235.2 ð åèç
235.2.0.1 å¿ è â 3 Major Free-Living Amebae
| Pathogen | Disease | Host | Course | Mortality |
|---|---|---|---|---|
| Naegleria fowleri | PAM | Immunocompetent | Rapid (1-2 wk) | > 97% |
| Acanthamoeba | GAE + Keratitis + Cutaneous + Disseminated | Immunocompromise (GAE); CL wearers (keratitis) | Subacute / chronic | 90%+ GAE |
| Balamuthia mandrillaris | GAE + Cutaneous | Immunocompetent + immunocompromise | Subacute / chronic | 89%+ |
235.2.0.2 å¿ è â Naegleria PAM
- Warm freshwater swimming + diving (lakes, hot springs, pools, neti pot)
- Nasal entry â cribriform plate â olfactory bulbs â CNS
- Sudden onset severe headache + fever + olfactory disturbance + stiff neck
- Mortality > 97%; < 10 documented survivors globally
- Treatment: combination (amphotericin B IV/IT + miltefosine + azithromycin + fluconazole + rifampin + dex + hypothermia)
- CDC 24/7 hotline for treatment guidance
235.2.0.3 å¿ è â Acanthamoeba Keratitis
- Contact lens wearers (tap water rinse, extended wear, swimming with lens)
- Severe pain disproportionate to findings
- Ring corneal infiltrate, pseudo-dendritic
- Often misdiagnosed as HSV initially
- Treatment: topical chlorhexidine/PHMB + propamidine + neomycin (long course); corneal transplant if severe
235.2.0.4 å¿ è â Acanthamoeba GAE
- Immunocompromise (HIV, transplant)
- Subacute / chronic
- Brain biopsy diagnostic
- Combination therapy + miltefosine + immune restoration
235.2.0.5 å¿ è â Balamuthia mandrillaris
- Immunocompetent + immunocompromise
- Subacute / chronic
- Cutaneous often precedes CNS (months-years)
- Multi-drug therapy + miltefosine
235.2.0.6 å¿ è â Miltefosine
- Key drug for free-living amebae
- FDA accelerated 2013
- CDC compassionate use
- Pregnancy contraindicated
235.2.0.7 å¿ è â Prevention
- Naegleria: avoid warm freshwater diving + neti pot with tap water + nose clip
- Acanthamoeba keratitis: contact lens hygiene + no tap water rinse + no swimming with lens
- Balamuthia: limit soil + water exposure (limited prevention)