infectious diseases
Primary Amebic Meningoencephalitis
Key Points
Primary amebic meningoencephalitis is rare, usually fatal. The infection is acquired when swimming in contaminated fresh water;Naegleria fowlerienters the CNS via olfactory neuroepithelium and the cribriform plate. Diagnostic tests should include a wet mount and Giemsa-stained specimen of CSF. Treat the infection with multiple antimicrobial agents, includingmiltefosine; if needed, treat seizures and cerebral edema with antiseizure drugs anddexamethasone. Survival is rare but, in recent cases, has been attributed to early diagnosis and treatment in combination with aggressive management of cerebral edema. 