Abstract
BackgroundPrimary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri. Although the disease is rare, the case fatality rate is very high. In this report, we describe the first case of PAM in Zambia.Case presentationThe patient presented with sudden onset of seizures and fever on admission. On physical examination he was febrile, comatose and with a stiff neck. Cerebral spinal fluid (CSF) collected on admission did not reveal any organism on microscopy or culture but showed elevated white cell count. A working diagnosis of severe septicemia with acute meningoencephalitis was then made and the patient was started on IV Cephtriaxone (2 g) twice daily. Despite receiving treatment, his condition deteriorated. A second CSF sample collected on day 3 was also negative for bacteria and other organisms. However, a repeat CSF sample collected on day 8 revealed numerous motile organisms that were identified as Naegleria on microscopy and confirmed to be N. fowleri on polymerase chain reaction. The patient died on day 8 of hospital admission after having received one dose of Amphotericin B (50 mg). Features consistent with PAM were detected on autopsy.ConclusionThe isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease.
Highlights
Primary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri
The isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease
We present and discuss the first recorded case of PAM due to N. fowleri in a young Zambian male patient
Summary
Naegleria fowleri is a pathogenic free living thermophilic amoeba mainly found in fresh water bodies such as lakes, hot springs, ponds and recreational spas [1]. Unlike other free living amoeba such as Acanthamoeba and Balamunthia that cause disease mainly in immunocompromised people, majority of N. fowleri PAM cases are observed in young immunocompetent individuals [2]. We present and discuss the first recorded case of PAM due to N. fowleri in a young Zambian male patient. The patient was febrile, microscopic examination of the CSF sample collected on anicteric and comatose with a Glasgow Coma Scale of 6 day 8 showed numerous highly motile amoebic trophozoout of 15. He presented with a stiff neck and decor- ites and cysts (Fig. 1a–d) which was later confirmed to be ticate posturing. To confirm that PAM was due to N. fowleri, DNA was amplified with primers NF-ITS-F1 [5′-GAC TTC ATT CGT TCT TGT AGA-3′] and NF-ITSR1 [5′-CTC TTG CGA GGT CCA GAC-3′] that targeted a 577 bp region of the internal transcribed spacer of the rRNA gene [7]
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