A Case of Primary Amebic Meningoencephalitis in Zaria, Nigeria

Lawande, R. V.; John, Isaac; Dobbs, Richard H.; Egler, L J

doi:10.1093/ajcp/71.5.591

Cited by 28 publications

(14 citation statements)

References 17 publications

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“…In PAM, infection occurs via the olfactory tract, and infection of the brain is direct; hematogenous spread does not occur in humans. In a young child in northern Nigeria, there was no association with swimming in water and death that occurred from PAM due to N. fowleri (2).…”

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confidence: 89%

Primary Meningoencephalitis by Naegleria fowleri : First Reported Case from Mangalore, South India

et al. 2002

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A fatal case of primary amebic meningoencephalitis (PAM) in a 5-month-old infant is described. The disease may have been contracted during bathing. The source of water was from an artificial well. The clinical presentation, the isolation of the ameba from the cerebrospinal fluid, the poor response to amphotericin B, and the ultimate fatal outcome are all consistent with the diagnosis of PAM. On the basis of its ability to grow at temperatures above 30°C, the morphology of the trophozoite, and the presence of flagellate forms, the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri amebae were recovered from samples of water from the well. To our knowledge this case represents the second case of PAM in an infant in the absence of the history of swimming.Naegleria fowleri, a free-living ameba, is ubiquitous and worldwide in distribution. It can infect humans and cause significant disease. It penetrates through the cribriform plate and can cause fulminant and rapidly fatal meningoencephalitis. Most of the infections have been associated with bathing in streams, ponds or lakes, and indoor swimming baths where the water is warm (7). We report on a case of primary amebic meningoencephalitis (PAM) in an infant who had not been swimming. To our knowledge this is the first case of PAM to be reported in Mangalore, India.Case history. A 5-month-old infant presented with a history of fever, vomiting for 1 week, and convulsions for 3 days. On physical examination, the child was febrile (38.5°C), continuous convulsions were present, and the pupils were reactive. There was a progressive deterioration of consciousness, leading to coma. There was no significant finding in the cardiovascular system or respiratory system or by abdominal examination. A computed tomography scan showed mild effacement of the basal cisterns and a thin hypodense collection in bilateral frontal convexity, suggesting a possibility of subdural hygroma or subdural effusion.Laboratory data included a total leukocyte count of 7,300/ mm 3 , with 71% neutrophils, 26% lymphocytes, and 3% eosinophils. The hemoglobin concentration was 10.2 g/dl. No parasites were seen in the peripheral smear. The blood electrolyte picture showed sodium at 133 mmol/liter, potassium at 4.4 mmol/liter, chloride at 95 mmol/liter, bicarbonate at 18.6 mmol/liter, phosphorus at 4.7 mg/dl, blood urea nitrogen at 14 mg/dl, a serum calcium level of 9.2 mg%, and a random blood sugar level of 120 mg/dl.The cerebrospinal fluid (CSF) was cloudy and hemorrhagic; and analysis showed the presence of sugar at a concentration of 10 mg/dl, proteins at a concentration of 361 mg/dl, and a cell count of 130 cells/mm 3 , with 80% neutrophils and 20% lymphocytes. Gram staining showed numerous polymorphonuclear leukocytes but no bacteria. Examination of a wet mount showed actively motile trophozoites suggestive of PAM. A Giemsa-stained smear showed trophozoites.CSF sediment culture on 1.5% nonnutrient agar preseeded with a lawn culture of Escherichia coli yielded oval, motile, flagellated for...

