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Real-Time PCR Confirmation of a Fatal Case of Primary Amoebic Meningoencephalitis in Turkey Caused by Naegleria fowleri or Brain-Eating Amoeba

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Abstract

Background

Naegleria fowleri, the causative agent of primary amoebic meningoencephalitis (PAM), is a free-living amoeba. It is a water-borne infection usually detected in children and young people with healthy immune system who swim, dive and perform activities in fresh and hot springs.

Purpose

In this study, it was aimed to raise awareness in the differential diagnosis of meningitis etiopathogenesis by showing that N. fowleri may also be the causative agent, albeit very rarely, in meningitis cases in Turkey.

Methods

Our case was an 18-year-old male patient whose relatives stated that he has gone to the hot spring; his headache complaint started after 2 to 3 days after return from the hot spring. Cerebrospinal fluid (CSF) sample taken from the patient was investigated by direct microscopic examination, real-time PCR method and sequence analysis.

Results

The CSF sample collected was taken into distilled water considering the possibility of transformation of trophozoites to intermediate form and incubated at 37 °C for 1 to 2 h, and pear-shaped non-permanent flagellated forms were observed in the direct microscopic examination, and molecular typing was performed to confirm the diagnosis. This study was a comprehensive case of N. fowleri whose etiological agent was isolated and confirmed by real-time PCR in Turkey.

Conclusion

Clinician awareness would be the key factor in correctly diagnosing PAM. It is also recommended to investigate all likely environmental water sources in Turkey for more detailed information on the distribution and molecular identification of Naegleria species, ultimately to evaluate the potential pathogenic threat to human health and to develop strategies to combat such threats.

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Acknowledgements

We are grateful to Ibne Karim M. Ali who provided N. fowleri and B. mandrillaris positive control DNA from Free-Living and Intestinal Amebas (FLIA) Lab, CDC, Atlanta, Georgia, USA.

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Authors and Affiliations

  1. Microbiology Laboratory of Mehmet Akif İnan Education and Research Hospital, Sanlıurfa, Turkey

    Koray Oncel

  2. Infection Diseases Department of Mehmet Akif İnan Education and Research Hospital, Sanlıurfa, Turkey

    Leman Karaagac

  3. Faculty of Medicine, Department of Parasitology, Ege University, Izmir, Turkey

    Hande Dagcı

  4. Faculty of Medicine, Department of Parasitology, Tokat Gaziosmanpasa University, Tokat, Turkey

    Mehmet Aykur

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  1. Koray Oncel
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Correspondence to Mehmet Aykur.

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Supplementary Information

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Supplementary file1 (MP4 123640 KB) Video 1: Trophozoites of N. fowleri active movement show in the CSF samples

Supplementary file2 (MP4 119302 KB) Video 2: Movements of the flagellate form of N. fowleri after incubation of the CSF sample in distilled water for 1–2 hours

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Oncel, K., Karaagac, L., Dagcı, H. et al. Real-Time PCR Confirmation of a Fatal Case of Primary Amoebic Meningoencephalitis in Turkey Caused by Naegleria fowleri or Brain-Eating Amoeba. Acta Parasit. 67, 697–704 (2022). https://doi.org/10.1007/s11686-021-00514-0

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