2009 Southern Regional Meeting Abstracts
Session: Joint Plenary Poster Session and Reception
Primary Amebic Meningoencephalitis- A Case Report in the South
Kennedy JL3, Schexnayder SM2, Moss M2, Tailounie M2, Ortmann L2, Byrnes J2, Stovall SH1. 1Arkansas Children's Hospital, Little Rock, AR; 2Arkansas Children's Hospital, Little Rock, AR and 3Arkansas Children's Hospital/University of Arkansas for Medical Sciences, Little Rock, AR.
Purpose of Study: Primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri, a thermophilic, fresh water amoeba, occurs in previously healthy children and young adults with a recent history of water-sports activities.
Methods Used: We present a case report of a healthy 14 year old caucasian female with vomiting, fever, and headache and was diagnosed with PAM.
Summary of Results: The patient presented to her local hospital with headache, nausea, and stiff neck for two days. The patient had been to a lake in Oklahoma two weeks earlier. She was admitted to a local hospital and with a diagnosis of viral meningitis after lumbar puncture showed 533 WBC (41% PMNs, 51% lymphs) with glucose 67 mg/dl, protein 98 mg/dl and a negative gram stain. The night of admission, she developed tonic clonic seizure activity. She was intubated for a decreased level of consciousness and was transferred to our tertiary care facility.
On arrival at our facility a repeat lumbar puncture showed many WBC including 36 “other cells” with high protein and low glucose levels in CSF. Continuous EEG monitoring was begun and empiric antibiotics started. A head CT scan showed diffuse cerebral edema. Lab personnel reported “other cells” in CSF were suggestive of amoeba. Liposomal amphotericin B, rifampin, and fluconazole were begun after infectious disease consultation. CSF photos sent to the CDC confirmed the diagnosis of Naegleria fowleri. She developed anisocoria consistent with increased intracranial pressure and received osmotic therapy. An MRI the following day showed pus within the quadrigeminal plate cistern and leptomeninges. She subsequently developed bradycardia and hypotension, followed by a brief cardiopulmonary arrest. An external ventricular drain was placed, intracranial hypertension confirmed and intraventricular amphotericin B administered. The following day, her clinical examination confirmed brain death. An autopsy was performed.
Conclusions: This is a single case report of a pediatric patient with primary amebic encephalitis with N. fowleri resulting in rapid death despite aggressive therapy.
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