Background

Naegleria fowleri is a thermophilic ameba. It can be the causative agent of Primary Amoebic Menintoencephalitis (PAM), a rare and lethal disease which mortality rate is over 97%.

Objectives

We report a survival case of Primary Amoebic Meningoencephalitis for Naegleria fowleri infection in a 10-year-old girl from Spain.

Methods

Ten-year-old girl arrived to the Emergency Care Unit reporting progressive and persistent left ear pain, retroocular headache with diminution of consciousness level, Glasgow 14/15 with focal neurological symptoms. Blood analysis and Cerebroespinal fluid (CSF), after conducting a Computed Tomografy (CT), suggested bacterial infection.

She was admitted to Intensive Care Unit with the diagnostic of complicated otomastoiditis with cavernous sinus thrombophlebitis and meningitis. She was treated with meropenem and vancomycin. After eight days without response to treatment a MRI was performed, showing hemorrhagic infarction on the left cerebral peduncle, left hemiprotuberance and right thalamus.

Results

As all bacterial cultures, tuberculosis PCR and microbiology tests were negative, and she was swimming in an indoor pool, an amoebic meningoencephalitis was suspected. N.fowleri was detected in CSF and pool water.

Treatment using combination drug therapy (Amphotericin B deoxycholate, azithromycin, fluconazole, rifampicin and miltefosine) and management of intracranial pressure, allowed survival.

Conclusion

To the best of our knowledge, this is the first reported case of PAM in Spain. In our case, the clinical suspicion allowed an appropriate action. In meningitis with negative bacteriology and poor response to conventional treatment should be suspected rare microorganisms such as amoeba. The source of infection was identified, so Health authorities could be alerted.