Case Report of Pediatric Naegleria fowleri Meningoencephalitis

Background Naegleria fowleri , a pathogenic free-living amoeba, is the causative agent of primary amoebic meningoencephalitis (PAM), a rare but devastating disease. PAM is characterized by its acute onset, rapid progression, and severe clinical manifestations, with mortality rates exceeding 95%. Despite its rarity, the catastrophic outcomes associated with this infection underscore the critical importance of prevention. In this report, we present a rare pediatric fatality caused by PAM in China, highlighting the challenges of diagnosis and treatment. Case presentation We report a pediatric case of PAM that occurred in Lushan County, Pingdingshan City, Henan Province, China. The patient, a 6-year-old child, initially presented with persistent high fever on December 5, 2024, accompanied by headache, vomiting, and altered mental status. After receiving ineffective treatment at a local hospital, the child was transferred to the Eastern District of Henan Children’s Hospital on December 7 for further evaluation and management. Upon admission, cerebrospinal fluid was collected for laboratory analysis, and antimicrobial therapy, including amphotericin B, fluconazole, and rifampicin, was promptly initiated. Despite these interventions, the patient’s condition deteriorated rapidly, and the child succumbed to the infection on December 9. Conclusions The clinical presentation and laboratory findings strongly suggest that the child was infected with Naegleria fowleri , resulting in PAM. Epidemiological investigation suggests that the infection may have been acquired during bathing at a public bathhouse. Given the survival characteristics of the amoeba and the accelerating effects of global warming, which may expand its habitat, this sporadic case serves as a stark reminder of the lethal potential of PAM. With a mortality rate exceeding 95%, early recognition and prompt intervention are crucial. Clinicians should maintain a high index of suspicion and consider PAM in the differential diagnosis of patients presenting with similar symptoms, particularly in regions where exposure to warm freshwater environments is common.