UMEM Educational Pearls

Title: Brain-Eating Amoeba!

Posted: 7/24/2013 by Walid Hammad, MD, MBChB
Click here to contact Walid Hammad, MD, MBChB

General Information:

· Caused by the ameboflagellate Naegleria Fowleri

· Case fatality rate is estimated at 98%

· Commonly found in warm freshwater environments such as hot springs, lakes, natural mineral water, especially during hot summer months

· Incubation period 2-15 days

Relevance to the EM Physician:

· Clinical presentation: resembling bacterial meningitis/encephalitis

· Final diagnostic confirmation is not achieved until trophozoites are isolated and identified from CSF or brain tissue

· Treatment: Amphotericin B

Bottom Line:

· History of travel to tropical areas or exposure to warm or under-chlorinated water during summer time should raise the suspicion for Naegleria Fowleri. The amoeba is not sensitive to the standard meningitis/encephalitis therapy and amphotericin B must be added to the treatment regimen.

University of Maryland Section of Global Emergency Health

References

Su MY, Lee MS, Shyu LY, Lin WC, Hsiao PC, Wang CP, Ji DD, Chen KM, Lai SC. A fatal case of Naegleria fowleri meningoencephalitis in Taiwan. Korean J Parasitol. 2013 Apr

Naegleria fowleri, Kelly Fero , ParaSite, February 2010 retrieved from http://www.stanford.edu/group/parasites/ParaSites2010/Katherine_Fero/FeroNaegleriafowleri.htm