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Naegleria fowleri meningoencephalitis — DTM&H MCQ

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HardProtozoal infectionsNaegleria fowleri meningoencephalitisDTM&H

A 16-year-old boy develops fever, severe headache and rapidly progressive coma 5 days after swimming in warm freshwater in Pakistan. CSF shows neutrophilic meningitis and bacterial cultures are negative. What is the most likely diagnosis?

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Correct answer: A — Primary amoebic meningoencephalitis

Primary amoebic meningoencephalitis is the single best answer because acute fulminant meningoencephalitis after warm freshwater nasal exposure is typical of Naegleria fowleri. Acanthamoeba granulomatous encephalitis is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that the short incubation and rapid progression distinguish it from Acanthamoeba disease.

Reference: Manson's Tropical Diseases; WHO neglected tropical diseases guidance; CDC DPDx