Naegleria Fowleri, a Rare Amoebic Outbreak in Pakistan – Its Clinical Presentation, Diagnosis and Management
During this month, eight cases of Naegleria fowleri have been reported in Karachi, Pakistan. Naegleria causes acute Primary Amoebic Meningoencephalitis (PAM) which is a fatal disease of brain. It destroys brain tissue quickly, hence also called the “Brain Eater”. It usually involves base of the brain, cerebellum and brain stem. It occurs mostly in young healthy individuals.
The usual source of acquiring Naegleria is diving in fresh water ponds, lakes and swimming pools. Some cases of bath water have also been reported. It occurs during warm weather. During the warm months, thermophilic bacteria grows very well. The usual pathogenesis is via olfactory nerve to the brain. Death is certain in 1-2 weeks without treatment. Healthy children and young adults are at increased risk of acquiring infection.
The PAM is difficult to diagnose because its signs and symptoms are same as bacterial or viral meningitis. Thus its diagnosis is relies on clinical power of diagnostics. Headache, nausea, vomiting, fever, lethargy, increase somnolence, seizures, stiff-neck and sudden onset of coma in otherwise healthy people are the main symptoms of its acute presentation.
For the diagnosis of PAM, increase in the number of polymorphonuclear leukocytes (PMNs) in the Cerebro-spinal Fluid (CSF) is a major clue. Most of the times, Naegleria is diagnose by histological examination. Polymerase Chain Reaction (PCR) technique helps for the early detection. Sometimes laboratory diagnosis is base on CSF examination of fresh specimen which should be examine under microscope and identify trophozoite. Another option of naegleria diagnosis is CSF culture, which takes time.
PAM is can be treated with amphotericin B, rifampicin and miconazole intrathcally as early as possible to improve survival. However amphotericin B remains the first line of drug despite its low efficacy and bad side effects. The combination therapy is more effective than single agent therapy. Furthermore, multi-route amphotericin B administration. Other drugs which have been tried with limited success include, anti-bacterial drugs, corticosteroids and anti Naegleria immunoglobulins.
Prognosis is depended upon early diagnosis if it occurs within a few days. Only a few patients were survived. The survival of patient is in fact base on prompt diagnosis and aggressive management. Despite compliance and prompt treatment, case fatality is more than 95%.
A major research break-through is needed in the field of Naegleria, both for the diagnostic compounds as well as on useful treatment combinations.
About the Author: Subhan Iqbal is a final year medical student in Dow Medical College, Karachi, Pakistan. He plans to pursue my career in Internal Medicine. He can be reached at: [email protected]
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