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June 1992

Amebic Encephalitis Unlikely

Author Affiliations

Pittsburgh, Pa

Arch Intern Med. 1992;152(6):1330-1331. doi:10.1001/archinte.1992.00400180166033

To the Editor. —  A successful treatment of primary amebic meningoencephalitis (PAM) was described by Brown1 in the June 1991 issue of the ARCHIVES. Brown stated that a previously healthy 32-year-old summer-camp swimming instructor was admitted to the hospital with severe headache, fever (37.9°C), and meningeal signs that rapidly progressed to coma. The computed tomographic scan of the head was normal, and a lumbar puncture yielded cloudy cerebrospinal fluid (CSF) with 5356 × 106/L white blood cells (0.98 neutrophils), a glucose level of 5.55 mmol/L, and a protein level of 6.10 g/L.Gram's staining of the CSF was negative for bacteria, and three motile amebas were seen on wet mount by a "pathologist experienced with freeliving amebas." The patient also had been waterskiing in a small, relatively stagnant, freshwater lake several days prior to the onset of symptoms.The patient was treated with amphotericin B and rifampin,