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Section 2
Section 3
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Section 5
Appendices

The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.

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Section 3. Summaries of Infectious Diseases

Amebic Meningoencephalitis and Keratitis

(Naegleria fowleri, Acanthamoeba species, and Balamuthia mandrillaris)

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: Naegleria fowleri can cause a rapidly progressive, almost always fatal, primary amebic meningoencephalitis. Early symptoms include fever, headache, and sometimes, disturbances of smell and taste. The illness rapidly progresses to signs of meningoencephalitis, including nuchal rigidity, lethargy, confusion, and altered level of consciousness. Seizures are common. Death occurs within a week of onset of symptoms. No distinct clinical features differentiate this disease from fulminant bacterial meningitis.

Granulomatous amebic encephalitis caused by Acanthamoeba species and Balamuthia mandrillaris has a more insidious onset and progression of manifestations occurring weeks to months after exposure. Signs and symptoms may include personality changes, seizures, headaches, nuchal rigidity, ataxia, cranial nerve palsies, hemiparesis, and other focal deficits. Fever often is low grade and intermittent. The course may resemble that of a bacterial brain abscess or a brain tumor. Skin lesions (pustules, nodules, ulcers) may be present without central nervous system involvement, particularly in patients with acquired immunodeficiency syndrome.

Amebic keratitis, usually attributable to Acanthamoeba species and rarely to other species, occurs primarily in people who wear contact lenses and resembles keratitis caused by herpes simplex, bacteria, or fungi except for a usually more indolent course. Corneal inflammation (radial keratoneuritis or stromal ring infiltrate), pain, photophobia, and secondary uveitis are predominant features.


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ETIOLOGY: Naegleria fowleri, Acanthamoeba species, and Balamuthia mandrillaris are free-living amebae that exist as motile, infective trophozoites and environmentally hardy cysts.


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EPIDEMIOLOGY: Naegleria fowleri is found in warm fresh water and moist soil. Most infections with N fowleri have been associated with swimming in warm, natural bodies of water, but other sources have included tap . . . [Go to Full Text]


Related text in Red Book:

Drugs for Parasitic Infections

Red Book 2006: 790-820. [Extract] [Full Version]  



This topic has been referenced by these articles:

  • Ndiaye, I. C., Rassi, S. J., Wiener-Vacher, S. R. (2002). Cochleovestibular Impairment in Pediatric Cogan's Syndrome. Pediatrics 109: e38-38 [Abstract] [Full Version]