Primary amoebic meningoencephalitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Natural History, Complications and Prognosis
The disease is both exceptionally rare and highly lethal: there had been fewer than 200 confirmed cases in recorded medical history as of 2004,[1] 300 cases as of 2008,[2] with an in-hospital case fatality rate of ~97% (3% patient survival rate). [3]
The high mortality rate of this disease is largely blamed on the unusually non-suggestive symptomology of the early-stage disease compounded by the necessity of microbial culture of the cerebrospinal fluid to effect a positive diagnosis. The parasite also demonstrates a particularly rapid late-stage propagation through the nerves of the olfactory system to many parts of the brain simultaneously (including the vulnerable medulla).
For those reasons, it has been suggested that physicians should give an array of antimicrobial drugs, including the drugs used to treat amoebic encephalitis, before the disease is actually confirmed in order to increase the number of survivors. However, administering several of those drugs at once (or even some of them known to treat the condition) is often very dangerous and unpleasant for the patient.
After the organisms have multiplied and largely consumed the olfactory bulbs, the infection rapidly spreads through the mitral cell axons to the rest of the cerebrum, resulting in onset of frank encephalitic symptoms, including cephalgia (headache), nausea, and rigidity of the neck muscles, progressing to vomiting, delirium, seizures, and eventually irreversible coma. Death usually occurs within 14 days of exposure as a result of respiratory failure when the infection spreads to the brain stem, destroying the autonomic nerve cells of the medulla oblongata.
References
- ↑ Wiwanitkit V (2004). "Review of clinical presentations in Thai patients with primary amoebic meningoencephalitis". MedGenMed. 6 (1): 2. PMC 1140726. PMID 15208515.
- ↑ Caruzo G, Cardozo J (2008). "Primary amoebic meningoencephalitis: a new case from Venezuela". Trop Doct. 38 (4): 256–7. doi:10.1258/td.2008.070426. PMID 18820207. Unknown parameter
|month=ignored (help) - ↑ "Amebic Meningoencephalitis". Retrieved 16 July 2010.