Published Date: 2010-08-29 17:00:04
Subject: PRO/EDR> Amebic meningoencephalitis, primary - USA: (MN)
Archive Number: 20100829.3077
AMEBIC MENINGOENCEPHALITIS, PRIMARY - USA: (MINNESOTA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 27 Aug 2010
Source: Twincities.com [edited]
Health officials confirm a 7-year-old girl has died of a very rare
form of meningitis, but they say the public is not at risk.
The Minnesota Department of Health says the disease was caused by a
common kind of amoeba associated with warm freshwater. In very rare
cases, it can cause a severe brain infection that's nearly always fatal.
The particular organism infects people by entering the body through
the nose, generally when people swim.
In the 10 years ending in 2007, 33 infections were reported in the
U.S., mostly in southern states. By comparison, drowning deaths occur
1200 times more often.
Health officials say the girl swam at several locations in the weeks
before her death, and they note it has been an unusually warm summer.
Dr. Richard Danila, an epidemiologist with the department, says the
case does not signal any increased risk to the public from any
particular body of water, and people should not avoid swimming.
[Encephalitis from free living amoeba occurs worldwide except in the
arctic regions. The route of infection is through the nasal mucosa
directly into the brain. The diagnosis is difficult and requires a
brain biopsy with histology, supplemented by PCR.
Several species of free living amoeba may cause encephalitis:
_Naegleria fowleri_, _Acanthamoeba_, _Balamuthia mandrillaris_, and
recently _Paravahlkampfia francinae_ have been described.
A recent review of amebic encephalitis in the United Sates was
published in 2009: Hannafin B et al. Update on emerging infections:
News from the Centers for Disease Control and Prevention. Primary
amebic meningoencephalitis-Arizona, Florida, and Texas, 2007. Ann
Emerg Med. 2009;54:469-72.
Treatment is difficult, and several combinations of amphotericin B
plus azithromycin, rifampicin and fluconazole have reportedly had
effect in animal models or single human cases.
The broad spectrum anti-protozoan drug nitazoxanide is theoretically
an option, but no studies or cases have been reported. - Mod.EP]
[For the interactive HealthMap/ProMED map of Minnesota, see
<http://healthmap.org/r/00DI>. - Mod.MPP]