Post-neurosurgical meningitis by Naegleria fowleri and Staphylococcus aureus in Ecuador: A case report.

This report describes the first documented case in Ecuador of primary amoebic meningoencephalitis caused by Naegleria fowleri, in coinfection with methicillin-resistant Staphylococcus aureus (MRSA) associated with a ventriculoperitoneal shunt (VPS). A 23-year-old male with a history of severe traumatic brain injury developed central nervous system infection symptoms after VPS placement. Despite targeted antibiotics for MRSA, clinical deterioration continued. Whole genome sequencing confirmed N. fowleri, prompting antiparasitic treatment with amphotericin B and fluconazole, resulting in partial improvement. This case underscores the need to consider rare pathogens in atypical neurological cases and highlights the diagnostic value of genome sequencing in complex infections.