Acute Bacterial Meningitis Research Articles

Thalamic Auditory Center Activity in Healthy Children and Patients with Acute Bacterial Meningitis

Thalamic Auditory Center Activity in Healthy Children and Patients with Acute Bacterial Meningitis

Acute Bacterial Meningitis in Children with Fever and Fits Aged 6-59 Months Old

Objective: To find out the frequency of acute bacterial meningitis (ABM) in children presented with fever and fits aged 6-59 months old. Methodology: This cross-sectional study was done at The Department of Pediatric Medicine, Bolan Medical College/Hospital Quetta from September 2017 to February 2019. A total of 168 children, of either gender, aged between 6-59 months who presented with 1st episode of febrile seizure, and who arrived at emergency department within 12 hours of episode were included. Samples of cerebrospinal fluid (CSF) were obtained. Later, results were analyzed. Results: Of total 168 patients, 111 (66.1%) were male. The mean age was 27.19±13.80 months while the mean weight and frontooccipital circumference (FOC) was found 12.01 ± 2.05 kg and 48.68 ± 2.77 cm correspondingly. Twenty-four (14.3%) patients were diagnosed with ABM. The most common organism found among 11 positive CSF cultures was Streptococcus pneumonia in 6 (54.6%). Conclusion: Every clinician needs to thoroughly evaluate infants or young children after a simple febrile seizure. Lumber puncture can be done in every child if there is any suspicion of meningitis. Keywords: Acute bacterial meningitis, febrile seizures, fever, fits.

Clinical-epidemiological characteristics of acute bacterial meningitis in children of Khmelnitskyi region (Podilsky region, Ukraine): fifteen-year-long

Acute bacterial meningitis (ABM) leads to a significant number of complications and high mortality. The aim - to analyze the etiological structure, epidemiological, socio-demographic features and complications in ABM in children of Khmelnitskyi region during 2004-2018. Materials and methods. The analysis of 346 cases of ABM, of which 217 boys and 129 girls was conducted. The etiology of meningitis was determined by bacterioscopy, bacteriological sowing, latex agglutination and polymerase chain reaction. Complications were revealed based on the clinical picture and computed tomography and мagnetic resonance imaging. The processing of the results was carried out using analytical method, t-criterion and constructing 95% confidence interval. Results. The disease started with fever 346 (100%), neck stiffness 289 (83.5%) and vomiting 273 (78.9%), less common, alteration of consciousness 28 (8.1%) and seizures 9 (2.6%). The high level of the cytosis were observed in meningococcal (5801.3±4856.7 cells/mm3) and Hib meningitis (5152.6±4153.1 cells/mm3), the lowest level was in pneumococcal meningitis (2601.0±1839.6 cells/mm3). The highest level of liquor protein was in pneumococcal meningitis (179.0±51.0 mg/dl), and the lowest level was in meningococcal meningitis (102.0±49.0 mg/dl) and Hib meningitis (112.0±56.0 mg/dl). The etiological factor was established in 121 (35.0%) of patients. 52 (15.4%) of patients had neurological complications. Conclusions. The majority (58.1%) of ABM are in children under the age of 3. The main causative agent remains N. meningitidis - 57.9%, the second place is S. pneumoniae - 21.5%, the third Hib - 9.9% of cases. Frequent complications were brain edema 32 (61.5%), seizures 19 (36.5%) and hydrocephalus 8 (15.4%). The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

Changes in the incidence of acute bacterial meningitis caused by Streptococcus pneumoniae and the implications of serotype replacement in children in Colombia after mass vaccination with PCV10.

IntroductionAcute bacterial meningitis (ABM) is a public health problem. The disease has reemerged after the introduction of pneumococcal conjugate vaccines (PCVs) due to an increase in serotypes that are not covered. The objective was to determine the changes in the disease incidence before and after the introduction of the 10-valent vaccine (PCV10) in Colombia.MethodsThis multicenter study was conducted in 17 hospitals in Colombia. Data were collected from January 2008 to December 2019 in 10 hospitals in Bogotá and from January 2017 to December 2019 in seven hospitals in Cali, Medellín and Cartagena. The data were grouped into three periods: 2008–2011, 2012–2015, and 2016-2019.ResultsOf the 706 cases of invasive pneumococcal disease, 81 (11.4%) corresponded to meningitis. The relative incidence in Bogotá in the first period was 0.6 per 100,000 patients ≤ 5 years, decreased to 0.4 per 100,000 patients ≤ 5 years in the second period and increased in the third period to 0.7 per 100,000 patients ≤ 5 years. Serotypes covered by PCV10 decreased from 75 to 9.1%, with Spn19A (31.8%) and Spn34 (13.6%) emerging in the third period. Increased resistance to penicillin (13 to 37%) and to ceftriaxone (5.9 to 16%) was due to the emergence of multidrug-resistant Spn19A. The total mortality rate was 23.5% and increased from 12 to 33%.ConclusionsABM due to pneumococcus has high morbidity and mortality rates. Reemergence of the disease has been observed due to the inclusion of polymerase chain reaction (PCR) for diagnosis and replacement of circulating serotypes after the introduction of PCV10, with an increase in Spn19A, which causes death and exhibits antimicrobial resistance. Continued surveillance is needed.

Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

BackgroundThe SARS-CoV-2 omicron variant produces more symptoms in the upper respiratory tract than in the lower respiratory tract. This form of “common cold” can cause inflammation of the oropharynx and the Eustachian tube, leading to the multiplication of bacteria such as Streptococcus pneumoniae in the oropharynx. Eustachian tube dysfunction facilitates migration of these bacteria to the middle ear, causing inflammation and infection (otitis media), which in turn could lead to further complications such as acute mastoiditis and meningitis.Case presentationIn January 2022, during the rapid spread of the omicron variant of the SARS-CoV-2 virus, two patients presented to the emergency room at our hospital complaining of headache and a low level of consciousness. A few days prior to admission, the patients had been diagnosed with COVID-19 based on clinical manifestations of a cold virus, without respiratory failure. Cranial computed tomography revealed signs of bilateral invasion of the middle ear in both cases. Lumbar puncture was compatible with acute bacterial meningitis, and S. pneumoniae was isolated in cerebrospinal fluid in both patients. RT-PCR tests for SARS-CoV-2 were repeated, confirming the presence of the omicron variant in one of the patients. We were unable to confirm the variant in the second patient due to the low viral load in the nasopharyngeal sample obtained at admission. However, the time of diagnosis (i.e., during the peak spread of the omicron variant), strongly suggest the presence of the omicron variant. Both patients were admitted to the intensive care unit and both showed rapid clinical improvement after initiation of antibiotic treatment.ConclusionsThe omicron variant of the SARS-CoV-2 virus can promote the development of otitis media and secondary acute bacterial meningitis. S. pneumoniae is one of the main bacteria involved in this process.

Non-steroidal anti-inflammatory drugs ketorolac and etodolac can augment the treatment against pneumococcal meningitis by targeting penicillin-binding proteins.

Streptococcus pneumoniae is the principal etiological agent of acute bacterial meningitis (ABM) which has fatal outcome in children and elderly. Due to poor blood-brain barrier (BBB) permeation, conventional β-lactam antibiotics fail to establish the requisite bactericidal concentration in central nervous system leading to resistance in meningeal infections. The present study intended to identify potential therapeutic alternatives against Streptococcal meningitis. Virtual screening, pharmacokinetics/pharmacodynamics (PK/PD) and anti-bacterial evaluations were employed to screen potential drugs. Molecular docking and structural dynamics simulations were performed to analyze the binding affinity and interaction stability of the drugs against the conventional Penicillin binding protein (PBP) targets. Screened drugs were also checked for interactions with other possible Streptococcal targets and relevant host targets. Non-steroidal anti-inflammatory drugs (NSAIDs) ketorolac and etodolac exhibiting high BBB-permeation and anti-bacterial potency were identified. Ketorolac and etodolac possessed uniform binding affinities against PBP1A, PBP2X, PBP2B and PBP3 with low inhibition constants (<50μM). Against PBP2B and PBP3, higher binding affinities were observed for ketorolac (-6.45 and -6Kcal/mol respectively) and etodolac (-6.36 and -6.55Kcal/mol respectively) than penicillin (-5.95 and -5.85Kcal/mol respectively) and cefotaxime (-5.08 and -5.07Kcal/mol respectively). The binding affinities were contributed by conventional H-bonds and non-canonical interactions with active site residues of PBPs. Structural dynamics simulations further indicated the overall stability of the drug-bound complexes through minimal overall average root-mean square fluctuations (RMSFs) (<1.0Å). The average binding affinities of Ketorolac and Etodolac with PBPs were marginally higher than other Streptococcal targets and comparable to their conventional inflammatory targets. Pharmacological and structural profiles indicated that ketorolac and etodolac can potentially subdue the cause and effects of streptococcal meningitis and hence encourage experimental validations.