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Primary Meningoencephalitis by Naegleria fowleri : First Reported Case from Mangalore, South India

et al. 2002

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“…Amphotericin B may also cause anemia, and many patients experience chills, fever, nausea, vomiting, and headache (23,25). Moreover, only 10 persons with PAM have been treated successfully with amphotericin B, alone or in combination with other drugs (1,2,6,17,20,21,24,(28)(29)(30)(31)(33)(34)(35). Therefore, fast-acting and efficient drugs are urgently needed for the treatment of PAM.…”

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Corifungin, a New Drug Lead against Naegleria, Identified from a High-Throughput Screen

Debnath

Tunac²,

Galindo-Gómez

et al. 2012

Antimicrob Agents Chemother

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c Primary amebic meningoencephalitis (PAM) is a rapidly fatal infection caused by the free-living ameba Naegleria fowleri. The drug of choice in treating PAM is the antifungal antibiotic amphotericin B, but its use is associated with severe adverse effects. Moreover, few patients treated with amphotericin B have survived PAM. Therefore, fast-acting and efficient drugs are urgently needed for the treatment of PAM. To facilitate drug screening for this pathogen, an automated, high-throughput screening methodology was developed and validated for the closely related species Naegleria gruberi. Five kinase inhibitors and an NFkappaB inhibitor were hits identified in primary screens of three compound libraries. Most importantly for a preclinical drug discovery pipeline, we identified corifungin, a water-soluble polyene macrolide with a higher activity against Naegleria than that of amphotericin B. Transmission electron microscopy of N. fowleri trophozoites incubated with different concentrations of corifungin showed disruption of cytoplasmic and plasma membranes and alterations in mitochondria, followed by complete lysis of amebae. In vivo efficacy of corifungin in a mouse model of PAM was confirmed by an absence of detectable amebae in the brain and 100% survival of mice for 17 days postinfection for a single daily intraperitoneal dose of 9 mg/kg of body weight given for 10 days. The same dose of amphotericin B did not reduce ameba growth, and mouse survival was compromised. Based on these results, the U.S. FDA has approved orphan drug status for corifungin for the treatment of PAM.

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“…6 Although the disease is typically associated with swimming or freshwater contact, it may also occur via inhalation of contaminated dust. [7][8][9] Cases have been reported along the East coast of the 11 Meningoencephalitis has been reported in the US (n = 91), Australia (n = 19) and Venezuela (n = 18), along with sporadic outbreaks globally. The US Centers for Disease Control and Prevention (CDC) reports 2-4 cases annually from collaborative surveillance reports of waterborne diseases.…”

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confidence: 99%

“…Once contracted, PAM is almost uniformly fatal, with only 10 survivors currently reported in the medical literature. 8,[16][17][18][19][20][21][22][23][24] One French study 25 extrapolated the risk of contracting PAM after swimming once in water containing an ameba concentration of 10 per liter as being approximately 8.5 ×10 -8 .…”

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confidence: 99%

Primary amebic meningoencephalitis: a silent killer

Grate

2006

CJEM

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One week after swimming in a man-made lake, a 9-year-old boy presented to the emergency department with headache, vomiting and lethargy. He had neck pain upon flexion and was unable to stand or walk. Cerebrospinal fluid examination revealed trophozoite and diflagellate forms consistent with Naegleria fowleri, an ameba species known to cause primary amebic meningoencephalitis. Despite aggressive management with amphotericin B and rifampin, he died 2 days later. This case report describes the clinical presentation, diagnostic findings and management of this uncommon but lethal entity. RÉSUMÉUne semaine après avoir nagé dans un lac artificiel, un garçon de 9 ans se présente à l'urgence : il a des maux de tête, vomit et est léthargique. Il a une douleur au cou à la flexion et est incapable de se tenir debout ou de marcher. Une analyse du liquide céphalorachidien révèle la présence de formes de trophozoïtes et de diflagellés correspondant à Naegleria fowleri, une espèce d'amibe reconnue pour causer la méningoencéphalite amibienne primitive. En dépit d'un traitement agressif à l'amphpotéricine b et à la rifampine, il est mort deux jours plus tard. Le rapport de cas décrit les symptômes cliniques, les constatations diagnostiques et le traitement de cette entité rare mais mortelle.

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A Case of Primary Amebic Meningoencephalitis in Zaria, Nigeria

Cited by 28 publications

References 17 publications

Primary Meningoencephalitis by Naegleria fowleri : First Reported Case from Mangalore, South India

Primary Meningoencephalitis by Naegleria fowleri : First Reported Case from Mangalore, South India

Corifungin, a New Drug Lead against Naegleria, Identified from a High-Throughput Screen

Primary amebic meningoencephalitis: a silent killer

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