{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:27:09Z","timestamp":1789986429924,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>\n                      Free-living amoeba is ubiquitous in fresh water, mud, and moist soil; although seldom pathogenic to humans,\n                      <jats:italic toggle=\"yes\">Naegleria fowleri<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Acanthamoeba<\/jats:italic>\n                      spp., and\n                      <jats:italic toggle=\"yes\">Balamuthia<\/jats:italic>\n                      spp. are known to cause infections of the central nervous system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We report two interesting cases, both of which presented with a rapid-onset and fulminant course. The first case details a 36-year-old male with a history of surgically corrected nasal bone fracture 15 years back, who presented with acute onset of fever, headache and convulsions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Direct smears of cerebrospinal fluid (CSF) revealed motile trophozoites resembling\n                      <jats:italic toggle=\"yes\">N. fowleri<\/jats:italic>\n                      and were later confirmed by molecular diagnosis (polymerase chain reaction [PCR]). Subsequently, the source was identified as water used for religious purposes. Unfortunately, the patient succumbed to cardiac arrest. The second case is that of a 4-year-old boy from Palakkad district, Kerala, who presented with sudden onset of nasal discharge, fever, headache, vomiting, seizures and altered sensorium. His CSF smear examination showed motile trophozoites resembling\n                      <jats:italic toggle=\"yes\">Acanthamoeba<\/jats:italic>\n                      spp. While undergoing treatment, he seized thrice before going into cardiac arrest. Despite extensive resuscitation measures, the child could not be revived and passed away. The postmortem CSF sample sent for molecular analysis confirmed infection by\n                      <jats:italic toggle=\"yes\">Acanthamoeba<\/jats:italic>\n                      spp.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Rapid progression and lack of definite treatment options make this a highly fatal condition. Although clinical presentations of both patients were indicative of pyogenic meningitis, parasitic infection was suspected when the CSF was found turbid with no bacteria, high protein, and low sugar. High index of suspicion helped us to get an early preliminary diagnosis from direct microscopy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/tp.tp_37_23","type":"journal-article","created":{"date-parts":[[2024,9,4]],"date-time":"2024-09-04T16:14:22Z","timestamp":1725466462000},"page":"108-112","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Free-living amoebic encephalitis \u2013 Case series"],"prefix":"10.4103","volume":"14","author":[{"given":"Sithara Nasar Thottathil","family":"Puthanpurayil","sequence":"first","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiswarya","family":"Mukundan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suryakala Ravi","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anu Pudurkara","family":"John","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithuna Rohini","family":"Thampi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"John","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College, Thrissur, Kerala, 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