abscess and encephalitis are rare but usually fatal, being caused by free-living amoebic infections usually occurring in immunocompromised patients. In patients receiving transplants, a literature review showed that the infection is universally fatal. The diagnosis is often missed despite appropriate investigations including lumbar puncture, computerized tomography, and brain biopsy. We present the first reported liver transplant patient with Acanthamoeba cerebral abscess. The diagnosis was made in brain tissue removed at decompressive frontal lobectomy. He was successfully treated with a 3-month course of co-trimoxazole and rifampicin. There was no recurrence of the disease after 11 years of follow-up.

Topics: Acanthamoeba; Adult; Amebiasis; Animals; Antimalarials; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Frontal Lobe; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Transplantation; Male; Opportunistic Infections; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Primary amebic meningoencephalitis (PAM) is a rapidly progressive and potentially fatal infection frequently contracted by swimming in bodies of warm fresh water. The etiological agent in most reported cases of PAM is the ameboflagellate Naegleria fowleri. Infection with this organism closely mimics and is often mistaken for a bacterial or a viral pyogenic meningitis. Recovery is rare and depends on rapid diagnosis and treatment. Physicians treating individuals who present with an acute pyogenic meningitis should consider the diagnosis of PAM, particularly if the patient has a recent history of swimming in warm fresh water. We review the recent literature for cases of PAM and the discuss ecology of N. fowleri and the clinical presentation, diagnosis, and treatment of PAM.

Topics: Amebiasis; Amphotericin B; Animals; Central Nervous System Protozoal Infections; Fresh Water; Humans; Naegleria fowleri; 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

An unusual case of peritonitis in a 61-year-old patient is reported where culture for bacteria and fungi were negative. Acanthamoeba was isolated and the patient was treated with Ceftazidine, Cefazolin, Levofloxacin, Fluconazole and Rifampicin with regular haemodialytic support. The patient was completely cured of the infection and continuous ambulatory peritoneal dialysis (CAPD) fluid became clear after 2 weeks of treatment. Diagnosis and treatment of Acanthamoeba infections are difficult due to the rarity of the infections, lack of familiarity of most clinicians with disease syndromes, and limitations of therapeutics options. Even an experienced microbiologist can easily mistake the amoebae in ascitic fluid for peritoneal macrophages or lymphocytes.

Topics: Acanthamoeba; Amebiasis; Drug Therapy, Combination; Fluconazole; Humans; Immunocompromised Host; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF) and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.

Topics: Adult; Amebiasis; Amebicides; Amphotericin B; Animals; Antiprotozoal Agents; Drug Therapy, Combination; Female; Humans; Meningitis; Naegleria fowleri; Ornidazole; Rifampin

Acanthamoeba was implicated as the causative agent of chronic meningitis in three apparently immunocompetent children. Diagnosis was established by cerebrospinal fluid wet mount examination and culture. Two children improved rapidly with combination oral therapy composed of trimethoprim-sulfamethoxazole, rifampin and ketoconazole.

Topics: Acanthamoeba; Administration, Oral; Amebiasis; Animals; Anti-Infective Agents; Antifungal Agents; Child; Child, Preschool; Chronic Disease; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Ketoconazole; Magnetic Resonance Imaging; Male; Meningitis; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Acanthamoeba, a free-living ameba of soil and water, produces the rare infections of granulomatous amebic encephalitis and amebic keratitis. We report a 38-year-old white man with the acquired immunodeficiency syndrome (AIDS) who experienced Acanthamoeba infection that presented as multiple skin nodules without associated encephalitis. Histologic examination revealed necrotizing granulomatous inflammation with numerous amebic organisms that were cultured and identified as Acanthamoeba group 2, probably Acanthamoeba castellani by monoclonal antibodies. Results of in vitro susceptibility testing demonstrated resistance to all six tested drugs. A partial clinical response, however, was obtained with multidrug therapy.

Topics: Acanthamoeba; Adult; AIDS-Related Opportunistic Infections; Amebiasis; Amebicides; Amphotericin B; Animals; Anti-Bacterial Agents; Antimetabolites; Antiparasitic Agents; Drug Therapy, Combination; Flucytosine; Humans; Male; Rifampin

Primary amoebic meningoencephalitis due to Naegleria fowleri was found in a 38-year-old Chinese man living in Hong Kong who presumably acquired the infection from swimming in a hot spring in neighbouring China. Amoebic cysts were identified in tissue taken from a brain abscess. The patient responded to surgical drainage and a 6-week course of amphotericin B, rifampicin and chloramphenicol. This is one of 6 cases of successful treatment of primary amoebic meningoencephalitis documented in the medical literature.

