Kerala issues technical guidelines for diagnosis, management of amoebic meningoencephalitis

Sub: Sci

Sec: Health

Context:

Kerala has issued technical guidelines for diagnosis, management of amoebic meningoencephalitis.
These guidelines/standard operating procedure (SOP) are to be followed by all hospitals when dealing with cases of acute meningitis.

More on news:

Five cases of Amoebic meningoencephalitis have been reported in adolescents in the State in the past three months and with three young lives lost.
These guidelines are possibly the first set of guidelines in the country on amoebic meningoencephalitis which is a fatal infection.

What is amoebic meningoencephalitis?

Primary Amoebic Meningoencephalitis (PAM) is a rare but often fatal infection of the brain caused by the amoeba Naegleria fowleri, commonly known as the “brain-eating amoeba.”
It is non-communicable.
The causative agent is Naegleria fowleri which is a free-living amoeba typically found in warm freshwater environments such as lakes, rivers, hot springs, and poorly maintained swimming pools.
The amoeba enters the human body through the nose, usually when people are swimming or diving in contaminated water.
Once inside the nose, the amoeba travels up the olfactory nerve to the brain, where it causes severe inflammation and destruction of brain tissue.
The disease progresses rapidly, often leading to death within about 5 days after the onset of symptoms.

What is the treatment for amoebic meningoencephalitis?

Treatment includes antimicrobial therapy typically involving a combination of drugs, including amphotericin B, rifampin, and miltefosine, among others.
The best drug regimen should include an amebicidal drug (or a combination of drugs) with good in vitro activity that is capable of crossing the blood-brain barrier.

What are the recommended SOP?

A history of nasal exposure to fresh water in the 14 days before symptom onset should be asked of any patient who presents with symptoms of acute meningitis.
For patients with meningitis who have a history of recent nasal exposure to fresh water, the cerebro-spinal fluid (CSF) specimen should undergo rapid testing for N. fowleri/FLA .
All cases diagnosed as PAM through CSF microscopy should be immediately initiated on the recommended multi-drug regimen and supportive therapy.
All cases of PAM should be treated by a multidisciplinary team comprising physicians / pediatricians, intensivists, ID specialists, neurologists and microbiologists.