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Primary Amoebic Meningoencephalitis

Ritu Gupta, M K Parashar, Aditya Kale

    The Journal of the Association of Physicians of India
    |November 24, 2015
    PubMed

    Insights

    Primary amoebic meningoencephalitis caused by Naegleria fowleri was identified in a patient with retroviral disease. Early treatment with Amphotericin B and other medications led to patient improvement.

    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.

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