A 5-month-old infant presented with a history of fever, vomiting for 1 week, and convulsions for 3 days. On physical examination, the child was febrile (38.5°C), continuous convulsions were present, and the pupils were reactive. There was a progressive deterioration of consciousness, leading to coma. There was no significant finding in the cardiovascular system or respiratory system or by abdominal examination. A computed tomography scan showed mild effacement of the basal cisterns and a thin hypodense collection in bilateral frontal convexity, suggesting a possibility of subdural hygroma or subdural effusion.
Laboratory data included a total leukocyte count of 7,300/mm3, with 71% neutrophils, 26% lymphocytes, and 3% eosinophils. The hemoglobin concentration was 10.2 g/dl. No parasites were seen in the peripheral smear. The blood electrolyte picture showed sodium at 133 mmol/liter, potassium at 4.4 mmol/liter, chloride at 95 mmol/liter, bicarbonate at 18.6 mmol/liter, phosphorus at 4.7 mg/dl, blood urea nitrogen at 14 mg/dl, a serum calcium level of 9.2 mg%, and a random blood sugar level of 120 mg/dl.
The cerebrospinal fluid (CSF) was cloudy and hemorrhagic; and analysis showed the presence of sugar at a concentration of 10 mg/dl, proteins at a concentration of 361 mg/dl, and a cell count of 130 cells/mm3, with 80% neutrophils and 20% lymphocytes. Gram staining showed numerous polymorphonuclear leukocytes but no bacteria. Examination of a wet mount showed actively motile trophozoites suggestive of PAM. A Giemsa-stained smear showed trophozoites.
CSF sediment culture on 1.5% nonnutrient agar preseeded with a lawn culture of Escherichia coli yielded oval, motile, flagellated forms of Naegleria fowleri (length, about 15 μm) after 48 h of incubation, as observed in a wet mount preparation
Laboratory data included a total leukocyte count of 7,300/mm3, with 71% neutrophils, 26% lymphocytes, and 3% eosinophils. The hemoglobin concentration was 10.2 g/dl. No parasites were seen in the peripheral smear. The blood electrolyte picture showed sodium at 133 mmol/liter, potassium at 4.4 mmol/liter, chloride at 95 mmol/liter, bicarbonate at 18.6 mmol/liter, phosphorus at 4.7 mg/dl, blood urea nitrogen at 14 mg/dl, a serum calcium level of 9.2 mg%, and a random blood sugar level of 120 mg/dl.
The cerebrospinal fluid (CSF) was cloudy and hemorrhagic; and analysis showed the presence of sugar at a concentration of 10 mg/dl, proteins at a concentration of 361 mg/dl, and a cell count of 130 cells/mm3, with 80% neutrophils and 20% lymphocytes. Gram staining showed numerous polymorphonuclear leukocytes but no bacteria. Examination of a wet mount showed actively motile trophozoites suggestive of PAM. A Giemsa-stained smear showed trophozoites.
CSF sediment culture on 1.5% nonnutrient agar preseeded with a lawn culture of Escherichia coli yielded oval, motile, flagellated forms of Naegleria fowleri (length, about 15 μm) after 48 h of incubation, as observed in a wet mount preparation
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