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Microbiological Profile of Meningoencephalitis Due to Pathogenic Free-Living Amoebae: A Case Series From Kerala,

Pressy Sankar1, Anitha P Moorkoth1, Sumeeta Khurana2

  • 1Microbiology, Government Medical College, Kozhikode, Kozhikode, IND.

Cureus
|March 24, 2026
PubMed
Abstract

Insights

Free-living amoebae (FLA) meningoencephalitis is a rare, fatal CNS infection. Rapid CSF wet mount microscopy aids early diagnosis, and prompt multidrug therapy improves survival, though mortality remains high.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Protozoology

Background:

  • Free-living amoebae (FLA) cause rare but fatal central nervous system (CNS) infections (meningoencephalitis).
  • Limited data exists on FLA infections in the Indian subcontinent.
  • This case series focuses on Kerala, India, detailing clinical profiles, diagnostics, treatments, and outcomes of FLA meningoencephalitis.

Purpose of the Study:

  • To describe the clinical characteristics of FLA meningoencephalitis in Kerala, India.
  • To highlight diagnostic challenges and evaluate treatment strategies.
  • To report outcomes and assess the impact of early diagnosis and treatment.

Main Methods:

  • Retrospective observational study of 12 microbiologically confirmed FLA meningoencephalitis cases.
  • Data collected from May 2024 to April 2025 at a tertiary care center.
  • Analysis of clinical features, laboratory findings, diagnostics, treatments, and outcomes.

Main Results:

  • 12 patients (6-56 years) with FLA meningoencephalitis were studied; 58.3% were male.
  • Common symptoms included fever (91.7%), headache (83.3%), and altered mental status (50%).
  • CSF analysis revealed elevated protein, low glucose, and pleocytosis; wet mount microscopy detected motile trophozoites in all cases. Mortality was 41.7%.

Conclusions:

  • FLA meningoencephalitis presents with non-specific neurological symptoms, complicating early diagnosis.
  • Rapid CSF wet mount microscopy is crucial for early diagnosis in resource-limited settings.
  • Prompt multidrug therapy initiation improves survival, with outcomes better than global averages for *Acanthamoeba* infections.
Keywords:
acanthamoeba sppbalamuthia mandrillarisfree-living amoebaindiakeralameningoencephalitisnaegleria fowleri

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