Primary amoebic encephalitis

This condition is caused by free living amoebae of the species Naegleria fowleri. They live in moist soil and most cases have been reported in children who have been swimming or playing in stagnant water. Amoebae enter the nasal cavity, cross the nasal epithelium, and ascend to the brain along olfactory nerves and blood vessels to frontal and basal meninges and spread, causing a florid necrotising inflammation.

Clinically the presentation is of a sudden onset of severe meningitis indistinguishable from bacterial meningitis.140 The clue to diagnosis is the history of exposure to warm, stagnant water. CSF examination reveals pleocytosis in which polymorphs predominate, raised protein, and reduced glucose. No organisms are seen on the gram stain and special examination of fresh, warm specimens of CSF will show motile trophozoites. Most patients die rapidly despite treatment, but survival following treatment with amphotericin B has been described,141 and this should be given in the highest tolerated dose parenterally, reinforced by intracisternal injection and by rifampicin and tetracycline, which have some activity against Naegleriae.142

Acanthamoeba spp. tend to cause a subacute granulomatous meningoencephalitis.

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