Primary Amoebic Meningoencephalitis in children: a report of two fatal cases and review of the Literature

Abstract Background Primary amoebic meningoencephalitis (PAM) is a rare, almost uniformly fatal disease of cerebral invasion by Naegleria fowleri , occurring most commonly after swimming in warm fresh water in summer months. Treatment using the experimental medication miltefosine has demonstrated improved survival and favorable neurocognitive outcome in a 2013 North American case. Little has been described regarding electrographic recordings of such patients and little to compare known pediatric cases of survival. Patient Descriptions We describe two children, aged 4 and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures. With evidence of pyogenic meningitis and examination of cerebrospinal fluid (CSF) demonstrating motile trophozoites on wet mount, N. fowleri meningoencephalitis was diagnosed. Amoebicidal antibiotic regimens with miltefosine were administered. Continuous electroencephalographam (EEG) monitoring demonstrated evolution from diffuse slowing to seizures, status epilepticus, and eventually global attenuation and absence of activity. Both patients ultimately died following complications of progressively increasing intracranial pressure (ICP) and hemodynamic compromise. Conclusions Primary amoebic meningoencephalitis is a serious, sporadic infection. Herein describes our experience with two fatal pediatric cases, the evolution of EEG findings, and comparisons to the 13 reported cases of pediatric survivors.