Comprehensive Review of Primary Amebic Meningoencephalitis in Emergency Medicine Setting

Authors

• Jonathan Sloop, University of LynchburgFollow

Specialty

Emergency Medicine

Advisor

Tom Colletti

Abstract

This article provides a focused review of Primary Amebic Meningoencephalitis (PAM) with emphasis on recognition and management in the emergency department. Primary Amebic Meningoencephalitis (PAM), caused by Naegleria fowleri, is a rapidly progressive central nervous system infection with a mortality rate approaching 95%. Although rare in occurrence, early symptoms mimic bacterial or viral meningitis, leading to delayed diagnosis and thus delayed proper treatment. Infections commonly occur after exposure to warm freshwater. This then allows the amoeba to enter through the nasal passages and migrate along the olfactory nerve and eventually enter the brain where it can trigger severe edema and inflammation.

Diagnosis remains challenging as imaging is mostly non-specific and initial cerebral spinal fluid findings resemble bacterial meningitis. Confirmatory PCR testing is essential to establish the diagnosis of PAM and properly treat a rapidly progressing disease in the ED setting. Management requires immediate initiation of amphotericin-B and a further combination therapy typically guided by the CDC. Given the rapid progression and extremely high fatality of PAM, maintaining clinical suspicion in meningitis presentations with relevant water exposure is crucial. Early recognition, timely CSF testing, and immediate treatment offer the only chance to improve survival in this otherwise devastating disease.

Recommended Citation

Sloop J. Comprehensive Review of Primary Amebic Meningoencephalitis in Emergency Medicine Setting. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).