Volume 17, Number 2—February 2011
Dispatch
Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan
Sadia Shakoor, Mohammad Asim Beg, Syed Faisal Mahmood
, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia Zafar
, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia ZafarTable
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.
