Primary amebic meningoencephalitis: Summarization on cases with early diagnosis by identification of amebae trophozoite in the cerebrospinal fluid.

Dear Sir,

Primary amebic meningoencephalitis (PAM) is a deadly neurological infection caused by free-living ameba. Clinically, the free-living ameba can be found in freshwater sources, and the patients usually have a history of contact to the water.[1] The fatality in PAM is very high. The recent report by Sood et al. noted that “prompt diagnosis” could be helpful in the management of the patients and prompt treatment could help patients’ survival.[2] Here, the authors tried to summarize the data on published article in PubMed to study the outcome of management in PAM patients with identification of amebae trophozoite in the cerebrospinal fluid (CSF). According to the retrospective study, there are at least 18 cases of PAM with identification of amebae trophozoites in the CSF in nine reports.[123456789] In all cases, the early diagnosis could be derived due to identification of trophozoites in CSF and confirmed with specific ameba culture. Despite early treatment, 5 from 18 cases (27.8%) survived after treatment. In the 13 death cases, two cases were due to cousins’ requests for discharge against medical advice before complete standard treatment. Of interest, the high survival rate in those cases can confirm the usefulness of careful CSF examination in suspicious case to derive early diagnosis. Indeed, Wiwanitkit noted that “inability to detect the amebic trophozoite” can result in delayed specific treatment and fatality.[1] It can be concluded that wet mount CSF examination by a clinical microscopist is very important in the early diagnosis.

Kaushal et al. concluded that CSF examination is a useful diagnostic approach for PAM and should be carefully done in any case who “manifest similarly to pyogenic meningitis but whose CSF shows no bacterial organisms.”[6] In addition, following up CSF examination can be useful. Clearance of trophozoite is a good sign and can be also seen in the reported survival cases.

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