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Naegleria (Diagnosis)

eMedicine Pediatrics, 2011

Naegleria infection is best differentiated based on the patient's history and examination of the CSF, including wet-mount preparation of spun CSF.
Workup Laboratory Studies For practical purposes, N fowleri meningoencephalitis must be rapidly diagnosed.
Patients who present with a clinical picture of meningitis (ie, fever, , meningismus, nausea and vomiting) should undergo a spinal tap as soon as they present.
The WBC count can be within the reference range in early infections but rapidly increases to range from 400-26,000 cells/µL with a neutrophilic predominance.
The CSF glucose level may be low or within the reference range, but the CSF protein is usually elevated.
A wet mount must be made because the trophozoites of N fowleri lyse during the heat fixation that precedes the Gram stain.
In examining CSF for N fowleri , a regular glass slide for a wet mount is preferred to a WBC counting chamber.
One patient has been reported who had a CT scan of the head that demonstrated diffuse enhancement of the gray matter and obliteration of the interpeduncular and quadrigeminal cisterns.
Other Tests EEG may show signs of reduced cerebral blood flow, including slow and disorganized fundamental rates.
Procedures The main diagnostic procedure for PAM is to obtain CSF for wet-mount examination for N fowleri, along with standard laboratory examination of the CSF (eg, WBC, RBC, glucose, protein, bacterial and fungal cultures).
N fowleri can be cultured on nonnutrient agar plates, which have a lawn of gram-negative bacteria, such as Escherichia coli, covering its surface.