Global & Disaster Medicine

California, 2018: A Case of Fatal Naegleria fowleri Meningoencephalitis

Vugia DJ, Richardson J, Tarro T, et al. Notes from the Field: Fatal Naegleria fowleri Meningoencephalitis After Swimming in Hot Spring Water — California, 2018. MMWR Morb Mortal Wkly Rep 2019;68:793–794. DOI: icon

In October 2018, a previously healthy boy was admitted to an intensive care unit at a southern California hospital after experiencing 2 days of headache, vomiting, and fever and 1 day of altered mental status. He was initially treated empirically for bacterial and viral meningitis and subsequently displayed decreased level of consciousness and experienced respiratory failure, requiring intubation and mechanical ventilation. Computed tomography scan of the brain showed diffuse cerebral edema. A wet mount of cerebrospinal fluid obtained by lumbar puncture revealed amebic organisms consistent with Naegleria species, and a treatment regimen for Naegleria was added, including miltefosine (1), which is now commercially available.* The infectious disease clinician notified CDC, which then notified state and local public health. Polymerase chain reaction testing of a cerebrospinal fluid specimen at the Mayo Clinic on hospital day 2 identified N. fowleri, a free-living ameba found in warm fresh water that causes primary amebic meningoencephalitis (PAM). The patient’s condition continued to worsen, and he died on hospital day 3...…”

Naegleria fowleri banner - trophs under a microscope with contrast

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