• amoebiasis
• cerebrospinal fluid
• meningoencephalitis

Amoebae are amphizoic, ubiquitous, and opportunistic protozoa that can affect different organs including skin, lungs, eyes, and the brain.^1,2 In the central nervous system (CNS), two main, well defined disease entities have been described: primary amoebic meningoencephalitis, which is caused by Naegleria fowlery and is rapidly fatal, and granulomatous amoebic encephalitis, which is caused by Acanthamoeba spp and Balamuthia mandrillaris and is characterised by focal granulomatous lesions in the brain following a subacute or chronic course. CNS infections caused by free living amoebae are uncommon and, as of October 1996, for example, only 166 cases of granulomatous amoebic encephalitis have been reported from around the world.¹ Identification of amoebae in cerebrospinal fluid (CSF) samples is a rare event.^1,2

We have recently seen a patient with meningoencephalitis in whom amoebic forms were identified in the CSF. She was a 48 year old woman who was admitted to our neurological clinic because of vertigo, headache, bilateral hypacusia, ataxia, diplopia, dysphonia, dysphagia, anosmia, ageusia, tetraparesis, occurrence of transient clonic fits in the right upper limb, and vomiting episodes. The onset of her illness dated from about six weeks earlier, when she began to complain of a maddening noise, like a rustle, in the right ear, dizziness, difficulty in maintaining the erect posture, and vertigo. She was …