Abstract：
BACKGROUND: Naegleria fowleri, the causative agent of primary amoebic meningoencephalitis (PAM), is a free-living amoeba. It is a water-borne infection usually detected in children and young people with healthy immune system who swim, dive and perform activities in fresh and hot springs.
OBJECTIVE: In this study, it was aimed to raise awareness in the differential diagnosis of meningitis etiopathogenesis by showing that N. fowleri may also be the causative agent, albeit very rarely, in meningitis cases in Turkey.
METHODS: Our case was an 18-year-old male patient whose relatives stated that he has gone to the hot spring; his headache complaint started after 2 to 3 days after return from the hot spring. Cerebrospinal fluid (CSF) sample taken from the patient was investigated by direct microscopic examination, real-time PCR method and sequence analysis.
RESULTS: The CSF sample collected was taken into distilled water considering the possibility of transformation of trophozoites to intermediate form and incubated at 37 °C for 1 to 2 h, and pear-shaped non-permanent flagellated forms were observed in the direct microscopic examination, and molecular typing was performed to confirm the diagnosis. This study was a comprehensive case of N. fowleri whose etiological agent was isolated and confirmed by real-time PCR in Turkey.
CONCLUSIONS: Clinician awareness would be the key factor in correctly diagnosing PAM. It is also recommended to investigate all likely environmental water sources in Turkey for more detailed information on the distribution and molecular identification of Naegleria species, ultimately to evaluate the potential pathogenic threat to human health and to develop strategies to combat such threats.
OBJECTIVE: In this study, it was aimed to raise awareness in the differential diagnosis of meningitis etiopathogenesis by showing that N. fowleri may also be the causative agent, albeit very rarely, in meningitis cases in Turkey.
METHODS: Our case was an 18-year-old male patient whose relatives stated that he has gone to the hot spring; his headache complaint started after 2 to 3 days after return from the hot spring. Cerebrospinal fluid (CSF) sample taken from the patient was investigated by direct microscopic examination, real-time PCR method and sequence analysis.
RESULTS: The CSF sample collected was taken into distilled water considering the possibility of transformation of trophozoites to intermediate form and incubated at 37 °C for 1 to 2 h, and pear-shaped non-permanent flagellated forms were observed in the direct microscopic examination, and molecular typing was performed to confirm the diagnosis. This study was a comprehensive case of N. fowleri whose etiological agent was isolated and confirmed by real-time PCR in Turkey.
CONCLUSIONS: Clinician awareness would be the key factor in correctly diagnosing PAM. It is also recommended to investigate all likely environmental water sources in Turkey for more detailed information on the distribution and molecular identification of Naegleria species, ultimately to evaluate the potential pathogenic threat to human health and to develop strategies to combat such threats.
摘要：
背景：Naegleriafowleri，原发性阿米巴脑膜脑炎（PAM）的病原体，是自由生活的变形虫.它是一种水传播的感染，通常在免疫系统健康的儿童和年轻人中发现，潜水和执行活动在新鲜和温泉。
目的：在本研究中，它的目的是通过显示N.fowleri也可能是病原体来提高对脑膜炎病因的鉴别诊断的认识，尽管很少，在土耳其的脑膜炎病例中。
方法：我们的病例是一名18岁的男性患者，其亲属表示他去了温泉；他的头痛症状在温泉返回后2至3天后开始。通过直接显微镜检查从患者身上采集的脑脊液（CSF）样本，实时PCR方法和序列分析。
结果：考虑到滋养体转化为中间形式的可能性，将收集的CSF样品放入蒸馏水中，并在37°C下孵育1至2小时，在直接显微镜检查中观察到梨形非永久性鞭毛形式，并进行分子分型以确认诊断。这项研究是在土耳其分离并通过实时PCR确认的N.fowleri的综合病例。
结论：临床医生的意识将是正确诊断PAM的关键因素。还建议调查土耳其所有可能的环境水源，以获取有关Naegleria物种分布和分子鉴定的更详细信息，最终评估对人类健康的潜在致病威胁，并制定应对此类威胁的策略。
目的：在本研究中，它的目的是通过显示N.fowleri也可能是病原体来提高对脑膜炎病因的鉴别诊断的认识，尽管很少，在土耳其的脑膜炎病例中。
方法：我们的病例是一名18岁的男性患者，其亲属表示他去了温泉；他的头痛症状在温泉返回后2至3天后开始。通过直接显微镜检查从患者身上采集的脑脊液（CSF）样本，实时PCR方法和序列分析。
结果：考虑到滋养体转化为中间形式的可能性，将收集的CSF样品放入蒸馏水中，并在37°C下孵育1至2小时，在直接显微镜检查中观察到梨形非永久性鞭毛形式，并进行分子分型以确认诊断。这项研究是在土耳其分离并通过实时PCR确认的N.fowleri的综合病例。
结论：临床医生的意识将是正确诊断PAM的关键因素。还建议调查土耳其所有可能的环境水源，以获取有关Naegleria物种分布和分子鉴定的更详细信息，最终评估对人类健康的潜在致病威胁，并制定应对此类威胁的策略。