The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter Study

Abstract Objective Acute bacterial meningitis (ABM) declined after implementing conjugate Haemophilus influenzae type B and the pneumococcal vaccines worldwide. However, it still contributes to significant morbidity and mortality. The Biofire FilmArray Meningitis Encephalitis (FAME) panel can rapidly diagnose common bacterial and viral pathogens. Several studies suggested that the use of FAME may accelerate diagnosis and decrease the time to pathogen-specific therapy. However, the clinical utility is still controversial due to scarce data and relatively high costs. Therefore, we aimed to evaluate the diagnostic performance of FAME in children. Methods A retrospective multicenter cross-sectional study was conducted to evaluate FAME in diagnosing ABM in children with a suspected central nervous system infection between January 2017 and May 2021. Results This study consisted of 179 children diagnosed with central nervous system infection who had parallel testing done using FAME and traditional microbiological diagnostic methods. Twenty-two FAME results were positive; 8 (36.3%) were bacterial pathogens and 14 (53.7%) were viral pathogens. The most common viral pathogen was human herpesvirus 6 (n = 6; 27.2%), followed by herpes simplex virus 1 (n = 4; 18.1%), Enterovirus spp. (n = 2; 9%), Parechovirus (n = 2; 9%), and Cytomegalovirus (n = 1; 4.5%). Bacterial pathogens included S. pneumoniae (n = 3; 13.6%), H. influenzae (n = 3; 13.6%), Neisseria meningitidis (n = 1; 4.5%), and Streptococcus agalactiae (n = 1; 4.5%). Bacterial culture confirmed S. pneumoniae infection in only 1 of 8 (12.5%) patients, while 7 of 8 bacterial meningitis were only detected by FAME. Conclusion FAME may also help with diagnosis and pathogen identification in patients who have already had antibiotics before cerebrospinal fluid collection. The use of FAME to detect infections quickly may minimize the improper use of medications, treatment duration, and the cost of hospitalization.

Role of Computed Tomography Scan in the Management of Pediatric Acute Bacterial Meningitis: An Experience from a Tertiary Care Hospital in Lahore

Background: Acute Bacterial Meningitis (ABM) is not an uncommon ailment seen both in developing and developed countries. For the patients presenting with fever and seizures, the trend of doing CT scan brain is on the rise, which may not be justifiable in all cases. Objective: To determine the frequency of radiological findings on computed tomography (CT) of the brain among children presenting with acute bacterial meningitis. Materials &amp; Methods: This cross-sectional study was conducted in Department of Pediatrics KEMU/Mayo Hospital Lahore after IRB approval. Patients with CSF-proven ABM whose CT brains had been performed were enrolled retrospectively, and the presence of hydrocephalus, cerebral infarct, edema and abscess as per CT report were recorded. Data were stratified for age, gender and duration of symptoms. Chi-square test was applied to compare findings in stratified groups. Results: A total of 165 ABM patients with a mean age of 6.2 ±1.3 years; 68.5% (113) males and 31.5% (52) females were included. CT brain was normal in 92 (55.8%), while 29 (17.6%) had cerebral edema, 20 (12.1%), 11 (6.7%) and 13 (7.9%) had cerebral infarct, hydrocephalus and cerebral abscess respectively. Conclusion: Computed Tomography is a useful tool for detecting intracranial complications of ABM. But routine use of CT-brain in every patient without clear indications should be avoided to decrease the risk of radiation exposure as well as to save resources. Keywords: Acute bacterial meningitis, Children, Cerebrospinal fluid, Computed tomography, complications

Childhood meningitis in rural Gambia: 10 years of population-based surveillance.

The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2-23-month age group, but lower at 5 per 100,000 in the 5-14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care.

Treatment of hyponatremia in children with acute bacterial meningitis.

PurposeFew studies have evaluated hyponatremia management in children with bacterial meningitis (BM). Thus, we aimed to describe variations in clinical practice, the effectiveness of sodium management, and adverse outcomes in children with BM and hyponatremia.MethodsThis retrospective cross-sectional study conducted at a tertiary institution analyzed participants' demographic, clinical, and sodium-altering treatment data. The sodium trigger for treatment was defined as pretreatment sodium level, with response and overcorrection defined as increments of ≥5 and >10 mmol/L after 24 h, respectively.ResultsThis study enrolled 364 children with BM (age: <16 years; 215 boys). Hyponatremia occurred in 62.1% of patients, among whom 25.7% received sodium-altering therapies; 91.4% of those individuals had moderate/severe hyponatremia. Monotherapy was the most common initial hyponatremia treatment. After 24 h of treatment initiation, 82.4% of the patients responded. Logistic regression analyses revealed that ΔNa24 <5 mmol/L [odds ratio (OR) 15.52, 95% CI 1.71–141.06, p = 0.015] and minimum Glasgow Coma Scale (GCS) score ≤ 8 (OR 11.09, 95% CI 1.16–105.73, p = 0.036) predicted dysnatremia at 48 h after treatment initiation. Although rare, persistent moderate/severe hyponatremia or hypernatremia at 48 h after treatment initiation was associated with a high mortality rate (57.1%).ConclusionThis study found that most cases of hyponatremia responded well to various treatments. It is important to identify and institute appropriate treatment early for moderate or severe hyponatremia or hypernatremia in children with BM. This study was limited by its non-randomized nature.