Topics: Adult; Amebiasis; Amphotericin B; Animals; Brain Abscess; Chloramphenicol; Combined Modality Therapy; Craniotomy; Drainage; Drug Therapy, Combination; Hong Kong; Humans; Male; Meningoencephalitis; Naegleria fowleri; Rifampin

Topics: Adolescent; Amebiasis; Amphotericin B; Animals; Cerebrospinal Fluid; Drug Therapy, Combination; Female; Humans; Itraconazole; Meningoencephalitis; Naegleria; Rifampin

BALB/c mice inoculated nasally with Acanthamoeba culbertsoni, resulting in amebic encephalitis and death 3-7 days, were treated with rifampicin prophylactically (daily for 2 days with 75 and 100 mg/kg) and after infection (daily for 5 days with doses of 10-100 mg/kg). Prophylactic treatment resulted in full protection against infection, as assessed by absence of symptoms of central nervous system malfunction and negative brain culture 10 days after inoculation. Curative treatment was effective at the same doses; however, at doses of 10, 25, and 50 mg/kg, only two of six animals were free of symptoms and infection.

Topics: Acanthamoeba; Amebiasis; Animals; Disease Models, Animal; Female; Male; Meningitis; Mice; Mice, Inbred BALB C; Rifampin

A 55-year-old diabetic aboriginal woman presented with a two-week history of fever, altered mental state and convulsions. On the basis of computed tomographic scanning a diagnosis of cerebral abscess was made. The pus that was drained produced no bacterial growth but, on microscopy, amoebic cysts were observed. Special cultures produced a growth of Acanthamoeba. The patient appeared to respond to drainage of the abscess and antiprotozoal therapy. Unfortunately, she developed necrotizing enteritis which led ultimately to her death. Antibiotic sensitivity and pathogenicity testing suggest that the Acanthamoeba were unusually virulent. The problems of diagnosis and management are discussed.

Topics: Acanthamoeba; Amebiasis; Animals; Animals, Suckling; Brain Abscess; Chloramphenicol; Drug Therapy, Combination; Female; Humans; Mice; Middle Aged; Rifampin; Time Factors

Topics: Amebiasis; Amphotericin B; Animals; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Male; Meningoencephalitis; Mice; Rifampin; Tetracycline

Topics: Amebiasis; Amphotericin B; Child; Female; Humans; Meningoencephalitis; Miconazole; Rifampin

In the summer of 1978, two children who had recently been swimming in freshwater lakes in Florida died from primary amoebic meningoencephalitis. Despite early and intensive treatment with amphotericin B, both patients died three to five days after the onset of illness. Amoebae were observed in wet preparations of cerebrospinal fluid and in sections of cerebral tissue and were identified as Naegleria fowleri by the indirect immunofluorescent antibody technique. The amoebae were highly virulent in mice. The isolate of N. fowleri was extremely sensitive in vitro to amphotericin B (minimal inhibitory concentration [MIC], 0.15 microgram/ml), somewhat sensitive to miconazole (MIC, 25 micrograms/ml), and resistant to rifampin (MIC, less than or equal to 100 micrograms/ml). Treatment with amphotericin B (7.5 mg/kg of body weight per day) administered intraperitoneally protected 60% of the mice. Lower doses of amphotericin B alone or in combination with miconazole (100 mg/kg) or rifampin (220 mg/kg) were not protective. These results suggest that amphotericin B remains the single effective agent in treatment of primary amoebic meningoencephalitis.

Topics: Adolescent; Amebiasis; Amphotericin B; Animals; Child; Humans; Male; Meningoencephalitis; Mice; Miconazole; Rifampin; Serologic Tests; Swimming

Topics: Acute Kidney Injury; Amebiasis; Antimalarials; Cholera; Drug Resistance, Microbial; Encephalitis; Glomerulonephritis; Helminthiasis; Hepatitis B Antigens; Humans; Leprosy; Malaria; Neurologic Manifestations; Parasitic Diseases; Pyrimethamine; Rifampin; Sulfonamides; Thiabendazole; Tropical Medicine; Trypanosomiasis, African