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Primary amoebic meningoencephalitis: first reported case from Rohtak, North India
Naveen Gupta1, Hemlata Bhaskar, Shalini Duggal
1National Institute of Communicable Diseases, New Delhi. nicdnaveen@gmail.com
Summary
This case report details a fatal instance of primary amoebic encephalitis (PAM) in a young leukemia patient. The amoeba Naegleria fowleri was identified, highlighting PAM as a consideration in unexplained meningoencephalitis.
Area of Science:
- Neurology
- Infectious Diseases
- Parasitology
Background:
- Primary amoebic encephalitis (PAM) is a rare and often fatal infection of the central nervous system caused by Naegleria fowleri.
- Acute leukemic leukemia (ALL) patients, even in remission, may present with complex neurological symptoms requiring broad differential diagnoses.
Observation:
- A 20-year-old male with acute leukemic leukemia (ALL) type L2, in remission, presented with symptoms suggestive of meningoencephalitis.
- Cerebrospinal fluid (CSF) analysis revealed the presence of amoebic trophozoites and flagellate forms, with no bacterial or fungal pathogens identified.
- The patient exhibited a poor response to amphotericin B treatment.
Findings:
- The isolated amoeba was identified as Naegleria fowleri based on its morphology, ability to grow at high temperatures (42-45°C), and presence of flagellate forms in CSF.
- The clinical course, diagnostic findings, and treatment response were consistent with PAM.
- Combination therapy included amphotericin B, tetracycline, rifampicin, and miconazole.
Implications:
- This case underscores the importance of considering PAM in the differential diagnosis of acute purulent meningoencephalitis, particularly in immunocompromised individuals.
- Early recognition and diagnosis of Naegleria fowleri infection are critical, although treatment options remain limited and outcomes are often poor.
- Further research into effective therapeutic strategies for PAM is warranted.
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