Recent interventions in treating bacterial meningitis

Bacterial meningitis (BM) affects the central nervous system (CNS) and is a significant long-term sequela for 50% of survivors globally. Resource-poor areas have a higher prevalence of acute bacterial meningitis than resource-rich ones. The pathogenesis of BM involves intricate pathways linked to bacterial survival and proliferation in the circulation, increased blood-brain barrier (BBB) permeability, oxidative […]

Heparin Binding Protein in Early Differential Diagnosis of Bacterial Meningitis.

Heparin-binding protein is a serine protease that is mobilized rapidly from emigrating polymorphonuclear leukocytes that acts as a chemoattractant activator of monocyte and macrophages. We investigated the potential role and efficacy of serum and cerebrospinal fluid heparin binding protein in differentiating bacterial meningitis from tuberculosis and viral meningitis. A case diagnosed with acute bacterial meningitis (n:37), viral meningitis (n:30) and tuberculous meningitis (n:30) was included in this study. The diagnosis was based on history, clinical criteria, cerebrospinal fluid examination, latex agglutination and culture, and response to therapy. Heparin-binding protein was measured using enzyme-linked immunosorbent technique in both cerebrospinal fluid and serum. Cerebrospinal fluid heparin-binding protein levels were 7.81 ± 0.23ng/mL in bacterial meningitis, 6.11 ± 0.3ng/mL in tuberculosis meningitis and 5.75 ± 0.1ng/mL in viral meningitis. The mean serum level was 14.98 ± 1.1ng/mL in bacterial meningitis, 6.89 ± 0.4ng/mL in tuberculosis meningitis, and 6.02 ± 0.4ng/mL in viral meningitis. Both heparin-binding protein levels were significantly higher in patients with bacterial meningitis. We found that serum and cerebrospinal fluid heparin binding protein is a useful marker for differentiating bacterial meningitis from non-bacterial meningitis.

Global Epidemiology of Vaccine-preventable Bacterial Meningitis.

Global Epidemiology of Vaccine-preventable Bacterial Meningitis.

Case-fatality and sequelae following acute bacterial meningitis in South Africa, 2016 through 2020

ObjectivesProviding country-specific estimates of case fatality and sequelae from bacterial meningitis (BM) is important to evaluate and monitor progress toward the World Health Organization's roadmap to “defeating meningitis by 2030”. MethodsFrom 2016-2020, GERMS-SA conducted enhanced surveillance at 26 hospitals across South Africa. Episodes of laboratory-confirmed BM due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis were included. Risk factors for in-hospital death and sequelae at hospital discharge among survivors were analyzed. ResultsOf 12,717 invasive bacterial infections reported nationally, 39% (4980) were from enhanced surveillance sites, including 4159 pneumococcal, 640 H. influenzae, and 181 meningococcal infections. BM accounted for 32% (1319/4159) of pneumococcal, 21% (136/640) of H. influenzae, and 83% (151/181) of meningococcal invasive diseases. Clinical data were available for 91% (1455/1606) of BM: 26% (376/1455) were aged <5 years, 50% (726/1455) were female, and 62% (723/1171) with known HIV results, were HIV-infected. In-hospital case fatality was 37% (534/1455), and 24% (222/921) of survivors had adverse sequelae. Risk factors for death included altered mental status, HIV infection, and comorbidities. Risk factors for adverse sequelae included altered mental status and antimicrobial nonsusceptibility. ConclusionBM in South Africa has a high case fatality, and adverse sequelae frequently occur among survivors. Those with comorbidities (including HIV) are at the highest risk.

What are the effects of non-corticosteroid adjuvant therapies for people with acute bacterial meningitis?

What are the effects of non-corticosteroid adjuvant therapies for people with acute bacterial meningitis?

Infectious causes of acute encephalitis syndrome hospitalizations in Central India, 2018-20.

We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p<0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination.

Risk factors for acute encephalitis and early seizure recurrence in complex febrile seizures.

