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Volume 9
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10.3390/pathogens9080629
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Article

Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation

by
Lissette Retana Moreira
1,2,
Leidy Zamora Rojas
3,
Muriel Grijalba Murillo
4,
Silvia Elena Molina Castro
5 and
Elizabeth Abrahams Sandí
1,2,*
1
Departamento de Parasitología, Universidad de Costa Rica, San Pedro, Montes de Oca 11501, Costa Rica
2
Centro de Investigación en Enfermedades Tropicales (CIET), Universidad de Costa Rica, San Pedro, Montes de Oca 11501, Costa Rica
3
Hospital Maximiliano Peralta Jiménez, Caja Costarricense de Seguro Social, Cartago 30102, Costa Rica
4
Laboratorio Clínico Hospital Enrique Baltodano, Caja Costarricense de Seguro Social, Liberia, Guanacaste 50101, Costa Rica
5
Instituto de Investigaciones en Salud (INISA), Universidad de Costa Rica, San Pedro, Montes de Oca 11501, Costa Rica
*
Author to whom correspondence should be addressed.
Pathogens 2020, 9(8), 629; https://doi.org/10.3390/pathogens9080629
Submission received: 14 July 2020 / Revised: 27 July 2020 / Accepted: 30 July 2020 / Published: 1 August 2020
(This article belongs to the Special Issue Selected Papers from the International Meeting on the Biology and Pathogenicity of Free-Living Amoebae (FLAM2019))
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Abstract

During the first trimester of 2020, the Ministry of Health of Costa Rica reported the first three cases of primary amebic meningoencephalitis (PAM). In two cases, laboratory personnel of the hospitals preliminarily identified amoeboid forms in cerebrospinal fluid (CSF) samples. For the molecular confirmation of species, CSF samples were sent to our laboratory. We carried out microscopic analyses and exflagellation assays. Besides, samples were cultured in 2% casein hydrolysate medium and in non-nutrient agar plates supplemented with Escherichia coli. Finally, PCR and sequencing were employed for the molecular diagnosis and species identification. In all cases, the presence of Naegleria fowleri was confirmed. An environmental investigation to identify the possible infection sources was also performed. Water samples from hot springs and groundwater from an artisan well were collected and after filtration and culture in non-nutrient agar plates supplemented with E. coli, thermotolerance and exflagellation assays were carried out. For the positive samples, PCR and sequencing were performed, confirming the presence of N. fowleri in several water samples. The report of these cases and the possible association with hot springs has had a significant impact on the population and health authorities of Costa Rica.
Keywords: Primary amoebic meningoencephalitis; Naegleria fowleri; hot springs; water well; Costa Rica Primary amoebic meningoencephalitis; Naegleria fowleri; hot springs; water well; Costa Rica

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MDPI and ACS Style

Retana Moreira, L.; Zamora Rojas, L.; Grijalba Murillo, M.; Molina Castro, S.E.; Abrahams Sandí, E. Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation. Pathogens 2020, 9, 629. https://doi.org/10.3390/pathogens9080629

AMA Style

Retana Moreira L, Zamora Rojas L, Grijalba Murillo M, Molina Castro SE, Abrahams Sandí E. Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation. Pathogens. 2020; 9(8):629. https://doi.org/10.3390/pathogens9080629

Chicago/Turabian Style

Retana Moreira, Lissette, Leidy Zamora Rojas, Muriel Grijalba Murillo, Silvia Elena Molina Castro, and Elizabeth Abrahams Sandí. 2020. "Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation" Pathogens 9, no. 8: 629. https://doi.org/10.3390/pathogens9080629

APA Style

Retana Moreira, L., Zamora Rojas, L., Grijalba Murillo, M., Molina Castro, S. E., & Abrahams Sandí, E. (2020). Primary Amebic Meningoencephalitis Related to Groundwater in Costa Rica: Diagnostic Confirmation of Three Cases and Environmental Investigation. Pathogens, 9(8), 629. https://doi.org/10.3390/pathogens9080629

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