1424. Miltefosine for Treatment of Free-living Ameba Infections Caused by Acanthamoeba species, Balamuthia mandrillaris, and Naegleria fowleri
Session: Poster Abstract Session: CNS Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • IDWeek 2013 Miltefosine Poster Final.pdf (252.4 kB)
  • Background: Free-living amebae (FLA) live in fresh water and soil. Acanthamoeba species and Balamuthia mandrillaris can cause a subacute to chronic central nervous system infection in humans called granulomatous amebic encephalitis while Naegleria fowleri causes an acute infection called primary amebic meningoencephalitis (PAM). Acanthamoeba spp. and B .mandrillaris also cause disseminated infections involving other organ systems.  These infections are often fatal and undiagnosed prior to death. When the diagnosis is made premortem, treatment is often ineffective. Miltefosine, an investigational drug with in vitro activity against FLA, has been given since 2009 with CDC assistance under compassionate use for FLA infections.

    Methods: We reviewed the literature and case reports submitted to CDC to determine treatment regimens and compare mortality for case-patients with non-keratitis Acanthamoeba spp. infection, B. mandrillaris infection, and PAM based on treatment regimen. Fisher’s exact test was used to analyze proportions.

    Results: We identified 63 cases of non-keratitis Acanthamoeba spp. infection for which treatment was documented from 1955 to 2012. Among seven cases treated with a miltefosine-containing regimen, 5 (71%) survived compared with 9/56 (16%) not treated with miltefosine (P= 0.005). We identified 60 B. mandrillaris infections from 1974 to 2012 for which treatment was documented. Among 14 treated with a miltefosine-containing regimen, 6 (43%) survived compared with 6/46 (13%) patients not treated with miltefosine (P= 0.05). One identified PAM case received miltefosine but did not survive compared with 1/127 (0.8%) not treated with miltefosine from 1962 to 2012.

    Conclusion: While the number of Acanthamoeba spp. and B. mandrillaris infections treated with a miltefosine-containing regimen is small, we conclude that a miltefosine-containing treatment regimen does offer a survival advantage for these often fatal infections. Due to PAM’s rapid progression to death, the ability to quickly administer miltefosine is necessary to determine its efficacy against PAM. CDC should provide drug to clinicians for FLA infections under an expanded access IND until it becomes commercially available in the United States.

    Jennifer Cope, MD, Sharon Roy, MD, Jonathan S. Yoder, MSW, MPH and Michael Beach, PhD, Centers for Disease Control and Prevention, Atlanta, GA


    J. Cope, None

    S. Roy, None

    J. S. Yoder, None

    M. Beach, None

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