Primary amoebic meningoencephalitis: two new cases from Pakistan

Abstract

Naegleria fowleri causes a fatal infection of the central nervous system. Only one case of N. fowleri meningoencephalitis has previously been reported from Pakistan. We describe two cases of primary amoebic meningoencephalitis. A 24-year-old man presented with a two-day history of high grade fever, headaches and vomiting. He was put on intrathecal amphotericin B, fluconazole and rifampicin when motile trophozoites were identified on a wet mount of cerebrospinal fluid. The patient did not improve and died on the sixth day of admission. The second case was a 30-year-old man who presented with a three-day history of high grade fever, vomiting and agitation. His clinical course was marked by a rapid deterioration. He received intrathecal amphotericin B, fluconazole and broad spectrum antibiotics when motile trophozoites on wet mount were observed. Again, the patient's condition did not improve and he died on the eighth day of admission.

Drugs used for the treatment of cerebral and disseminated infections caused by free‐living amoebae

“…The most relevant drug combinations gathered in the current work for PAM treatment associated either (a) amphotericin B and an azole (fluconazole, ketoconazole or miconazole), with or without rifampicin (combination B PAM ), or (b) amphotericin B, azithromycin, fluconazole, or rifampicin with or without miltefosine (combination A PAM ; Table 1). 56,59–83 In the latter combination, miltefosine was associated with rifampicin in 28 cases out of 34, 60–64,70,73,76 both drugs presenting the highest EDU according to our analysis (Figure 4b). The combination A PAM , which was the closest to the one recommended by the CDC, was successful in 18% of the 34 clinical cases treated by this drug association.…”

Isolation of Thermotolerant Pathogenic Naegleria australiensis from Diverse Water Resources Including Household Drinking Water in Pakistan

“…In support at least 13 PAM cases have already been reported in Karachi, Pakistan, who had no history of aquatic activities and it was believed the infections likely occurred through ablution with tap water (Shakoor et al 2011). There are few reports of PAM caused by Naegleria have been reported from Pakistan previously (Saleem et al 2009;Shariq et al 2014). Seven out of 15 (46.66%) Naegleria species have been identified during this study but originally 15 out of 59 (25.42%) samples were positive for Naegleria DNA during PCR.…”