infectious diseases
Granulomatous Amebic Encephalitis
Treatment of Granulomatous Amebic Encephalitis
A combination of antiparasitic drugs, includingmiltefosine Consultation with the Centers for Disease Control and Prevention Optimal treatment ofAcanthamoebaencephalitis is unclear. For all cases, immediate consultation with the Centers for Disease Control and Prevention (CDC) is recommended (call theCDC Emergency Operations Centerat 770-488-7100). Multiple drugs (often > 5) are typically used in combination. Although the number of patients treated with a regimen containingmiltefosineis small,miltefosineappears to offer a survival advantage and is recommended. Other drugs that have been used in combination withmiltefosineto treatAcanthamoebaencephalitis includepentamidine,sulfadiazineortrimethoprim/sulfamethoxazole,flucytosine, an azole (fluconazole,itraconazole, orvoriconazole),rifampinandamphotericin B. ForB. mandrillarisencephalitis,miltefosinein combination with other drugs such asflucytosine,pentamidine,fluconazole, and/orsulfadiazineplus eitherazithromycinorclarithromycinplus surgical resection have been used. A case ofSappinia pedataencephalitis was successfully treated with a combination ofazithromycin,pentamidine,itraconazole, andflucytosineplus surgical resection of the central nervous system (CNS) lesion. Addingmiltefosineto this regimen should be considered in future cases. Skin and disseminated infections caused byAcanthamoebaspecies orB. mandrillarisare usually treated with the same drugs plus surgical debridement of cutaneous lesions. 