Progressed presentation and overall outcome
After the pt's first tonic-clonic seizure, consciousness never regained. Admission to ICU followed quickly after with increasing occurrence of seizures. The lumbar puncture (values available under Lab Results & Imaging page) led to a presumptive diagnosis of bacterial meningitis. Medications administered included lorazepam, ceftriaxone and vancomycin while the pt's head CT remained normal.
The morning of the second day in the PICU, the pt exhibited a sudden change in seizure activity in which her electroencephalogram suddenly flattened and she became hypotensive. The pt had a second head CT with a clear area of hypodensity (swelling) in the right frontal lobe. With documented cerebral edema, an intracranial pressure monitor was placed and medications were changed to hypertonic saline, mannitol (osmotic diuretic) and several different vasopressive agents. With no change in EEG activity after the shift in treatment modality, the pt was declared brain dead and permission for autopsy was granted by the family.
During autopsy, ameboid forms were noted with histological samples. Hemorrhagic necrosis was seen in several places in and around the brain--including optic and olfactory nerves, middle cerebral arteries, and right and left cerebellum.
The morning of the second day in the PICU, the pt exhibited a sudden change in seizure activity in which her electroencephalogram suddenly flattened and she became hypotensive. The pt had a second head CT with a clear area of hypodensity (swelling) in the right frontal lobe. With documented cerebral edema, an intracranial pressure monitor was placed and medications were changed to hypertonic saline, mannitol (osmotic diuretic) and several different vasopressive agents. With no change in EEG activity after the shift in treatment modality, the pt was declared brain dead and permission for autopsy was granted by the family.
During autopsy, ameboid forms were noted with histological samples. Hemorrhagic necrosis was seen in several places in and around the brain--including optic and olfactory nerves, middle cerebral arteries, and right and left cerebellum.
The suspected Cause
The pt was reported to have gone swimming two weeks prior to onset of symptoms in two separate lakes in which the pt repeatedly brought her head below the water level, swallowed, and likely aspirated water. The pt's family likewise participated but no one else developed an amoebic infection. While living in Minnesota where infections like these are uncommon, the temperature of the water when the pt had been swimming was quite warm (22.1 and 24.5 degrees Celsius) with algal blooms present. This case holds the title of the highest latitude ever documented for amoebic N. fowleri.