CSF Gram stain showing N. fowleri trophs - CDC
On July 18, 2013, 12-year-old Kali enjoyed the day with two of her friends at a nearby waterpark. In addition to a picnic area, the park had a pond with lots of fun things like a slide, logroll, swings and an activity called the Wipeout. The pond was man made and was somewhat muddy. The next morning, Kali awoke with a throbbing headache and a temperature of 103° F (39.4° C). Her mother made an appointment to see a physician at 3:00 PM, but as the morning progressed, Kali couldn’t hold her gaze and her eyes rolled back into her head. Realizing the severity of the situation, her mother and grandmother wrapped her in wet towels and quickly took her to the emergency room (ER) of the Arkansas Children’s Hospital. The ER physicians did a spinal tap to rule out meningitis. In the laboratory, a routine Gram stain was done on the spinal fluid.
In addition to numerous polymorphonuclear neutrophils (PMNs), the medical laboratory scientist saw trophozoites of N. fowleri. Kali began to hallucinate and suffer from diplopia. Her physicians realistically did not offer much hope of survival. Nevertheless, they lowered her temperature to 93° F (33.9° C) by circulating chilled water in gel packs placed against her skin. Included in her regimen of antibiotics was amphotericin B and miltefosine. She was put into an induced coma. On September 11, after 55 days in the hospital, Kali was released to go home. At the time of her release she was unable to speak and was only able to walk using braces. Fortunately these problems were not long term. Several factors may have contributed to Kali’s survival. She may have been exposed to the organism previously and somehow built up an immunity. The strain of N. fowleri may not have been as virulent as in other cases. Very important was the early diagnosis and drug intervention.