The Deadly Amoeba: A Rare Case Report of Primary Amoebic Meningoencephalitis by Naegleria Fowleri
DOI:
https://doi.org/10.37506/e0d7s454Keywords:
Amoeba , fatal, meningoencephalitis , Naegleria fowleriAbstract
Introduction
Naegleria fowleri (N.fowleri), a thermophilic, free-living amoeba found in warm freshwater, causes primary amoebic meningoencephalitis (PAM), a rare, highly fatal brain infection with over 97% mortality. PAM mimics bacterial meningitis, presenting vague symptoms like fever and headache, progressing to severe neurological signs.
Case report
Post mortem viscera of a 46 year old male was received with the alleged history of altered sensorium. The gross examination of brain showed opaque, granular leptomeninges with multiple necrotic grey brown areas of 1.5–2.5 cm were noted in the frontal, parietal and temporal lobes and both cerebellum. Microscopy revealed neutrophilic exudate, necrosis, hemorrhage, dense inflammatory infiltrates and round to oval PAS positive, amoebic trophozoites, consistent with N.
Conclusion
This case marks only the second reported case of N. fowleri meningoencephalitis in Haryana. Increased awareness, public education and water monitoring are crucial for prevention. Early detection through improved diagnostic protocols can significantly reduce the associated high mortality rates.
References
Yoder JS, Eddy BA, Visvesvara GS, Capewell L,
Beach MJ. The epidemiology of primary amoebic
meningoencephalitis in the USA, 1962-2008. Epidemiol
Infect. 2010;138(7):968–75.
De Jonckheere JF. Origin and evolution of the
worldwide distributed pathogenic amoeboflagellate
Naegleria fowleri. Infect Genet Evol. 2011;11(7):1520–
Mushtaq MZ, Mahmood SB, Aziz A. A fatal case
of primary amoebic meningoencephalitis (PAM)
complicated with diabetes insipidus (DI): a case report
and review of the literature. Case Reports in Infectious
Diseases. 2020;2020(1):4925819.
Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA,
Visvesvara GS, Ratard RC, et al. Primary amebic
meningoencephalitis deaths associated with sinus
irrigation using contaminated tap water. Clin Infect
Dis. 2012;55(9):79–85.
Grace E, Asbill S, Virga K. Naegleria fowleri:
pathogenesis, diagnosis, and treatment options.
Antimicrob Agents Chemother. 2015;59(11):6677-81.
Cooper AM, Aouthmany S, Shah K, Rega PP. Killer
amoebas: Primary amoebic meningoencephalitis in a
changing climate. JAAPA. 2019;32(6):30-5.
Ong TYY, Khan NA, Siddiqui R. Brain-Eating
Amoebae: Predilection Sites in the Brain and Disease
Outcome. J Clin Microbiol. 2017;55(7):1989-97
Ahmad Zamzuri M’I, Abd Majid FN, Mihat M,
Ibrahim SS, Ismail M, Abd Aziz S, Mohamed Z,
Rejali L, Yahaya H, Abdullah Z, Hassan MR, Dapari
R, Mohd Isa AM. Systematic Review of Brain-Eating
Amoeba: A Decade Update. Int J Environ Res Public
Health. 2023;20(4):3021.
Madarová L, Trnková K, Feiková S, Klement C,
Obernauerová M. A real-time PCR diagnostic method
for detection of Naegleria fowleri. Exp Parasitol.
;126(1):37-41
Visvesvara GS, Moura H, Schuster FL. Pathogenic and
opportunistic free-living amoebae: Acanthamoeba
spp., Balamuthia mandrillaris, Naegleria fowleri, and
Sappinia diploidea. FEMS Immunol Med Microbiol.
;50(1):1-26.
Gupta N, Bhaskar H, Duggal S, Ghalaut PS, Kundra
S, Arora DR. Primary amoebic meningoencephalitis:
first reported case from Rohtak, North India. Braz J
Infect Dis. 2009;13(3):236-7.
Regu K, Rajendran R, Bhaskaran KS, Rajendran
A, Tamizharasu W. Primary Amoebic
Meningoencephalitis in Kerala– An Emerging Public
Health Concern. JCommun Dis. 2004;56(1):25-35.
Suseela KV, Khan F, Kottoor SJ. An unusual
case of neutrocytic, culture-negative meningitis
in an immunocompetent adult. JRSM Open.
;12(5):20542704211009354.
Panda A, Khalil S, Mirdha BR, Singh Y, Kaushik S.
Prevalence of Naegleria fowleri in Environmental
Samples from Northern Part of India. PLoS One.
;10(10):e0137736.
Sugita Y, Fujii T, Hayashi I, Aoki T, Yokoyama T,
Morimatsu M, Fukuma T, Takamiya Y. Primary
amebic meningoencephalitis due to Naegleria fowleri:
an autopsy case in Japan. Pathol Int. 1999;49(5):468-70.
Cogo PE, Scagli M, Gatti S, Rossetti F, Alaggio R,
Laverda AM, Zhou L, Xiao L, Visvesvara GS. Fatal
Naegleria fowleri meningoencephalitis, Italy. Emerg
Infect Dis. 2004;10(10):1835-7.
Chomba M, Mucheleng’anga LA, Fwoloshi S, Ngulube
J, Mutengo MM. A case report: primary amoebic
meningoencephalitis in a young Zambian adult. BMC
Infect Dis. 2017;17(1):532.
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