PMC8258632_01
Wright-Giemsa stain of CSF demonstrating N. fowleri organisms and inflammatory cells. A) Three organisms (arrowheads) adjacent a segmented neutrophil showing prominent vacuolation (arrow). B) Three vacuolated trophozoites are pictured on high-magnification. A single small, pale nucleus can be identified in each organism, each of which is smaller than the individual segments of surrounding segmented neutrophils. C) A single trophozoite is present at the bottom of the field (arrowhead), not to be confused with a macrophage (black arrow) or vacuolated lymphocyte (white arrow) at the top of the image. D) A cluster of organisms (arrowheads) and inflammatory cells of multiple types. Multiple similar clusters were present on the slide, some of which showed nearly completely obscured trophozoites.
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A CSF sample from this EVD showed protein of >1gm/dL, and a Wright-Giemsa stain showed amebic trophozoites with exuberant neutrophilic response (Fig. 1).