A fulminating, hemorrhagic, necrotizing meningoencephalitis
Occurs in healthy children and young adults and is rapidly fatal
Early symptoms include headache, fever, stiff neck, and lethargy, often associated with rhinitis and pharyngitis
Vomiting, disorientation, and other signs of meningoencephalitis develop within 1 or 2 days, followed by coma and then death within 7–10 days
Cerebrospinal fluid (CSF) shows hundred to thousands of leukocytes and erythrocytes per cubic millimeter
Protein is usually elevated, and glucose is normal or moderately reduced
A fresh wet mount of the CSF may show motile trophozoites
Staining with Giemsa or Wright stain will identify trophozoites
Species identification is based on morphology and immunologic methods
Amphotericin B is drug of choice
Four survivors in North America were treated with amphotericin B, rifampin, and other agents
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