BACKGROUND: Primary amoebic @entity5422 (PAM) is a rapidly progressing waterborne illness that predominately affects @entity1 and is nearly always fatal. PAM is caused by Naegleria fowleri, a free-living amoeba found in bodies of warm freshwater worldwide. METHODS: We reviewed exposure location, clinical signs and symptoms, diagnostic modalities, and treatment from confirmed cases of PAM diagnosed in the United States during 1937-2013. @entity1 were categorized into the early ( @entity1109 ) or late (ie, central nervous system signs) group on the basis of presenting clinical characteristics. Here, we describe characteristics of the survivors and decedents. RESULT: The median age of the @entity1 was 12 years (83% aged  <=18 years); males (76%) were predominately affected (N = 142). Most infections occurred in southern-tier states; however, 4 recent infections were acquired in northern states: Minnesota (2), Kansas (1), and Indiana (1). Most (72%) of the @entity1 presented with central nervous system involvement. Cerebrospinal fluid analysis resembled @entity4008 with high opening pressures, elevated white blood cell counts with predominantly neutrophils (median, 2400 cells/ L [range, 5-26 000 cells/ L]), low @entity413 levels (median, 23 mg/dL [range, 1-92 mg/dL]), and elevated protein levels (median, 365 mg/dL [range, 24-1210 mg/dL]). Amoebas found in the cerebrospinal fluid were diagnostic, but PAM was diagnosed for only 27% of the @entity1 before death. Imaging results were abnormal in approximately three-fourths of the @entity1 but were not diagnostic for @entity281 . Three @entity1 in the United States survived. CONCLUSIONS: To our knowledge, this is the first comprehensive clinical case series of PAM presented in the United States. PAM is a @entity221 with limited treatment success and is expanding into more northern regions. Clinicians who suspect that they have a @entity1 with PAM should contact the US Centers for Disease Control and Prevention at 770-488-7100 (available 24 hours/day, 7 days/week) to discuss diagnostic testing and treatment options (see cdc.gov/naegleria).

Diagnosis, Clinical Course, and Treatment of Primary Amoebic XXXX in the United States, 1937-2013.

@entity1 :: ('9606', 'Species') :: ['children', 'Patients', 'patients', 'patient'] @entity4008 :: ('MESH:D016920', 'Disease') :: ['bacterial meningitis'] @entity5422 :: ('MESH:D008590', 'Disease') :: ['meningoencephalitis'] @entity1109 :: ('MESH:D012678', 'Disease') :: ['ie, flu-like symptoms'] @entity281 :: ('MESH:D007239', 'Disease') :: ['amoebic infection'] @entity221 :: ('MESH:D005334', 'Disease') :: ['fatal illness'] @entity413 :: ('MESH:D005947', 'Chemical') :: ['glucose']
@entity5422 :: (MESH:D008590,Disease) :: ['Meningoencephalitis']
