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Primary Amebic Meningoencephalitis


Presentation

  • Primary amebic meningoencephalitis presents clinically in a fashion that may be indistinguishable from bacterial and viral meningitis.[ncbi.nlm.nih.gov]
Fever
  • In August 2007, a boy aged 12 years was admitted to a hospital with a 6-day history of fever. His mother reported her son had become disoriented and lethargic.[cdc.gov]
  • The illness begins suddenly with the abrupt onset of fever, headache, nausea, and vomiting.[ncbi.nlm.nih.gov]
  • Treatment If a camper or staff person develops a sudden onset of fever, headache, stiff neck, or vomiting, trained medical care should be immediately secured.[acacamps.org]
  • Am Fam Physician. 2016 Apr 15;93(8):644. to the editor : When seeing patients with headache and fever, particularly in warmer months, physicians in the United States should consider the diagnosis of primary amebic meningoencephalitis (PAM).[aafp.org]
Unable to Stand
  • He had neck pain upon flexion and was unable to stand or walk. Cerebrospinal fluid examination revealed trophozoite and diflagellate forms consistent with Naegleria fowleri, an ameba species known to cause primary amebic meningoencephalitis.[ncbi.nlm.nih.gov]
  • On the day of discharge, the patient was able to keep his head straight, sitting and eating by himself, but unable to stand and walk.[pjms.com.pk]
Crying
  • The fever came down and the patient started opening his eyes, moving his hands and feet and also crying. From the day 20 th, feeding was started with soup and milk.[pjms.com.pk]
Laboratory Technician
  • Because early diagnosis and therapy are critical, laboratory technicians must be able to quickly identify amebae on CSF specimens.[pediatrics.aappublications.org]
Respiratory Distress
  • distress/asthma-like stomach cramping/nausea/vomiting eye irritation/blurred vision erratic heart beat (weeks) sudden rages/personality changes short term memory loss 17.[slideshare.net]
Vomiting
  • The symptoms include headache, nausea, rigidity of the neck muscles, vomiting, delirium, seizures and coma. primary amebic menencephalitis naegleriasis amebic encephalitis PAM naegleria infection Naegleria fowleri infection Primary Amoebic Meningoencephalitis[wikidata.org]
  • On June 17, 2015, a previously healthy woman aged 21 years went to an emergency department after onset of headache, nausea, and vomiting during the preceding 24 hours.[ncbi.nlm.nih.gov]
  • Primary amebic meningoencephalitis can progress rapidly from changes in smell or taste, headaches, a stiff neck, nausea, and vomiting to confusion and death.[merckmanuals.com]
Nausea
  • The symptoms include headache, nausea, rigidity of the neck muscles, vomiting, delirium, seizures and coma. primary amebic menencephalitis naegleriasis amebic encephalitis PAM naegleria infection Naegleria fowleri infection Primary Amoebic Meningoencephalitis[wikidata.org]
  • On June 17, 2015, a previously healthy woman aged 21 years went to an emergency department after onset of headache, nausea, and vomiting during the preceding 24 hours.[ncbi.nlm.nih.gov]
  • Primary amebic meningoencephalitis can progress rapidly from changes in smell or taste, headaches, a stiff neck, nausea, and vomiting to confusion and death.[merckmanuals.com]
Photosensitivity
  • On August 31, 2007, a man aged 22 years was admitted to a hospital with symptoms of photosensitivity, altered mental status, and a severe headache that had begun suddenly 2 days before.[cdc.gov]
Headache
  • The symptoms include headache, nausea, rigidity of the neck muscles, vomiting, delirium, seizures and coma. primary amebic menencephalitis naegleriasis amebic encephalitis PAM naegleria infection Naegleria fowleri infection Primary Amoebic Meningoencephalitis[wikidata.org]
  • On November 16, 2012, the patient had visited the emergency department with a headache; he was treated symptomatically and released.[ncbi.nlm.nih.gov]
  • On September 2, 2007, a boy aged 10 years was evaluated in a local ED for headache, body aches, high fever, nausea, vomiting, and fainting. His symptoms had begun on August 31 with headache and lethargy.[cdc.gov]
Seizure
  • The symptoms include headache, nausea, rigidity of the neck muscles, vomiting, delirium, seizures and coma. primary amebic menencephalitis naegleriasis amebic encephalitis PAM naegleria infection Naegleria fowleri infection Primary Amoebic Meningoencephalitis[wikidata.org]
  • We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures.[ncbi.nlm.nih.gov]
  • METHODS AND RESULTS We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures.[unboundmedicine.com]
Confusion
  • The following day, the patient returned to the emergency department by ambulance with fever, confusion, agitation, and a severe headache, for which he was admitted.[ncbi.nlm.nih.gov]
  • They may become confused and sleepy and may have seizures. The infection can progress rapidly, causing death within 10 days.[merckmanuals.com]
  • After admission to a hospital, his symptoms rapidly progressed to a fever of 104.0 F (40.0 C), confusion, and abdominal pain. Motile amebae, later identified as N. fowleri, were found in CSF on September 3--4.[cdc.gov]
  • Furthermore: symptoms usually start about 5 days after infection (but can range from 1–9 days). symptoms can include headache, fever, nausea, or vomiting. later symptoms can include stiff neck, confusion, lack of attention to people and surroundings,[acacamps.org]
Altered Mental Status
  • We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures.[ncbi.nlm.nih.gov]
  • METHODS AND RESULTS We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures.[unboundmedicine.com]
  • Initial symptoms include severe frontal headache, fever, nausea, and vomiting followed by stiff neck, seizures, altered mental status, hallucinations, and coma. There have been 4 known survivors in North America.[tlarremore.wordpress.com]
  • Stage Two: Stage two of the infection involves signs and symptoms include a stiff neck, altered mental status, hallucinations, seizures, and coma.[disabled-world.com]
Lethargy
  • Headache, lethargy and coma developed in this patient, and her condition progressed to death 8 days after the onset of clinical symptoms.[ncbi.nlm.nih.gov]
  • There can still be a successful outcome when a patient presents with lethargy/somnolence, considered to be one of the "late" signs.[orlandomedicalnews.com]
  • Primary Amebic Meningoencephalitis (PAM) 1-14 days incubation period symptoms usually within a few days after swimming in warm still waters infection believed to be introduced through nasal cavity and olfactory bulbs symptoms include headache, lethargy[slideshare.net]
  • Blood 2012 119:3658; doi: A 7-year-old boy with no prior illness or altered immunity presented to the emergency department with a 36-hour history of fever (103.7 F), emesis, headache, and lethargy.[doi.org]

