A 14-year-old boy swims daily in a warm stagnant pond. He presents with sudden severe bifrontal headache, high fever, neck stiffness, vomiting, and altered sensorium of 2 days duration. CSF shows neutrophilic pleocytosis, elevated protein, low glucose, and wet mount examination reveals highly motile amoeboid trophozoites. The drug of choice added to supportive care is:

• A Albendazole with praziquantel
• B Metronidazole monotherapy
• C Amphotericin B with miltefosine ✓
• D Ivermectin with doxycycline

Explanation

Primary amoebic meningoencephalitis caused by Naegleria fowleri follows nasal exposure to warm freshwater. Motile trophozoites on wet mount of CSF are diagnostic. Survival is rare but best reported with a multidrug regimen centred on amphotericin B plus miltefosine, often combined with rifampicin and azithromycin. Metronidazole alone is unreliable because Naegleria differs from Entamoeba in drug susceptibility.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.