A case of primary amebic meningoencephalitis in a Nigerian farmer

A fatal case of primary amebic meningoencephalitis (PAME) in a 35-year-old Nigerian Muslim farmer is described. The disease was contracted during ritual washing before prayers, which involved the sniffing of water up his nose to clean it. The water came from a man-made pond at his farm. The clinical presentation, isolation of the ameba from the cerebrospinal fluid and nasal passages, poor response to amphotericin B, and ultimate fatal outcome prove this to be a case of PAME. On the basis of its ability to grow at 42 degrees C, morphology of the trophozoite, cyst, and flagellate forms, animal pathogenicity, and nuclear division the ameba was identified as Naegleria fowleri. Pathogenic N. fowleri were recovered from samples of water and soil from the pond. This represents the fourth proven case of PAME from northern Nigeria.