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Fatal primary amoebic meningoencephalitis in a Norwegian tourist returning from Thailand
Tore Taksdal Stubhaug1, Olaug Marie Reiakvam2, Christen Rune Stensvold3
1Department of Microbiology, Oslo University Hospital - Ullevaal, Oslo, Norway.
Introduction:
Primary amoebic meningoencephalitis (PAM) is a rare disease caused by the free-living amoeba Naegleria fowleri. Infection occurs by insufflation of water containing amoebae into the nasal cavity, and is usually associated with bathing in freshwater. Nasal irrigation is a more rarely reported route of infection.
Case Presentation:
A fatal case of PAM in a previously healthy Norwegian woman, acquired during a holiday trip to Thailand, is described. Clinical findings were consistent with rapidly progressing meningoencephalitis. The cause of infection was discovered by chance, owing to the unexpected detection of N. fowleri DNA by a PCR assay targeting fungi. A conclusive diagnosis was established based on sequencing of N. fowleri DNA from brain biopsies, supported by histopathological findings. Nasal irrigation using contaminated tap water is suspected as the source of infection.
Conclusion:
The clinical presentation of PAM is very similar to severe bacterial meningitis. This case is a reminder that when standard investigations fail to identify a cause of infection in severe meningoencephalitis, it is of crucial importance to continue a broad search for a conclusive diagnosis. PAM should be considered as a diagnosis in patients with symptoms of severe meningoencephalitis returning from endemic areas.
Insights
Primary amoebic meningoencephalitis (PAM), a rare and fatal brain infection caused by Naegleria fowleri, can be contracted through nasal irrigation. This case highlights the importance of considering PAM in severe meningoencephalitis, especially after travel.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Primary amoebic meningoencephalitis (PAM) is a rare, fatal infection caused by the free-living amoeba Naegleria fowleri.
- Infection typically occurs via nasal insufflation of contaminated freshwater, often associated with recreational activities.
- Nasal irrigation presents a less common, yet significant, route of Naegleria fowleri transmission.
Observation:
- A case of fatal PAM is presented in a Norwegian woman who traveled to Thailand.
- Clinical presentation mimicked rapidly progressing meningoencephalitis.
- Naegleria fowleri DNA was unexpectedly detected by a fungal PCR assay, aiding diagnosis.
Findings:
- Conclusive diagnosis was established through sequencing of Naegleria fowleri DNA from brain biopsies and histopathological analysis.
- Nasal irrigation with contaminated tap water was identified as the suspected source of infection.
- The patient's presentation was clinically indistinguishable from severe bacterial meningitis.
Implications:
- This case underscores the critical need for broad diagnostic investigation in severe meningoencephalitis when standard tests are inconclusive.
- PAM should be considered in the differential diagnosis for patients presenting with severe meningoencephalitis symptoms, particularly those with a history of travel to endemic areas.
- Awareness of alternative infection routes like nasal irrigation is crucial for preventing Naegleria fowleri infections.
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