Naegleria Fowleri Disease
When individuals are subjected to polluted water, protozoa enter the host’s nasopharynx and pass via the mucous membrane, the subchondral layer, and the nasal neuron before accessing the smelling bulbs. As a result, it causes Primary Amebic Meningoencephalitis (PAM) by destroying the nervous system (CNS). Considering its rarities, only seven instances of Naegleria fowleri sickness have been reported in China thus far (Mungroo et al., 2019). None of them has sustained because of a substantial rise in CSF and intraocular pressure.
Because the amoeba travels through the nose, contamination is most commonly transmitted through swimming, skiing, or other activities that drive water into the nasal passages. Infections are caused in patients who dipped their faces in thermal springs or used neti jars filled with contaminated water from the tap to clear their noses. If an individual has a sudden onset of fever, headaches, stiff neck, or nausea, they ought to seek medical assistance as soon as possible, particularly if they have recently been in warm water. The virus does not spread from person to person.
Scenario Recorded
A previously healthy lady aged forty-two years visited the emergency department claiming to have a severe and continuous headache. Before going to the health facility, she had taken some NSAIDs (non-steroidal anti-inflammatory drugs) but did not feel any better. She reported that the pain of the headache was excruciating and unbearable. She also recorded to have stayed in the freshwater for five days as a form of recreation. Symptoms arise two to fifteen days after. Death generally happens three to seven days following the onset of illness. The average period from sign start to end is 5.3 days. Only a few people have been known to have sustained an outbreak worldwide.
Diagnosis
Temperature, 39.2°C; heartbeat, 88 pulse rate of 88/m; breathing rate, 34 inhales/m; cardiac output, 135/55 mmHg were all noted throughout the test. A CT scan of the head revealed no abnormalities despite a strong meningeal irascibility indication and a left Babinski indication on physical examination. A repeat blood test indicated a leucocyte frequency of 10,480 cells/mm3 (80 percent neutrophils) and then a concentration of 2.6 mg/L of C-reactive protein (CRP). During this surgery, a needle is placed between two vertebrae in the lumbar region. A little volume of CSF is taken and submitted to a lab to be checked under magnification for the presence of the naegleria amoeba. A neural tap can also prevent proinflammatory cytokines and evaluate the spinal fluid volume.
Following surgery, the CSF was unclear, with higher pressure (300 mmHg), an acceptable Pandy’s examination, relatively reduced sugar (1 mmol/L), significantly higher leukocytes (1,170 cells/mm3 plus 83 percent neutrophils), and peptide (>300 mg/dl). The customer was diagnosed with bacterial meningitis and received proper treatment as a consequence of the findings. She was sedated, anesthetized, and sent to the critical care unit due to her agitation and difficulty breathing (ICU). Prior to the examination, the majority of patients rapidly enter a severe coma with dramatically raised intracranial and CSF pressures, which can lead to loss of life. Second, there are no substantial medical studies testing the efficacy of a certain treatment option.
Treatment
To treat pyogenic meningitis, the patient was given 2g meropenem every eight hours, 600 mg linezolid every twelve hours, mannitol, and dexamethasone intravenously. On the second night of her ICU stay, she was less attentive, and a pupil dilation test revealed frozen and enlarged pupils. As a consequence, 150 mL of 20 percent mannitol was given for thirty minutes before CT scanning. Hydrocephalus, brain edema, hyperdense interhemispheric fissure cistern, and suprasellar cistern sign were all found on the brain CT scan, confirming cerebral hernia as well as meningoencephalitis. In addition, the exterior ventricular system for drainage was then installed, plus CSF specimens were taken and re-evaluated.
The lady was subsequently diagnosed as having PAM, and the PCR yielded positive amplicons for Naegleria spp. as well as Naegleria fowleri at the intensity sequences of roughly 410 bp as well as 310 bp, correspondingly. Following this understanding, the linezolid prescription was immediately halted. The patient was immediately put on a regimen of venous conventional amphotericin B (5 mg at first, then on the following day, 10mg is administered. While on the third day it should be 25mg, and then after that, 50 mg per day) with fluconazole (400 mg/day). Early diagnosis of PAM with i.v. Amphotericin B and fluconazole, as well as oral rifampicin, may provide some chance of a remedy for this dangerous illness. Even though this lethal condition can be cured if handled early and successfully, most physicians have never heard of it. As a result, doctors must be mindful in regards to PAM occurring in all instances of infected meningitis, particularly in individuals who have recently been exposed to seawater during the warm months.
Prognosis
Even though his vital signs became reasonably constant with average body temperature, heart rate, and pressure after five days of goal therapies, a revisit CSF investigation for trophozoites was negligible. Her heart rhythm remained relatively steady with average heat, pulsation, and pressure, the Glasgow coma measurement (GCS) analysis consistently displayed three points, and no sudden respiration was observed. Given the prospects, the client was transported to a local health center on August 31st, where she passed on September 5th.
Reference
Mungroo, M., Khan, N., & Siddiqui, R. (2019). Naegleria fowleri: Diagnosis, treatment options and pathogenesis. Expert Opinion on Orphan Drugs, 7(2), 67-80. Web.