title: Naegleria fowleri That Induces Primary Amoebic Meningoencephalitis: Rapid Diagnosis and Rare Case of Survival in a 12-Year-Old Caucasian Girl.
abstract: Primary amoebic meningoencephalitis (PAM) is a rare and almost always fatal disease that is caused by Naegleria fowleri, a freshwater thermophilic amoeba. Our case involves an adolescent female who presented with fever of unknown origin. A lumbar puncture was performed, and the Wright-Giemsa and Gram stained cerebrospinal fluid (CSF) cytospin slides showed numerous organisms. Experienced medical technologists in the microbiology and hematology laboratories identified the organisms as morphologically consistent with Naegleria species. The laboratory made a rapid diagnosis and alerted emergency department care providers within 75 minutes. The patient was treated for PAM with amphotericin, rifampin, azithromycin, fluconazole and aggressive supportive therapy including dexamethasone. The Centers for Disease Control and Prevention (CDC) was contacted, and miltefosine, an investigational medication, was started. Additional treatment included an intraventricular shunt and controlled hypothermia in order to mitigate potential cerebral edema. Our patient is a rare success story, as she was diagnosed swiftly, successfully treated, and survived PAM.
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Dunn
authors.affiliation: Department of Pathology, Clinical Laboratory Arkansas Children's Hospital, Little Rock.
authors.forename: Tameika
authors.initials: T
authors.lastname: Reed
authors.affiliation: Department of Pathology, Clinical Laboratory Arkansas Children's Hospital, Little Rock.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Stewart
authors.affiliation: Department of Pathology, University of Arkansas for Medical Sciences, Little Rock Department of Pathology, Clinical Laboratory Arkansas Children's Hospital, Little Rock RALevy@uams.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Levy
mesh_terms: D000562:Amebiasis / Q000175:diagnosis* / Q000628:therapy; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D020808:Central Nervous System Protozoal Infections / Q000175:diagnosis* / Q000628:therapy; D002555:Cerebrospinal Fluid / Q000469:parasitology*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D042241:Early Diagnosis; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000469:parasitology / Q000628:therapy; D016848:Naegleria fowleri; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use
chemical_list: D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B; D017963:Azithromycin; D015725:Fluconazole; D012293:Rifampin
keywords: Naegleria fowleri; primary amoebic meningocephalitis; thermophilic amoeba, microbiology, body fluid morphology, and body fluid interpretation