The purpose of this study is to elucidate risk factors for central nervous system infection and early seizure recurrence in children with febrile seizures (FSs) and thus facilitate outpatient management of complex FS. This single-center, retrospective cohort study investigated 688 children (6-60months old) with FSs in Japan during 2011-2021. We investigated the incidence and clinical manifestations of children with acute encephalitis or bacterial meningitis. Logistic regression modeling was used to examine risk factors for seizure recurrence within 24h. Among children with recurrent FSs, the distribution of intervals between first and second FS was assessed. Among 145 children with complex FSs, 2 patients (1.4%) had acute viral encephalitis and none had bacterial meningitis. Acute encephalitis was found in 2 of 8 patients (25%) with FSs prolonged ≥30min and 2 of 3 patients (67%) requiring ≥2 intravenous anticonvulsants to stop seizures. Seizure recurrence within 24h was observed in 16% of participants and was independently associated with preceding use of diazepam and family history of FS. In 82% of patients with FS recurrence within 24h, early recurrences occurred within 8h of the first seizure. Conclusion: Patients with prolonged or refractory FSs are still indicated for hospital admission due to the risk of acute encephalitis. FS patients with a family history of FS may be managed safely by 8-h observation or single-dose rectal diazepam as prophylaxis against early recurrent seizure. What is Known: •Hospitalization has been recommended for children with complex febrile seizures due to the increased risk of central nervous infections. •Recent studies showed low incidences of bacterial meningitis (<1%) in children with complex febrile seizures in the presence of routine immunization. What is New: •Acute encephalitis was identified in 1.4% of children with complex febrile seizures, characterized by prolonged seizures ≥30 min and refractory seizures. •Early recurrent seizures may be safely managed by prophylactic diazepam or 8-h expectant observation.

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Childhood encephalitis in the Greater Mekong region: critical to public health policy

Hearing impairment in Angolan children with acute bacterial meningitis with and without otitis media.

Bacterial meningitis (BM) is a common cause of hearing loss in childhood. Our aim was to investigate bacterial aetiology, hearing impairment and outcome in childhood BM with vs. without otitis media (OM) in Angola. Hearing was tested by auditory brainstem response in 391 (76%) children with confirmed BM. The bacteria identified from the ear discharge were compared to those from cerebrospinal fluid (CSF). The hearing findings were compared among children with vs. without OM on days 1 and 7 of hospitalization, and at follow-ups of 1, 3 and 6month(s). No correlation was found in bacteriology between the ear discharge and CSF. On day 7 in hospital, hearing impairment (>40dB) was common, regardless of whether concomitant OM or not (in 27% vs. 30%, respectively). Any hearing deficit on day 7 was associated with a higher risk of complicated or fatal clinical course (OR 2.76, CI95% 1.43-5.29, p=0.002). No significant difference prevailed in hearing thresholds between children with or without OM in hospital on day 7 or at later follow-ups. Any hearing impairment during hospital stay associated with a higher risk for complicated clinical course or death.

Aquatics: A Boon or Bane under the Shadow of Naegleria fowleri:A Meta-analysis and Systemic review

Water sports activities during hot summer seasons attract all age groups specially children and young adult. Same season acts favorably for multiplication of Naegleria fowleri in stagnant or slow moving water and exposure will lead to highly fatal Primary Amoebic Meningoencephalitis. Naegleria fowleri travels from nasopharyngeal mucosa to brain to cause highly fatal disease. In-spite of more than 300 cases reported worldwide the figure is still underreported or erroneously reported due to Clinical &amp; Biochemical similarity with Acute Bacterial Meningitis. Radiological finding CT or MRI scan are also initially normal for initial 2 days and unable to differentiate between bacterial or parasitic meningoencephalitis. Diagnosis of low surviving disease depend mainly on Microscopy/Giemsa staining, which can be confirmed by amoebic culture, PCR and gene sequencing with the help of reference center (CDC). Treatment can be intravenous and/or intrathecal Amphotericin-B, Rifampicin and Fluconazole. Miltefosine shows some promising results but not found satisfactory. So, prevention is the only hope to fight with Naegleria fowleri infection, which needs to be looked at seriously by concerned authorities, especially in developing countries. A total of 29 articles selected for meta-analysis study from Pubmed &amp; Google Scholar. Surprising water exposure history found in many article that included enjoyment in Water-Splashing Festival, bathing in pond &amp; unchlorinated water, religious nasal cleaning practice with contaminated water, accidental fall in river with remain submerged for long time and many more, were results in fatal Primary Amoebic Meningoencephalitis. This review cover clinical management of the cases of Primary Amoebic Meningoencephalitis as well as more important it’s preventive aspect which include identification of source of Naegleria fowleri, restricted activity with public awareness about unknown dangers of fatal disease acquired during enjoyment, which was missed by some authors.