Akademik Veri Yönetim Sistemi
42nd International Symposium on Intensive Care & Emergency Medicine, Brussels, Belçika, 21 - 24 Mart 2023, sa.9011155, ss.143, (Tam Metin Bildiri)
Introduction: Primary amoebic meningoencephalitis (PAM) is rare but a life-threatening infection caused by free-living amoebas (FLA) [1]. Herein we present a complex PAM case that has been successfully treated.
Methods: 87 year old male was transferred to intensive care unit with an initial diagnosis of viral encephalitis. Medical history was normal except for a subdural hematoma operation 20 years ago. He was in Turkey for vacation. The patient was somnolent; had fever, altered sensorium and pneumonia. Leukocytosis and hyponatremia were present. Meropenem, vancomycin, clarithromycin and acyclovir treatments were started. Cultures and Herpes, Legionella, Listeria and tuberculosis tests were negative. The patient was orotracheal intubated due to generalized status epilepticus. Cranial imaging showed increased intracranial pressure, meningeal enhancement and subdural empyema in the right frontoparietal Burr- Hole region. He was operated. Incisions were made on the old scars and the Burr-Holes from previous surgery had been used. The CSF sample was colorless and had clean appearance. 20 leukocytes were counted and motile microorganisms with flagella were noticed during the count. A protozoa with vibratory movement was seen in the wet-mount preparation at 40x magnification (Fig. 1). Intravenous (IV) amphotericin-B, azithromycin, metronidazole and dexamethasone were administered. The patient, who was intubated for 11 days, was transferred from ICU on the 26th day healthily.
Results: PAM is an acute disease of the central nervous system caused by N. fowleri. Mortality of FLA infections may exceed 90%. Only 7 of 381 confirmed PAM cases survived and all of them got IV amphotericin-B [2].
Conclusions: Early diagnosis, neuroprotective management and effective treatment improve prognosis. Recently, miltefosine is proved to be effective.