Abstract
Meningoencephalitis caused by free-living amoebas (FLA) has a high mortality rate, and most treatments are ineffective. FLA includes Naegleria, Fowleri, Acanthamoeba, and Balamuthia mandrillaris (M). We explore the use of miltefosine in the treatment of one of these infections. The concerning mortality of the infection obligates us to look for more effective treatments for meningoencephalitis caused by FLA. During this review, we will consolidate the knowledge of using miltefosine in these three infections. We will investigate the mechanism by which the drug is effective in these infections as well. After this comprehensive review, we should assess if miltefosine improves the mortality and prognosis of the infection with the information collected. We used a Medical Subject Headings (MeSH) search on PubMed. Inclusion criteria included papers written in the English language and human subjects research for the past 25 years. Until today, there are no definitive guidelines to be followed when treating such patients. However, miltefosine has demonstrated promising results. Miltefosine decreases the usual mortality rate in the three infections; however, there are few reports due to the low frequency of these infections. Almost all cases we documented have survived. More information needs to be gathered for the use of miltefosine for these infections.
Highlights
Meningoencephalitis caused by free-living amoebas (FLA) has a high mortality rate, and most treatments are ineffective
The key is to perform a lumbar puncture with cerebrospinal fluid (CSF) analysis by a phase-contrast microscope is beneficial to ameba visualization
The drug's role is analyzed in the treatment of the three FLA (Naegleria, Balamuthia, and Acanthoamabe) meningoencephalitis
Summary
BackgroundNaegleria causes primary amebic meningoencephalitis (PAM). The parasite lives in temperatures above 30 degrees and can tolerate temperatures up to 45 degrees. 300 cases have been reported worldwide [1]. Inhalation of infected water leads to the involvement of the olfactory bulb. Extra central nervous system (CNS) infection has been reported [1]. In a CDC report, 79% of cases were male, and infections occurred mainly in the July-September period in the southern states [2]. For PAM, the median time from exposure to death is 9.9 days [3]. In a report of 111 cases, mortality was 99% [3]. The main symptoms of the disease are neurological. The disease presents rapid deterioration with profound mental alteration and severe intracranial hypertension leading to herniation and death a few days after the onset of symptoms [4]. Giemsa or trichrome stains help define morphology features [5]
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