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Volume 17, Number 2—February 2011

Dispatch

Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan

Sadia Shakoor, Mohammad Asim Beg, Syed Faisal MahmoodComments to Author , Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia Zafar
Author affiliations: Author ffiliations: Aga Khan University Hospital, Karachi, Pakistan (S. Shakoor, M.A. Beg, S.F. Mahmood, F. Ali, A. Zafar); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R. Bandea, R. Sriram, G.S. Visvesvara); Liaquat National Hospital, Karachi (F. Noman)

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Table

Clinical features and CSF analysis results for 13 patients with Naegleria fowleri meningoencephalitis, Karachi, Pakistan, 2008–2009*

Characteristic
Patient nos., in order of treatment
Descriptive statistics†
1
2
3
4
5
6
7
8
9
10
11
12
13
Age, y 31 25 30 36 60 30 64 18 22 16 18 18 35 Mean 31.0 ± 15.33
Date treatment sought 2008 Jul 2008 Sep 2009 Apr 2009 May 2009 Jul 2009 Jul 2009 Jul 2009 Jul 2009 Aug 2009 Aug 2009 Oct 2009 Oct 2009 Nov
Duration of illness before seeking treatment, d 2 1 2 4 4 1 2 5 2 2 2 3 3 Mean ± SD 2.5 ± 1.19
Duration of survival after symptom onset, d
6
15
3
6
7
9
7
6
5
3
3
7
6
Mean ± SD 6.38 ± 3.15
Fever + + + + + + + + + + + + + Present in 13/13 (100%)
Headache + + + + + + + + + + + + Present in 12/13 (92.3%)
Seizures
+

+

+

+

+
+
+
+

Present in 8/13 (61.5%)
CSF analysis
Glucose, mg/dL† <5 42 2 <5† 26 <5† <5‡ 30 <5‡ <5‡ 80 50 <5‡ Undetectable in 53.8%
Protein, mg/dL 1,028 418 909 774 504 1,147 1342 320 998 330 371 179 1,296 Mean ± SD 739.69 ± 405.29
Leukocytes,
cells/mm3 900 900 5,976 2,000 2,500 7,500 5,200 6,000 840 6,500 150 185 11,750 Mean ± SD 3,877.0 ± 3,565.37
Neutrophils, % 15 90 90 90 60 80 90 90 90 96 75 25 95 Neutrophilic pleocytosis, 84.6
Lymphocytes, % 85 10 10 10 40 20 10 10 10 4 25 75 5 Lymphocytic pleocytosis, 15.4
CSF amebic
culture NA + + + + + + + + + + + + NA
CSF PCR for
N. fowleri NA NA NA NA + + + NA NA NA NA NA NA NA

*All patients were male except patient no. 11, who was female. CSF, cerebrospinal fluid; +, present; NA, no data available.
†Statistics derived in SPSS software version 16.0 (LEAD Technologies, Charlotte, NC, USA).
‡Glucose <5 mg/dL= undetectable.

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