Makindo Medical Notes

Most Naegleria fowleri infections happen in young males, especially those 14 years old and younger.

Late Summer lake swim
Face splash, ingress comes at whim
Thin cribriform plate
LP gush gray CSF
Days rush fever, stupor, death
@DrCindyCooper

About

• Causes brain infection typically in young boys
• There is localised swelling and brain herniation
• Less seen in Chlorinated or salt water

Aetiology

• Naegleria fowleri is a free-living amoeba
• Found in warm fresh water (lakes, rivers, and hot springs) and soil.
• Unchlorinated swimming pools
• Naegleria fowleri enters through nose and the cribriform plate
• Usually when swimming, diving, or heads under fresh water,

Clinical

• Usually within 1 week of infection develops headache, fever, nausea, or vomiting.
• Meningism: stiff neck, confusion, seizures, hallucinations, and coma and death.

Investigations

• FBC, U&E, LFTs - unremarkable
• CT: brain swelling, haemorrhage
• CSF: may not be done as often there is increased ICP. If done can be grey to red. High red cells. WCC > 28,000 neutrophils. Trophozoites may be seen. Increased protein.

Management

• With a 95% fatality there are only about 10 living survivors of the infection. Some with significant brain damage.
• ABC, resuscitation, supportive. Often treated as bacterial meningitis
• Consider amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone.

References

• Primary Amoebic Meningoencephalitis: Neurochemotaxis and Neurotropic Preferences of Naegleria fowleri
• Brain-Eating Amoeba Infections Are Rare, but Deadly—Research Is Working on a Cure