235.4 📌 章末速蚘

235.4.0.0.1 Naegleria fowleri (PAM)
  • “Brain-eating ameba”
  • Warm freshwater swimming + diving + neti pot tap water
  • Nasal → cribriform plate → olfactory → CNS
  • Sudden severe headache + olfactory loss + stiff neck
  • Mortality > 97%; < 10 survivors
  • Treatment: combination (amphotericin B IV/IT + miltefosine + azithromycin + fluconazole + rifampin + dex + hypothermia)
  • Prevention: nose clip, boiled neti pot water
235.4.0.0.2 Acanthamoeba
  • Keratitis (contact lens wearers + tap water): ring corneal infiltrate, severe pain disproportionate
  • GAE (immunocompromise): subacute chronic encephalitis
  • Cutaneous + Disseminated (immunocompromise)
  • Treatment keratitis: topical chlorhexidine/PHMB + propamidine + neomycin long course
  • Treatment GAE: miltefosine + combination
235.4.0.0.3 Balamuthia mandrillaris
  • Immunocompetent + immunocompromise
  • Subacute / chronic GAE + cutaneous
  • Soil + water exposure
  • Miltefosine + multi-drug combination
  • Cutaneous often precedes CNS
235.4.0.0.4 General
  • Miltefosine = key drug for all 3
  • CDC 24/7 hotline for treatment guidance
  • Aggressive combination + early Tx = best chance survival
  • Climate change expanding Naegleria range
  • 盧醫垫 hint: 急 severe meningoencephalitis + freshwater exposure → PAM until R/O; contact lens + corneal pain → Acanthamoeba keratitis