Naegleria fowleriThat Induces Primary Amoebic Meningoencephalitis: Rapid Diagnosis and Rare Case of Survival in a 12-Year-Old Caucasian Girl

Abstract

Primary amoebic meningoencephalitis (PAM) is a rare and almost always fatal disease that is caused by Naegleria fowleri, a freshwater thermophilic amoeba. Our case involves an adolescent female who presented with fever of unknown origin. A lumbar puncture was performed, and the Wright-Giemsa and Gram stained cerebrospinal fluid (CSF) cytospin slides showed numerous organisms. Experienced medical technologists in the microbiology and hematology laboratories identified the organisms as morphologically consistent with Naegleria species. The laboratory made a rapid diagnosis and alerted emergency department care providers within 75 minutes. The patient was treated for PAM with amphotericin, rifampin, azithromycin, fluconazole and aggressive supportive therapy including dexamethasone. The Centers for Disease Control and Prevention (CDC) was contacted, and miltefosine, an investigational medication, was started. Additional treatment included an intraventricular shunt and controlled hypothermia in order to mitigate potential cerebral edema. Our patient is a rare success story, as she was diagnosed swiftly, successfully treated, and survived PAM.

A case report: primary amoebic meningoencephalitis in a young Zambian adult

“…The lack of information on PAM in Zambia indicates that there is limited or no awareness among clinical and laboratory staff leading to misdiagnosis of cases. In the few cases of PAM successfully managed [ 10 , 11 ] in other regions, correct and prompt diagnosis was done and treatment commenced without delay. In the absence of a detailed history of exposure, it is very difficult to clinically diagnose PAM as the infection presents like other types of meningitis.…”

Drugs used for the treatment of cerebral and disseminated infections caused by free‐living amoebae

“…The most relevant drug combinations gathered in the current work for PAM treatment associated either (a) amphotericin B and an azole (fluconazole, ketoconazole or miconazole), with or without rifampicin (combination B PAM ), or (b) amphotericin B, azithromycin, fluconazole, or rifampicin with or without miltefosine (combination A PAM ; Table 1). 56, In the latter combination, miltefosine was associated with rifampicin in 28 cases out of 34, [60][61][62][63][64]70,73,76 both drugs presenting the highest EDU according to our analysis (Figure 4b). The combination A PAM , which was the closest to the one recommended by the CDC, was successful in 18% of the 34 clinical cases treated by this drug association.…”

“…Moreover, in the combination A PAM associating both rifampicin and miltefosine with amphotericin B, azithromycin, and fluconazole, the outcome was also successful in 18% of 28 cases. [60][61][62][63][64] Nevertheless, the combination B PAM was used in a larger number of cases (45) and exhibited the same EDU value at 18% (Table 1). Therefore, this simplified combination associating only two or three molecules might also be recommended for PAM therapy, with a lower risk of toxicity for the patient.…”

“…The combination A PAM , which was the closest to the one recommended by the CDC, was successful in 18% of the 34 clinical cases treated by this drug association. Moreover, in the combination A PAM associating both rifampicin and miltefosine with amphotericin B, azithromycin, and fluconazole, the outcome was also successful in 18% of 28 cases 60–64 . Nevertheless, the combination B PAM was used in a larger number of cases (45) and exhibited the same EDU value at 18% (Table 1).…”

A Fatal Case of Primary Amoebic Meningoencephalitis from Recreational Waters

“…Specific diagnostic tools and general increased awareness of PAM are required to initiate treatment sooner. In the few cases of PAM that were successfully managed in the past, a correct and prompt diagnosis was made [12,13]. History of water exposure is…”