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Review Question - QID 215135

CNS Infections: Protozoa Naegleria fowleri Introduction QID: 215135 (M1.OMB.4819)
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QID 215135 (Type "215135" in App Search)
An 18-year-old man presents to the local emergency department with fever and altered mental status. According to his parents, they have been vacationing in sub-Saharan Africa for the past 2 weeks. During this time, the family went hiking, swimming, and on safari tours. The patient was last seen normal yesterday. His temperature is 102.2°F (39.0°C), blood pressure is 130/80 mmHg, pulse is 105/min, and respirations are 18/min. On examination, there are no abnormal lesions or marks on the patient. On passive flexion of the patient’s neck, there is reflex flexion of his hips and knees. The results of the lumbar puncture are shown below.

Pressure: 350 mm H2O
Leukocyte count: 500 cells/mm^3 [polymorphonuclear predominance]
Red blood cell count: 300 cells/mm^3 (reference range: 0 cells/mm^3)
Glucose: 25 mg/dL
Protein: 55 mg/dL
Gram stain: no organisms seen

Which of the following is the most likely etiology?
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