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Page 6 August 27, 2001 DPN
or permanent smears may be prepared
and stained with Wright's or Giemsa. The
amebae can be recognized by their nucleii
with a large karyosome; while living, the
contractile vacuole characteristic of all
free-living amebae can be observed.
Naegleria can be cultured from CSF on
non-nutrient agar, plated with attenuated
Esherichia coli to amplify amebae numbers
and allow detection. To distinguish N.
fowleri from other amebae, like Acanthameba
species, identification methods include
indirect fluorescent antibody procedures for
direct specimens, and transformation studies of
cultured organisms (forcing amebae to transform
to flagellated forms by manipulating environ-
mental conditions). Hospitals and physicians
wishing to submit specimens to TDH, should
ship 0.5 ml of unrefrigerated CFS overnight
(except on Friday or Saturday) to: TDH Labo-
ratory, 1100 W 49th St., Austin, TX 78756.
disease is rare, those infected usually die within, a
week. Only a handful of nonfatal cases have been
reported; most of the individuals presented with
CSF glucose levels that were uncharacteristically
normal. Table 1 describes treatment regimens
that have been successful in treating the few
patients who have survived PAM.
Swimming pools that are properly cleaned,
maintained, and treated with chlorine generally
are safe, as is salt water. TDH recommends that
people never swim in stagnant or polluted water
and take "No Swimming" signs seriously. Also,
people should hold their noses or use a plug
when jumping into lakes, rivers, ponds, or other
bodies of fresh water and avoid swallowing
water when swimming.
Reference
Taylor JP, Hendricks KA, and Dingley DD. Amebic
Meningoencephalitis. Inf in Med 1996;13(12):1017, 1024.
From 1980 through 2000, 20 cases of PAM
were reported in Texas, all fatal. Though the
Table 1. Successful Treatment Regimens for Amebic Encephalitis'
2,640 56mg/dL 340mg/dL
5,356 100mg.dL 61mg/dL
- normal 43mg/dL
Treatments Regimens
Drug
Amphotericin
Amphotericin
Ampicillin
Penicillin
Sulfadiazine
Amphotericin
B
B
B
Amphotericin B
Rifampin
Miconazole
Miconazole
Sulfisoxazole
Amphotericin B
Amphotericin B
Rifampin
Penicillin
Amphotericin B
Rifampin
Chloramphenicol
Route
IV
ITh
Dose/Duration
1 mg/kg/day
0.1mg every other day
IV 1.5mg/kg/day for 3 days, then
1.0mg/kg/day for 6 days
ITh 1.5 mg/day for 2 days, then 1.0mg
every other day for 8 days
PO 1 0mg/kg/day for 9 days
IV 350mg/m2/day for 9 days
ITh 10mg/day for 2 days, then
10mg every other day for 8 days
1g qid for 3 days
IV 75mg/day for 10 days
ITh 0.5mg every other day for 10 days
PO 600mg bid for 10 days
IV 24 million units/day for <1 day
IV 60mg/day
- 450mg/day
- 1g qid
ITH = intrathecal; dash = data were not available
Further information on PAM, including swimming pool maintenance and swimmers' precautions, is
contained in these issues of DPN: July 17, 1997 (Vol 57, No. 15) and July 16, 2001(Vol 61, No.
15). You may also contact Neil Pascoe, Infectious Disease Epidemiology and Surveillance Division,
at 512/458-7676; neil.pascoe@tdh.state.tx.us.
CSF Findings
Reference WBC Glucose Protein
Carter 12,000 - -
Seidel ,et al
Brown
Wang, et al
August 27, 2001
DPN
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