Naegleria fowleri

Case: 24 years old male is admitted 5 days after his visit to a water park with seizure, fever, severe headache, and altered mental status. There is a strong suspicion of Naegleria fowleri due to similar cases reported previously in the city. A spinal tap has been performed. Cerebrospinal fluid (CSF) pressure is expected to be? (select one) 

A) high

B) low

Answer: A

Naegleria fowleri is an ameboflagellate protozoan parasite and is distributed worldwide. Due to its thermophilic character, it is found in warm water sources. Recreational water activities are a well-known source of infection. It may cause primary amebic meningoencephalitis (PAM), an acute hemorrhagic meningoencephalitis.

CSF tends to be yellowish-white to grayish color before turning into a frankly hemorrhagic fluid. Characteristically, CSF pressure is very high, ranging from 300 to 600 mm H20, strongly favoring Naegleria fowleri. Diagnosis should be made in conjunction with epidemiological, clinical, radiological, and laboratory findings.

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References:

1. Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea. FEMS Immunol Med Microbiol 2007; 50:1.

2. Visvesvara GS. Free-living amebae as opportunist agents of human disease. J Neuroparasitol 2010; 1:1.

3. Qvarnstrom Y, Visvesvara GS, Sriram R, da Silva AJ. Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. J Clin Microbiol 2006; 44:3589.