Primary amoebic meningoencephalitis with subsequent organ procurement: a case study.

Primary amoebic meningoencephalitis (PAM) is a rare and rapidly fatal disease caused by the Naegleria fowleri amoeba. It is a diagnosis rarely seen by medical personnel, yet this amoeba is frequently encountered by people who frequent freshwater bodies of water in certain states. The disease primarily affects children and young adults who swim or take part in water sports in the waters in which the amoeba thrive. The disease presents with symptomatology similar to bacterial meningitis: headache, stiff neck, altered mental status, seizures, and coma with a quick progression to death. Rapid diagnosis is imperative to facilitate prompt treatment, although PAM has 95% mortality. There have been only 10 survivors reported in medical literature. This disease is a public-health risk to those living in affected areas of the country. Healthcare providers need to be cognizant of the disease as well, and, although recovery is rare, focus on prevention and risk reduction strategies is imperative. It is not completely understood why, of the millions of people are exposed to freshwater with the amoeba, only a few become infected with it. The Centers for Disease Control and Prevention have suggested that all freshwater areas should always assume a level of risk in waters, even when signage is not posted. This case study will review a fatal case of Naegleria fowleri infection in a young patient and will include the pathophysiology, diagnosis, treatment, nursing and public health implications, and organ procurement that occurred with the patient.

Assessment and management of acute diarrheal illness in adults.

Acute diarrheal illness (illness of less than two weeks' duration) accounts for numerous out-patient health care visits. This article provides an overview of the most common causes of acute diarrhea and presents a comprehensive approach to patient evaluation, diagnosis and management. A detailed outline of bacterial, viral, parasitic and travelers' diarrheal disorders is presented. Dysentery (blood and mucus in the stool) represents an additional challenge to the health care provider. Salient historical data, physical assessment and laboratory considerations are reviewed. Management objectives including diet/fluid replacement, pharmacologic modalities and prophylaxis are described. Emphasis is given to patient education and the unique role of the nurse practitioner in assisting the patient through the assessment and management of this common, distressing problem.