The core antimicrobial treatment consists of the antifungal drug amphotericin B, which inhibits the pathogen by binding to its cell membrane sterols, thus leading to cell membrane disruption and pathogen death; however, even with this treatment, the fatality rate is greater than 95%. New treatments are being sought. Miltefosine, an antiparasitic drug which inhibits the pathogen via disrupting its cell survival signal pathway PI3K/Akt/mTOR, has been used in a few cases with mixed results. A key factor to effective treatment is the speed of diagnosis. PAM is a rare occurrence and is not often considered as a likely diagnosis; therefore, the clinical laboratory’s identification of the microorganism may be the first time an amoebic etiology is considered. The rapid identification can help to avoid delays in diagnosis and therapy. Amoeba cultures and real-time PCR studies for<unk>  are diagnostic of PAM, however, they are not readily available at most institutions and would require being performed at a reference laboratory. The time of presentation of the patient can also affect the identification of the microorganism as PAM has a variable incubation time, ranging from 1 to 7 days. The clinical signs of PAM are similar to bacterial and viral meningitis, including fever, neck stiffness, and severe headaches. Symptoms can progress to prolonged nausea, vomiting, and even seizures. The disease can progress to acute hemorrhagic necrotizing meningoencephalitis, which can lead to death in as soon as 7–10 days. A variable delay in treatment can be secondary to time intervals in multiple stages of care, including exposure to exhibition of symptoms; arrival for treatment at a health care facility; workup of the diagnosis (initial diagnosis of likely bacterial meningitis); and finally, from diagnosis to initiation of recommended therapy. Successful treatment of PAM is a rare occurrence and can only be attempted after correct diagnosis, which relies on rapid recognition of the microorganism by medical technologists and pathologists. It is critical that medical technologists consistently provide timely CSF evaluation, explore the diagnosis of PAM, and look for amoebae in the setting of meningitis, especially in the summertime.
Naegleria fowleri
Mycoplasma pirum
Mycoplasma incognitus
Mycoplasma orale
Mycobacterium orygis
Alternaria tenuissima
Wolfiporia extensa
Cyclospora cayetanensis