Primary Amoebic Meningoencephalitis.

Area of Science:

• Neurology
• Infectious Diseases
• Microbiology

Background:

• Primary amoebic meningoencephalitis (PAM) is a rare and fatal infection of the central nervous system.
• Naegleria fowleri, a free-living amoeba, is the causative agent, often associated with freshwater exposure.
• Co-infection with retroviral disease presents unique diagnostic and therapeutic challenges.

Observation:

• A 40-year-old patient with a history of well water use and retroviral disease presented with symptoms of severe headache, fever, nausea, vomiting, and slurred speech.
• Cerebrospinal fluid (CSF) analysis revealed elevated protein, low glucose, and lymphocytic predominance, with negative cryptococcal antigen.
• Wet mount preparation of CSF confirmed the presence of motile Naegleria fowleri.

Findings:

• Despite normal CT and MRI findings, PAM was diagnosed based on CSF microscopy.
• The patient received a combination therapy including Amphotericin B, Metronidazole, Rifampicin, Antiretroviral Therapy (ART), and Anti-tuberculosis Therapy (ATT).
• This treatment regimen resulted in symptom relief and clinical improvement.

Implications:

• This case highlights the importance of considering PAM in immunocompromised patients, even with non-specific symptoms.
• Prompt diagnosis and aggressive combination therapy, including Amphotericin B, can improve outcomes in Naegleria fowleri infections.
• Further research is needed to understand the interaction between retroviral disease and PAM and to optimize treatment strategies.