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However, none of these researchers ever mentioned a possible link of the diseases to recent vaccination and especially to vaccine boosters. fatal cases of primary amoebic encephalomyelitis occurred soon after the victims had been swimming in these thermal pools. Naegleria gruberi was identified as the causative organism. A great number of papers continued to be published in medical journals dealing with cases of amoebic encephalitis. A number of children and young adults developed brain disease and died after swimming in lakes or falling and scraping their faces. While the small wound healed, weeks or months later they developed con- vulsions and other neurological signs and died within days of what was usually diagnosed as a fulminant encephalitis. Sometimes posthumously, but often in autopsies performed straight away after deaths, amoebas were found proliferating in the brains of these unfortunate individuals. ea Bree uurvEL vt papero Vu! journals dealing with cases of amoebic encephalitis. A number of AMOEBA RESEARCH IN OTHER COUNTRIES children and young adults developed brain disease and died after Butt (1966) described three cases of amoebic meningoen- swimming in Jakes or falling and scraping their faces. While the — cephalitis in the United States and coined the term "primary ame- small wound healed, weeks or months later they developed con- _ bic meningoencephalitis”. All victims did extensive swimming vulsions and other neurological signs and died within days of what —_and diving in small land-locked lakes within a two-mile radius in was usually diagnosed as a fulminant encephalitis. Sometimes central Florida. The pathological findings were very much the posthumously, but often in autopsies performed straight away same as those reported in the Australian cases. It was concluded after deaths, amoebas were found proliferating in the brains of that the soil amoebas are stimulated to excyst to the infectious or Me YY PU an these unfortunate individuals. trophozoite form by gram-negative bacilli which are present in the faecal stream, in decaying vegetation and in some small lakes dur- AMOEBA RESEARCH IN AUSTRALIA ing summer, as well as in drainage ditches, swamps and sewage A lot of useful amoeba research has been done in Australia. In _outfalls. 1965, Fowler and Carter of the Pathology Department of Adelaide The above authors also concluded that other cases may be Children's Hospital described three cases—a nine-year-old boy _ missed and that, furthermore, the human amoebic discase may not and two eight-year-old girls. All were considered by their parents always have a fatal outcome. Some of Culbertson's experimental to be healthy and suffering no previous illness. The first symp- animals were giving signs of recovery from amoebic infection. toms, lethargy and disinterest in their Indeed, Seidel et al. (1982) usual activities, appeared on the | reported on a successful treatment fourth day before death. All chil- A number of children and young of primary amoebic meningoen- dren became feverish, unwell and cephalitis. A nine-year-old girl complained of severe headache, sore adults developed brain disease and complained of a mild headache, throat and blocked nose. They were ' died after swimming in lakes or falling nausea, vomiting and increased given antibiotics for "upper respira- and scraping their faces. lethargy. On the morning of tory tract infection". However, with- j : admission she was unresponsive. in another day, the children's condi- ‘Sometimes posthumously, but often in Moving amoebas were found in her tion deteriorated, they started severe autopsies performed straight away cerebrospinal fluid (CSF). The girl iting, | F 4 ; d emo vomiting, lost consciousness an after deaths, amoebas were found and her family had been swimming were taken to the local hospital with in Deep Creek hot springs in the a provisional diagnosis of meningi- proliferating i in the brains of these San Bernardino National Forest on unfortunate individuals. tis. Despite intravenous glucose- two occasions before the onset of saline fluid, chloramphenicol, peni- the girl's disease. cillin and sulphadiazine, they fell This was the same area which into coma and died of cardio-respira- was a source of fatal infection with tory failure on the way to the Adelaide Children's Hospital. Naegleria fowleri primary amoebic meningoencephalitis in 1971 Case 4 was a 28-year-old man suffering very much the same (Hecht et al., 1972). This patient was given antibiotics, antifungal symptoms as the three children, except for a two-week history of a agent and sulphosoxazol. Twenty-four hours later, the girl started sore throat and headache. recovering; her condition stabilised 48 hours later and gradually Post-mortem in all cases revealed lung oedema and vascular improved during one month's hospital stay. Cell counts and engorgement and in three of the hearts. The right-sided chambers _results of chemical studies of the spinal fluid remained abnormal were flabby and dilated, and the myocardium contained small foci _ for several months, but amoebas were not found after three days of of necrosis and inflammatory cell infiltration. The brain was also treatment. It is of interest that specific antibodies were demon- moderately swollen, with meningeal veins collapsed, superficial _strated in the girl's serum at seven, 10 and 42 days after admission, capillaries over the vertex engorged, and a few petechial haemor- _and that her father had a low titre of specific antibody but did not rhages present. The olfactory bulbs were very reddened, soft, and become ill. The mother's serum was negative for antibody. adherent by a mass of sticky exudate to the adjacent frontal brain A chronic amoebic meningoencephalitis was described in a 30- cortex. Microscopic examination of the meningeal exudate year-old patient in Nigeria (Cleland et al., 1982). He had a five- revealed small amoebas, some of them degenerate. Interestingly, year history of sleep disturbance that culminated in a confusional cultures of the brain and meningeal exudates from all the cases _ illness with convulsions from which he made a partial recovery yielded no bacteria, tubercle bacilli, torula or viruses. when sulfamethiazine was administered, although his sleep distur- It was concluded that the isolated amoebas belonged to the bance has not resolved. He was able to return home after two genus Acanthamoeba and thal the infection occurred via the olfac- weeks in hospital, but was lost for a follow-up. tory route. Callicott et al. (1968) described a case of an eight-year-old boy Carter (1968) and Carter et al. (1981) described a further six in Virginia, USA, who presented with a mild abdominal pain and cases (four children aged seven to ten years, and two adults aged anorexia, followed hy vomiting and fever, and a stiff neck. His 28 and 37 years) and one case (a two-and-a-half-year-old girl from physician administered one dose of penicillin G benzathine. The Perth, Western Australia) of amoebic meningoencephalitis in boy was admitted to the hospital. Acanthamoeba specimens were Australia. cultured from the cerebrospinal fluid and the boy was given ampi- Many other Australian authors contributed in a substantive way _cillin. He improved rapidly. to the knowledge of amoebas and human diseases caused by them. Most cases of primary amoebic meningoencephalitis were NEXUS * 45 APRIL-MAY 1996