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Primary amoebic meningoencephalitis: two new cases from Pakistan
Taimur Saleem1, Madiha Rabbani, Bushra Jamil
1The Aga Khan University, Stadium Road, Karachi, Pakistan. taimur@gmail.com
Tropical Doctor
|August 13, 2009
Summary
Naegleria fowleri causes fatal primary amoebic meningoencephalitis. This report details two Pakistan cases, both resulting in death despite aggressive treatment for this rare CNS infection.
Area of Science:
- Neurology
- Infectious Diseases
- Parasitology
Background:
- Naegleria fowleri is a free-living amoeba that causes primary amoebic meningoencephalitis (PAM), a rare and almost universally fatal central nervous system infection.
- Previous reports of PAM in Pakistan are scarce, highlighting the need for increased awareness and diagnostic capabilities.
Observation:
- Two cases of PAM in young men in Pakistan are presented.
- Both patients exhibited rapid neurological deterioration with symptoms including high fever, headaches, vomiting, and agitation.
- Motile trophozoites of Naegleria fowleri were identified in cerebrospinal fluid via wet mount microscopy.
Findings:
- Despite prompt administration of intrathecal amphotericin B, fluconazole, rifampicin, and broad-spectrum antibiotics, both patients succumbed to the infection.
- The first patient died on day six, and the second patient died on day eight of admission, indicating a fulminant disease course.
- Treatment efficacy appears limited in these severe cases of Naegleria fowleri infection.
Implications:
- These cases underscore the high mortality rate associated with Naegleria fowleri infections, even with aggressive therapeutic interventions.
- Enhanced surveillance and rapid diagnostics for PAM are crucial in regions where Naegleria fowleri may be endemic.
- Further research into novel therapeutic strategies is warranted to improve outcomes for patients with this devastating infection.
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