Pediatric Naegleria Clinical Presentation

Updated: Oct 14, 2021
  • Author: Nicholas John Bennett, MBBCh, PhD, FAAP, MA(Cantab); Chief Editor: Russell W Steele, MD  more...
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Naegleria fowleri infection usually occurs in children or young adults who have a history of exposure to swimming or diving in warm freshwater within the last 7-14 days. Most often, the first symptoms develop 2-5 days after the last exposure to contaminated water. The illness begins suddenly with the abrupt onset of fever, headache, nausea, and vomiting. Occasionally, a prodromal stage of altered taste (ie, ageusia) and smell (ie, parosmia) may occur. Altered mental status occurs in about two thirds of patients and is followed by rapid deterioration to coma and death.


Physical Examination

The physical findings in PAM result from rapid spread of N fowleri from the submucosal olfactory nerves through the cribriform plate and into the olfactory bulb. Virtually all patients have meningismus by the time they reach medical care. Patients do not usually develop focal neurologic defects; however, cranial nerve palsies involving III, IV, and V, as well as cerebellar ataxia and reduced deep tendon reflexes, have been reported. Patients often have papilledema and nystagmus. In the final stage just prior to death, the patient may have decerebrate posturing.