How is parasitic meningitis treated?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Primary amebic meningoencephalitis (PAM), caused by N fowleri, is usually fatal. The few survivors reported in the scientific literature benefited from early diagnosis and treatment with high-dose IV and intrathecal amphotericin B or miconazole and rifampin. More recently, miltefosine has been used to treat both N fowleri acute meningitis and Acanthamoeba chronic meningitis, resulting in cure in some instances, and should be used in suspected cases. [45]

Treatment of helminthic eosinophilic meningitis (such as that caused by A cantonensis or G spinigerum) is largely supportive. It includes adequate analgesia, therapeutic CSF aspiration, and the use of anti-inflammatory agents, such as corticosteroids. Anthelmintic therapy may be contraindicated, because clinical deterioration and death may occur as a consequence of severe inflammatory reactions to the dying worms.


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