Successful treatment of Acanthamoeba meningitis with combination oral antimicrobials

Area of Science:

• Neurology
• Infectious Diseases
• Microbiology

Background:

• Acanthamoeba infections are rare but serious, particularly in immunocompetent individuals.
• Chronic meningitis presents a diagnostic challenge, especially when caused by unusual pathogens.
• Understanding Acanthamoeba's role in central nervous system infections is crucial for timely diagnosis and treatment.

Observation:

• Three immunocompetent children presented with chronic meningitis.
• Cerebrospinal fluid analysis, including wet mount and culture, identified Acanthamoeba as the causative agent.
• Clinical presentation and diagnostic findings highlighted the potential for Acanthamoeba to cause prolonged CNS inflammation.

Findings:

• Acanthamoeba species were confirmed as the etiology of chronic meningitis in pediatric cases.
• Cerebrospinal fluid wet mount and culture are effective diagnostic methods for Acanthamoeba meningitis.
• Two out of three children showed rapid improvement with a specific combination oral antibiotic regimen.

Implications:

• This study underscores the importance of considering Acanthamoeba in the differential diagnosis of chronic meningitis, even in immunocompetent children.
• The identified combination oral therapy (trimethoprim-sulfamethoxazole, rifampin, ketoconazole) shows promise for treating Acanthamoeba meningitis.
• Further research into Acanthamoeba pathogenesis and optimal treatment strategies is warranted to improve patient outcomes.