Abstract
Naegleria fowleri is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a raised leucocyte count of 1100/µL with predominant polymorphonuclear cells, and wet mount prep for Naegleria fowleri was positive further confirmed with PCR. The patient was started Intravenous (IV) and intrathecal amphotericin-B, Per Oral (PO) miltefosine, IV rifampin, IV fluconazole, and IV dexamethasone. However, the patient started producing urine at 300–500 ml/hour. The patient's sodium levels increased from 144 to 175 mmol/L in 12 hours with raised serum osmolality and decreased urine osmolality and urine sodium. The patient was started on PO desmopressin of 0.2 micrograms twice daily after which his urine output dropped to 60–80 ml/hour and sodium decreased from 175 to 162 and, later 155 mmol/L; however, the patient expired. PAM is a rare and extremely fatal illness, but with increasing incidence now being reported in developing countries as a result of better diagnostics. DI is a very rare complication reported in these patients leading to poor outcome. The complication of diabetes insipidus (DI) has not been extensively studied in patients having PAM. Only three cases have been reported with this complication. No mechanism has been mentioned in the literature behind the development of DI in these patients, and no study has mentioned laboratory details of DI as mentioned in this report.
Highlights
Naegleria fowleri is a highly infective free-living amoeba usually isolated from soil and fresh water mostly during summer times when higher temperatures provide a conductive environment for its growth and proliferation [1, 2]
Infections with Naegleria fowleri are primarily associated with exposure to fresh water during recreational and religious activities; inadequately chlorinated water supply at homes and in swimming pools are fast becoming possible causes for infections with the organism [1, 3]. e organism enters the body via the nasal cavity when contaminated water is deeply inhaled
Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries as infections in developing countries remain mostly undiagnosed [3]
Summary
A fatal case of primary amoebic meningoencephalitis (PAM) complicated with diabetes insipidus (DI): A Case report and review of the literature Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_med_intern_med. Part of the Infectious Disease Commons, Internal Medicine Commons, Nervous System Diseases Commons, and the Neurology Commons. Case Reports in Infectious Diseases, 2020, 4925819.
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