Journal of Pediatric Neurosciences
LETTER TO THE EDITOR
Year
: 2016  |  Volume : 11  |  Issue : 1  |  Page : 90--91

Primary amebic meningoencephalitis: Summarization on cases with early diagnosis by identification of amebae trophozoite in the cerebrospinal fluid


Viroj Wiwanitkit 
 Department of Tropical Medicine, Hainan Medical University, Hainan, China; Department of Medicine, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Biological Science, Joseph Ayo Babalola University, Ikeji Arakeji, Osun State, Nigeria; Department of Community Medicine, Dr. D.Y. Patil Medical University, Pune, Maharashtra, India; Public Health Curriculum, Surin Rajabhat University, Surin, Thailand

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok 10160, Thailand




How to cite this article:
Wiwanitkit V. Primary amebic meningoencephalitis: Summarization on cases with early diagnosis by identification of amebae trophozoite in the cerebrospinal fluid.J Pediatr Neurosci 2016;11:90-91


How to cite this URL:
Wiwanitkit V. Primary amebic meningoencephalitis: Summarization on cases with early diagnosis by identification of amebae trophozoite in the cerebrospinal fluid. J Pediatr Neurosci [serial online] 2016 [cited 2022 May 29 ];11:90-91
Available from: https://www.pediatricneurosciences.com/text.asp?2016/11/1/90/181256


Full Text

Dear Sir,

Primary amebic meningoencephalitis (PAM) is a deadly neurological infection caused by free-living ameba. Clinically, the free-living ameba can be found in freshwater sources, and the patients usually have a history of contact to the water.[1] The fatality in PAM is very high. The recent report by Sood et al. noted that “prompt diagnosis” could be helpful in the management of the patients and prompt treatment could help patients' survival.[2] Here, the authors tried to summarize the data on published article in PubMed to study the outcome of management in PAM patients with identification of amebae trophozoite in the cerebrospinal fluid (CSF). According to the retrospective study, there are at least 18 cases of PAM with identification of amebae trophozoites in the CSF in nine reports.[1],[2],[3],[4],[5],[6],[7],[8],[9] In all cases, the early diagnosis could be derived due to identification of trophozoites in CSF and confirmed with specific ameba culture. Despite early treatment, 5 from 18 cases (27.8%) survived after treatment. In the 13 death cases, two cases were due to cousins' requests for discharge against medical advice before complete standard treatment. Of interest, the high survival rate in those cases can confirm the usefulness of careful CSF examination in suspicious case to derive early diagnosis. Indeed, Wiwanitkit noted that “inability to detect the amebic trophozoite” can result in delayed specific treatment and fatality.[1] It can be concluded that wet mount CSF examination by a clinical microscopist is very important in the early diagnosis.

Kaushal et al. concluded that CSF examination is a useful diagnostic approach for PAM and should be carefully done in any case who “manifest similarly to pyogenic meningitis but whose CSF shows no bacterial organisms.”[6] In addition, following up CSF examination can be useful. Clearance of trophozoite is a good sign and can be also seen in the reported survival cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Wiwanitkit V. Review of clinical presentations in Thai patients with primary amoebic meningoencephalitis. MedGenMed 2004;6:2.
2Sood A, Chauhan S, Chandel L, Jaryal SC. Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian J Med Microbiol 2014;32:193-6.
3Movahedi Z, Shokrollahi MR, Aghaali M, Heydari H. Primary amoebic meningoencephalitis in an Iranian infant. Case Rep Med 2012;2012:782854.
4Pisani F, Costa C, Oteri G, Ioli A. Identification of amoebae in the CSF in a patient with meningoencephalitis. J Neurol Neurosurg Psychiatry 2003;74:1445-6.
5Khanna V, Khanna R, Hebbar S, Shashidhar V, Mundkar S, Munim F, et al. Primary amoebic meningoencephalitis in an infant due to Naegleria fowleri. Case Rep Neurol Med 2011;2011:782539.
6Kaushal V, Chhina DK, Ram S, Singh G, Kaushal RK, Kumar R. Primary amoebic meningoencephalitis due to Naegleria fowleri. J Assoc Physicians India 2008;56:459-62.
7Hebbar S, Bairy I, Bhaskaranand N, Upadhyaya S, Sarma MS, Shetty AK. Fatal case of Naegleria fowleri meningo-encephalitis in an infant: Case report. Ann Trop Paediatr 2005;25:223-6.
8Gupta 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;13:236-7.
9Gautam PL, Sharma S, Puri S, Kumar R, Midha V, Bansal R. A rare case of survival from primary amebic meningoencephalitis. Indian J Crit Care Med 2012;16:34-6.