Naegleria Infection Clinical Presentation

  • Author: Subhash Chandra Parija, MBBS, MD, PhD, FRCPath; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 11, 2011
 

History

Most cases of primary amebic meningoencephalitis (PAM) involve a history of exposure to fresh warm water. Patients with PAM generally present with a history of bathing in a pond or lake 2-6 days prior to the onset of symptoms of meningeal irritation.

The index of suspicion should be increased in children and young adults who have a history of recently swimming in freshwater lakes, ponds, and pools. Isolated cases of PAM have followed bathing in tap and hot water.

Clusters of cases of PAM have been documented during the summer months when freshwater sources are warm. The higher temperature during the hot summer months facilitates the growth of N fowleri.

Next

Physical

The physical signs of PAM are similar to those of bacterial meningitis, as follows:

  • Fever
  • Alteration in taste (ageusia) or smell (parosmia)
  • Sudden-onset headache (usually frontal or bitemporal)
  • High temperature (up to 40°C)
  • Nausea, vomiting, or both
  • Stiff neck
  • Photophobia (later in the course of illness)
  • Positive Kernig and Brudzinski signs
  • Mental status changes
  • Physical findings associated with encephalitis and eventual herniation (cranial nerve palsies, seizures, coma)
  • Rapid onset of coma and death (within 2 wk)
Previous
Next

Causes

PAM is caused by infection with the ameba N fowleri.

Previous
Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath  Director-Professor of Microbiology, Head of Department of Microbiology, Jawaharlal Institute, Postgraduate Medical Education and Research, India

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath is a member of the following medical societies: Indian Academy of Tropical Parasitology, Indian Association of Biomedical Scientists, Indian Association of Medical Microbiologists, Indian Association of Pathologists and Microbiologists, Indian Medical Association, Indian Society for Parasitology, National Academy of Medical Sciences, India, and Royal College of Pathologists

Disclosure: Jawaharlal Institute of Postgraduate Medical education & Research , Pondicherry , India Salary Employment

Coauthor(s)

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Barnett Gibbs, MD  Assistant Chief, Department of Clinical Trials, Walter Reed Army Institute of Research, Infectious Disease Service, National Capital Consortium; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Disclosure: Nothing to disclose.

Diane H Johnson, MD  Assistant Director, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook School of Medicine

Diane H Johnson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Women's Association, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel R Lucey, MD, MPH  Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences

Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas M Kerkering, MD  Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Grate I Jr. Primary amebic meningoencephalitis: a silent killer. CJEM. Sep 2006;8(5):365-9. [Medline].

  2. Schuster FL. Cultivation of pathogenic and opportunistic free-living amebas. Clin Microbiol Rev. Jul 2002;15(3):342-54. [Medline].

  3. Centers for Disease Control and Prevention. Primary amebic meningoencephalitis--Arizona, Florida, and Texas, 2007. MMWR Morb Mortal Wkly Rep. May 30 2008;57(21):573-7. [Medline].

  4. Parija SC, Jayakeerthee SR. Naegleria fowleri: a free living amoeba of emerging medical importance. J Commun Dis. Sep 1999;31(3):153-9. [Medline].

  5. Cervantes-Sandoval I, Serrano-Luna Jde J, García-Latorre E, Tsutsumi V, Shibayama M. Mucins in the host defence against Naegleria fowleri and mucinolytic activity as a possible means of evasion. Microbiology. Dec 2008;154:3895-904. [Medline].

  6. Jung SY, Kim JH, Song KJ, Lee YJ, Kwon MH, Kim K. Gene silencing of nfa1 affects the in vitro cytotoxicity of Naegleria fowleri in murine macrophages. Mol Biochem Parasitol. May 2009;165(1):87-93. [Medline].

  7. Centers for Disease Control and Prevention. Factsheet of Naeglaria fowleri. Available at http://www.cdc.gov/ncidod/dpd/parasites/Naegleria/factsht_naegleria.htm.

  8. Jamerson M, Remmers K, Cabral G, Marciano-Cabral F. Survey for the presence of Naegleria fowleri amebae in lake water used to cool reactors at a nuclear power generating plant. Parasitol Res. Apr 2009;104(5):969-78. [Medline].

  9. Naegleria fowleri. Wikipedia. Available at http://en.wikipedia.org/wiki/Naegleria_fowleri. Accessed 9/25/2008.

  10. Marciano-Cabral F, Jamerson M, Kaneshiro ES. Free-living amoebae, Legionella and Mycobacterium in tap water supplied by a municipal drinking water utility in the USA. J Water Health. Mar 2010;8(1):71-82. [Medline].

