Clinical and Laboratory Diagnosis

As the clinical course of primary amoebic meningoencephalitis is rapid, prompt detection of amoebae is crucial to increase the likelihood of patient survival by initiating early treatment. In general, due to non-specific and overlapping signs and symptoms of primary amoebic meningoencephalitis with those of bacterial or viral meningitis, and the rarity of N. fowleri infections, most primary amoebic meningoencephalitis cases are diagnosed retrospectively, i.e., during the autopsy examination of brain tissues. However, in live patients, primary amoebic meningoencephalitis is commonly diagnosed through microscopic examination of cerebrospinal fluid specimens. It is time critical to diagnose primary amoebic meningoencephalitis and begin empiric antimicrobial therapy. The diagnosis of primary amoebic meningoencephalitis depends on clinical features together with microscopic and/or molecular identification of the parasites in the cerebrospinal fluid specimens. This overview presents the diagnostic approach to primary amoebic meningoencephalitis.