Comparison of the clinical presentations of Naegleria fowleri primary amoebic meningoencephalitis with pneumococcal meningitis: a case–control study
- 413 Downloads
Primary amoebic meningoencephalitis (PAM) is a rare but fatal infection caused by Naegleria fowleri. The infection is acquired by deep nasal irrigation with infected water. Patients present with signs and symptoms similar to pneumococcal meningitis, leading to delayed diagnosis and treatment and hence high mortality.
We conducted a case–control study comparing culture proven cases of PAM with pneumococcal meningitis presenting to our center between April 2008 and September 2014. Only patients with blood and/or cerebrospinal fluid cultures positive for Streptococcus pneumoniae during the same time period were included for comparison.
There were 19 cases of PAM and pneumococcal meningitis, each. When comparing PAM with pneumococcal meningitis, patients with PAM were more likely to be male (89.5 vs. 36.8 %), younger (mean age: 30 vs. 59 years), present with seizures (42.1 vs. 5.3 %). Both groups of patients presented with similar vital signs and there were no remarkable differences on physical examinations, Glasgow Coma Scale scores, laboratory and radiological investigations and cerebrospinal fluid parameters. PAM was also more likely to present if the city’s average maximum temperature was higher in the previous week (mean: 34.6 vs. 30 °C). There was history of fresh water contact in only one patient. On multivariate analysis, PAM was more likely if patients presented when the city’s average maximum temperature was high, being young males.
PAM and pneumococcal meningitis remain virtually indistinguishable; however, these predictive features should be validated in a prospective study and may lead to a viable algorithm for early management of these patients.
KeywordsPrimary amoebic meningoencephalitis Acute bacterial meningitis Naegleria fowleri Streptococcus pneumoniae Clinical presentation
Compliance with ethical standards
Conflicts of interest
The authors declare they have no conflicts of interest.
Sources of funding
The authors did not receive any funding or support for the manuscript.
- 2.Movahedi Z, Shokrollahi MR, Aghaali M, Heydari H. Primary amoebic meningoencephalitis in an Iranian infant. Case Rep Med. 2012;2012.Google Scholar
- 4.Capewell LG, Harris AM, Yoder JS, Cope JR, Eddy BA, Roy SL, et al. Diagnosis, clinical course, and treatment of primary amoebic meningoencephalitis in the United States, 1937–2013. J Pediatric Infect Dis Soc. 2015;4(4):e68–75.Google Scholar
- 17.Kazi AN, Riaz T. Deaths from rare protozoan encephalitis in Karachi blamed on unchlorinated water. BMJ. 2013;346:f3580.Google Scholar
- 22.Dawn NEWS Internet Edition. ‘Contaminated water’ being supplied to city. http://www.dawn.com/fixed/arch/arch_2009.html. Accessed 22 Jul 2009.