Mushtaq Muhammad Zain, Mahmood Saad Bin Zafar, Aziz Adil
Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
Case Rep Infect Dis. 2020 Jul 24;2020:4925819. doi: 10.1155/2020/4925819. eCollection 2020.
is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a raised leucocyte count of 1100/L with predominant polymorphonuclear cells, and wet mount prep for was positive further confirmed with PCR. The patient was started Intravenous (IV) and intrathecal amphotericin-B, Per Oral (PO) miltefosine, IV rifampin, IV fluconazole, and IV dexamethasone. However, the patient started producing urine at 300-500 ml/hour. The patient's sodium levels increased from 144 to 175 mmol/L in 12 hours with raised serum osmolality and decreased urine osmolality and urine sodium. The patient was started on PO desmopressin of 0.2 micrograms twice daily after which his urine output dropped to 60-80 ml/hour and sodium decreased from 175 to 162 and, later 155 mmol/L; however, the patient expired. PAM is a rare and extremely fatal illness, but with increasing incidence now being reported in developing countries as a result of better diagnostics. DI is a very rare complication reported in these patients leading to poor outcome. The complication of diabetes insipidus (DI) has not been extensively studied in patients having PAM. Only three cases have been reported with this complication. No mechanism has been mentioned in the literature behind the development of DI in these patients, and no study has mentioned laboratory details of DI as mentioned in this report.
是一种高度传染性的自由生活变形虫，通常从土壤和淡水中分离出来，主要发现它会感染中枢神经系统（CNS），导致原发性阿米巴脑膜脑炎（PAM）。作为脑膜炎的一个病因，PAM常常被其他更常见的脑膜炎病因所忽视。尽管在抗菌治疗和支持护理系统方面取得了所有进展，但这种罕见感染的死亡率仍高于95%，大多数病例出现在发达国家。我们报告一例44岁男性患者，有发热、头痛加重和全身无力症状。腰椎穿刺显示白细胞计数升高至1100/L，以多形核细胞为主， 湿片镜检阳性，PCR进一步证实。患者开始静脉注射（IV）和鞘内注射两性霉素B、口服（PO）米替福新、静脉注射利福平、静脉注射氟康唑和静脉注射地塞米松。然而，患者开始以每小时300 - 500毫升的速度产生尿液。患者的钠水平在12小时内从144 mmol/L升至175 mmol/L，血清渗透压升高，尿渗透压和尿钠降低。患者开始每日两次口服0.2微克去氨加压素，之后尿量降至每小时60 - 80毫升，钠从175 mmol/L降至162 mmol/L，后来又降至155 mmol/L；然而，患者最终死亡。PAM是一种罕见且极其致命的疾病，但由于诊断方法的改进，现在发展中国家报告的发病率有所增加。尿崩症（DI）是这些患者中报告的一种非常罕见的并发症，导致预后不良。在患有PAM的患者中，尿崩症（DI）并发症尚未得到广泛研究。仅报告了3例有此并发症的病例。文献中未提及这些患者发生DI的机制，也没有研究提及本报告中所述的DI的实验室细节。
