Acanthamoeba Infection in a Drowning Child

BACKGROUND Acanthamoeba infection is a potential life-threatening complication of drowning. The management of drowning-associated Acanthamoeba infection remains controversial. Survival reports on Acanthamoeba infection have been on case reports only. CASE DETAILS A 2-year-old, previously healthy Indonesian boy presented with decreased consciousness and inadequate breathing, followingdrowning. The event was unsupervised with unknown estimated time of submersion. Resuscitation was commenced and mechanical ventilated was applied. Sputum specimen revealed alive Acanthamoeba with pseudopods and cysts. Sputum culture resulted in Pseudomonas aeruginosa and cerebrospinal fluid was supportive for Acanthamoeba with 1-3 trophozoites and cyst. Imaging of the head showed cerebral edema and encephalitis. The patient received intravenous ceftazidime, metronidazole, fluconazole and rifampicin. The patient's consciousness was unsatisfactory regained resulting in an altered mental status. CONCLUSION No treatment so far has given a succesful outcome for Acanthamoeba. In this case, management with metronidazole, rifampicin and fluconazole showed regain of consciousness resulting in altered mental status.