Workup

  • (See Presentation, Workup, Treatment, and Medication.) Linam et al presented a survivor of amebic meningoencephalitis in North America.[emedicine.medscape.com]
Cryptococcus Antigen
  • CSF for the agglutination test for Cryptococcus antigen was also negative.[ncbi.nlm.nih.gov]

Treatment

Prognosis

  • The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics.[ncbi.nlm.nih.gov]
  • Prognosis is often very poor even with treatment 1-3 .[radiopaedia.org]
  • In conclusion, although PAM is a rare disease with poor prognosis, it should be considered in differential diagnosis of bacterial meningitis specially when CSF smear and culture is negative and patient has a history of contact with contaminated fresh[pjms.com.pk]
  • Primary amoebic meningoencephalitis (PAM) is a rare but fulminant disease leading to diffuse haemorrhagic necrotising meningoencephalitis, and has a very poor prognosis. 1 Naegleria fowleri is the causative agent.[mja.com.au]

Etiology

  • The etiological agent in most reported cases of PAM is the ameboflagellate Naegleria fowleri. Infection with this organism closely mimics and is often mistaken for a bacterial or a viral pyogenic meningitis.[ncbi.nlm.nih.gov]
  • It is suggested that in these 3 cases there may be a common etiologic pattern of intranasal inoculation resulting from prolonged swimming in tepid lake water.Pathological findings in the first 2 cases were presented to the 1964 Scientific Session of the[doi.org]

Epidemiology

  • We used epidemiologic risk factors and multiple cause-of-death mortality data to estimate the number of deaths that fit the typical pattern for primary amebic meningoencephalitis; we estimated an annual average of 16 deaths (8 male, 8 female) in the United[ncbi.nlm.nih.gov]
  • Standardized surveillance and reporting of amebic encephalitis, including PAM, is crucial to understanding the changing epidemiology.[cste.org]
Sex distribution
Age distribution

Pathophysiology

  • Herein, we present the case of an adolescent who died of PAM and review the (a) epidemiology, (b) pathophysiology, (c) available diagnostic modalities, (d) treatment options, and (e) outcomes of patients treated for N. fowleri infection of the central[ncbi.nlm.nih.gov]
  • […] greater awareness of disease or due to development of more rapid, highly sensitive and specific diagnostic tests. [3] About 300 cases have been reported so far with high case fatality rate of around 95%. [4] There has been advances in understanding of pathophysiology[ruralneuropractice.com]
  • Pathophysiology PAM can occur in previously healthy young individuals exposed to warm, especially stagnant, fresh water.[emedicine.medscape.com]
  • Following communication of his findings, Cooter and colleagues were able to directly observe the live amoeba in a CSF sample from a 10-year-old boy who presented with meningoencephalitis. 4, 5 Pathophysiology N. fowleri lives and multiplies in warm freshwater[mja.com.au]

Prevention

  • Review the Naegleria fowleri FAQ's from the Centers for Disease Control and Prevention.[acacamps.org]
  • PAM is best prevented by combinations of public health educational and behavioral modification strategies.[ncbi.nlm.nih.gov]
  • Centers for Disease Control and Prevention. Naegleria fowleria – primary amebic meningoencephalitis (PAM) – amebic encephalitis. . Accessed March 3, 2016. Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.[aafp.org]
  • Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention Atlanta USA[link.springer.com]

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