  11. Laseke I, Korte J, Lamendella R, Kaneshiro ES, Marciano-Cabral F, Oerther DB. Identification of Naegleria fowleri in warm ground water aquifers. J Environ Qual. Jan-Feb 2010;39(1):147-53. [Medline].

  12. Parija SC. Amoebae. In: Textbook of Medical Parasitology: Protozoology & Helminthology. 3rd ed. All India Publishers and Distributors; 2011:26-61.

  13. Kaushal V, Chhina DK, Ram S, Singh G, Kaushal RK, Kumar R. Primary amoebic meningoencephalitis due to Naegleria fowleri. J Assoc Physicians India. Jun 2008;56:459-62. [Medline].

  14. Gupta 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. Jun 2009;13(3):236-7. [Medline].

  15. Centers for Disease Control and Prevention. Emerging Infectious Diseases. Available at http://www.cdc.gov/ncidod/EID/index.htm. Accessed February 2011.

  16. Init I, Lau YL, Arin Fadzlun A, Foead AI, Neilson RS, Nissapatorn V. Detection of free living amoebae, Acanthamoeba and Naegleria, in swimming pools, Malaysia. Trop Biomed. Dec 2010;27(3):566-77. [Medline].

  17. Huang SW, Hsu BM. Survey of Naegleria from Taiwan recreational waters using culture enrichment combined with PCR. Acta Trop. Aug 2011;119(2-3):114-8. [Medline].

  18. Shin HJ, Im KI. Pathogenic free-living amoebae in Korea. Korean J Parasitol. Sep 2004;42(3):93-119. [Medline]. [Full Text].

  19. Rai R, Singh DK, Srivastava AK, Bhargava A. Primary amebic meningoencephalitis. Indian Pediatr. Dec 2008;45(12):1004-5. [Medline].

  20. Réveiller FL, Cabanes PA, Marciano-Cabral F. Development of a nested PCR assay to detect the pathogenic free-living amoeba Naegleria fowleri. Parasitol Res. May 2002;88(5):443-50. [Medline].

  21. Marciano-Cabral F, MacLean R, Mensah A, LaPat-Polasko L. Identification of Naegleria fowleri in domestic water sources by nested PCR. Appl Environ Microbiol. Oct 2003;69(10):5864-9. [Medline].

  22. Johnson PE, Deromedi AJ, Lebaron P, Catala P, Havens C, Pougnard C. High throughput, real-time detection of Naegleria lovaniensis in natural river water using LED-illuminated Fountain Flow Cytometry. J Appl Microbiol. Sep 2007;103(3):700-10. [Medline].

  23. Flores BM, Garcia CA, Stamm WE, Torian BE. Differentiation of Naegleria fowleri from Acanthamoeba species by using monoclonal antibodies and flow cytometry. J Clin Microbiol. Sep 1990;28(9):1999-2005. [Medline]. [Full Text].

  24. Madarová L, Trnková K, Feiková S, Klement C, Obernauerová M. A real-time PCR diagnostic method for detection of Naegleria fowleri. Exp Parasitol. Sep 2010;126(1):37-41. [Medline].

  25. Visvesvara GS. Amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment. Curr Opin Infect Dis. Dec 2010;23(6):590-4. [Medline].

  26. Vargas-Zepeda J, Gómez-Alcalá AV, Vásquez-Morales JA, Licea-Amaya L, De Jonckheere JF, Lares-Villa F. Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin. Arch Med Res. Jan-Feb 2005;36(1):83-6. [Medline].

  27. Kim JH, Jung SY, Lee YJ, Song KJ, Kwon D, Kim K, et al. Effect of therapeutic chemical agents in vitro and on experimental meningoencephalitis due to Naegleria fowleri. Antimicrob Agents Chemother. Nov 2008;52(11):4010-6. [Medline]. [Full Text].

  28. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (MMWR). Available at http://www.cdc.gov/mmwr/about.html. Accessed August 2011.

  29. Lower Colorado River Authority. Lower Colorado River Authority: Energy, Water, Community Services. Available at http://www.lcra.org. Accessed August 2011.

 
Previous
Next
 
H&E-stained photomicrograph (magnified 125X) that shows the cytoarchitectural histpathology found in a case of primary amoebic meningoencephalitis (PAM), caused by Naegleria gruberi. Courtesy of the CDC/Dr. George R. Healy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.