Free Living Amoeba Associated Meningoencephalitis: Case Series from Eastern India
Debarup Das1, Kokila Banerjee2, Soumitra Ghosh3, Anirban Datta3, Francis Kattady4, Yogiraj Ray5, Shantasil Pain3, Souvik Dubey1, Alak Pandit1, Biman Ray1, Sumeeta Khurana6, Atanu Biswas1
1Neurology, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, 2Microbiology, Drs. Tribedi and Roy Diagnostic Laboratory, 3General Medicine, 4Critical Care Medicine, 5Infectious Disease, IPGMER and SSKM hospital, 6Medical Parasitology, PGIMER
Objective:

To estimate the clinical and demographic profile, radiological spectrum and therapeutic outcomes of microbiologically diagnosed Free Living Amoeba (FLA) related meningoencephalitis cases.


Background:

Free living amoebas (FLA) are group of eukaryotic amoebas causing devastating consequences, fatally affecting Central Nervous System (CNS) with meningoencephalitis. There has been a recent surge in such cases particularly with Acanthamoeba in post COVID-19 pandemic period. In world literatures, experience with these notorious brain eating amoebas have been worrisome and lack clarity regarding management strategies.

Design/Methods:

Design

This Observational study was conducted between October 2022 to July 2024.

Setting

This study was conducted in a tertiary care hospital involving Institute of Post Graduate Medical Research and SSKM Hospital and Bangur Institute of Neurosciences in India.

Participants

We included all microbiologically (wet mount and/or PCR) diagnosed, FLA affected meningoencephalitis cases were included in our study


Results:

In our case series, out of 10 participants 5 were male, 5 were female. The age group was chiefly below 40 years (80%). All our cases were apparently immunocompetent with meningoencephalitis as presentation within 2 weeks (50%), and others were relatively subacute to chronic within 2-4 weeks (30%), more than 4 weeks (20%). All of our cases were diagnosed by demonstrating FLA on wet mount preparation and Neutrophilic predominant pleocytosis was demonstrated in 70% of the cases with high protein in all cases. FLA specific PCR was positive for Acanthamoeba sp. in 2 cases. They were treated with FLA specific triple drug regimen with Rifampicin, Fluconazole, Trimethoprim-Sulfamethoxazole with a very high cure rate (90%).


Conclusions:

There has been a surge of FLA, particularly Acanthamoeba associated meningoencephalitis from eastern India following COVID19 pandemic. Altered mucosal immune barriers might be at fault of this recent outbreak. Early diagnosis, lower threshold for suspicion and prompt therapeutic interventions are necessary to mitigate the catastrophic FLA related meningoencephalitis.


10.1212/WNL.0000000000211096
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