, Volume 44, Issue 4, pp 505–511 | Cite as

Comparison of the clinical presentations of Naegleria fowleri primary amoebic meningoencephalitis with pneumococcal meningitis: a case–control study

  • Mohammad Faizan Zahid
  • Muhammad Hamza Saad Shaukat
  • Bilal Ahmed
  • Mohammad Asim Beg
  • Muhammad Masood Kadir
  • Syed Faisal MahmoodEmail author
Original Paper



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.


Primary 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.

Supplementary material

15010_2016_878_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Mohammad Faizan Zahid
    • 1
  • Muhammad Hamza Saad Shaukat
    • 2
  • Bilal Ahmed
    • 3
  • Mohammad Asim Beg
    • 4
  • Muhammad Masood Kadir
    • 5
  • Syed Faisal Mahmood
    • 6
    Email author
  1. 1.Medical GraduateAga Khan UniversityKarachiPakistan
  2. 2.Medical CollegeAga Khan UniversityKarachiPakistan
  3. 3.Department of MedicineAga Khan UniversityKarachiPakistan
  4. 4.Section of Microbiology, Department of Pathology and Laboratory MedicineAga Khan UniversityKarachiPakistan
  5. 5.Department of Community Health SciencesAga Khan UniversityKarachiPakistan
  6. 6.Section of Infectious Diseases, Department of MedicineAga Khan UniversityKarachiPakistan

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