Archives of Medical Research 36 (2005) 83–86 CASE REPORT Successful Treatment of Naegleria fowleri Meningoencephalitis by Using Intravenous Amphotericin B, Fluconazole and Rifampicin Jesu ´s Vargas-Zepeda, a Alejandro V. Go ´mez-Alcala ´, b Jose ´ Alfonso Va ´zquez-Morales, a Leonardo Licea-Amaya, c Johan F. De Jonckheere d and Fernando Lares-Villa e a Department of Pediatrics, Hospital de Especialidades 1, Centro Me ´dico Nacional Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obrego ´n, Sonora, Me ´xico b Board of Medical Research, Delegacio ´n Sonora, Instituto Mexicano del Seguro Social, Ciudad Obrego ´n, Sonora, Me ´xico c Clinical Laboratory, Hospital de Especialidades 1, Centro Me ´dico Nacional Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obrego ´n, Sonora, Me ´xico d Research Institute for Tropical Diseases, Christian de Duve Institute of Cellular Pathology, Brussels, Belgium e Department of Biotechnology and Alimentary Sciences, Instituto Tecnolo ´gico de Sonora, Ciudad Obrego ´n, Sonora, Me ´xico Received for publication June 22, 2004; accepted October 22, 2004 (04/013). Background. Primary amebic meningoencephalitis (PAM) is an emerging disease with a rapidly fatal outcome. Only eight reports of cured cases have appeared in the medical literature to date. Methods. A 10-year-old boy developed PAM caused by Naegleria fowleri 1 week after swimming in an irrigation canal. He was admitted to our hospital after 9 h of severe headache and vomiting, fever, ataxic gait, mild confusion, and seizures were evident. Trophozoites were identified in the cerebrospinal fluid (CSF). Treatment with intravenous (i.v.) dexamethasone, amphotericin B, fluconaloze, and oral rifampicin was started. After several hours of conflicting clinical signs, recovery began, and on the third day he was conscious again. Hospital discharge occurred on day 23, after a normal brain CT scan. There was no sequel to the disease during the following 12 months. Results. The amebas present in the CSF were identified and confirmed as N. fowleri after observation of wet mounts and of cultures seeded on 1.5% non-nutrient agar plates covered with Escherichia coli, vegetative and cystic forms, enflagellation experiments in distilled water at 98°F, temperature tolerance testing and by indirect immunofluorescence using N. fowleri LEE antibody. The genotype was determined by PCR amplification and sequencing of the internal transcribed spacers (ITS) including the 5.8S rDNA. Conclusions. Early treatment of PAM by i.v. administration of amphotericin B and fluconazole, and oral administration of rifampicin can offer some hope of cure for this devastating disease.  2005 IMSS. Published by Elsevier Inc. Key Words: Naegleria fowleri, Free-living ameba, Primary amebic meningoencephalitis, Meningoencephalitis, Water-borne infections. Introduction Primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri is a generally fatal disease which develops in individuals who in the previous few days swam in bodies of water containing this free-living ameba (FLA) (1). Address reprint requests to: Dr. Alejandro V. Go ´mez-Alcala ´, Coordina- cio ´ n Delegacional de Investigacio ´ n en Salud, Delegacio ´ n Estatal del IMSS, Sonora, 5 de Febrero 205, Centro, Ciudad Obrego ´n, Sonora, Me ´xico CP 85000. E-mail: alejandro.gomezal@imss.gob.mx 0188-4409/05 $–see front matter. Copyright  2005 IMSS. Published by Elsevier Inc. doi: 10.1016/j.arcmed.2004.11.003 Even though PAM is still considered a rare disorder, the number of reports increases each year, with a fatal outcome in almost all cases. We have compiled only eight reports in which a cure was achieved (2–9), but for several of these it is debatable whether they were really caused by N. fowleri (10). In Mexico, there have been over 25 confirmed cases, most in the northwestern region of the country (11) with only one successfully treated case recorded (12). Amphotericin B remains the cornerstone of treatment, alone or in combination with other drugs (13), but no drugs