Naegleria fowleri-Abstract

Naegleria fowleri is a thermophilic, free-living amoeba that is most commonly found in warm
freshwater system such as lakes, rivers, ponds, and springs, but can also be found within soil.
When entering the human body through the nasal canal, it can cause Naegleriasis, also known as
Primary Amebic Meningoencephalitis (PAM), which is a rare disease that attacks the central
nervous system by destroying brain tissue.1 It is Nagleria’s capacity to destroy brain tissue that
gives it the moniker of the “brain eating amoeba”.1 Though it is rare, Naegleriasis is a disease of
extreme consequence and high mortality, and as such cases of a Naegleria infections are often
high profile and widely covered by the media.3
Naegleria is a mildly thermophilic amoeba that best thrives in temperatures ranging from
30℃ to 45℃.1 Naegleria exists across the globe within warm freshwater environments such as
lakes, rivers, ponds, and hot springs, but can also be found within the soil.2 Naegleria is
ubiquitous in their environments and survive by consuming bacteria within the water.2 Naegleria
are opportunistic pathogens, and cannot be spread to others like a bacterial or viral infection.
Naegleria fowleri gains entry to the human body when contaminated water enters the nasal
passages through either recreational activities in the water, the usage of contaminated water for
nasal irrigation such as use with neti pots, or otherwise.1 Once entering the nasal passage,
Naegleria penetrates the nasal mucosa and travels along the olfactory nerve in order to gain
access to the central nervous system through the olfactory bulbs.3 Once Naegleria enters the
central nervous system, it begins to release cytotoxins such as, acid hydrolases, phospholipases,
and neuraminidases, and begins to even consume human brain tissue.3 Additionally, the entry of
the Naegleria into the central nervous system causes a massive immune response that causes
inflammation in the brain which can lead to tissue death.3 The combination of the immune
response and the actions of Naegleria often lead to death.
Symptoms of Naegleriasis often appear within 2-8 days after infection, but some can appear
as soon as 24 hours.3 Common symptoms include severe headache, fever, chills, stiff neck,
confusion, seizures, comas, and an increase of pressure in the intracranial region and the cerebral
spinal fluid.3 Notably, the cerebral spinal fluid has been observed to have unusual color during
infection, with it taking a red color during late stage infection due to the increase in red blood
cell concentration.3 Additionally, the usage of Magnetic Resonance Imaging will show
abnormalities within the brain, and there has been observed cases of cardiac rhythm
abnormalities and myocardial necrosis.3
Naegleria fowleri is a rare disease so there have not been clinical trials to determine the most
effective treatment plan, but there are still some options. Amphotericin B was capable of
completely suppressing Naegleria and is the primary means of treating the disease, but is also
associated with numerous side effects.3 However, in some cases amphotericin b was used in
conjunction with fluconazole with increased effectiveness.3 Additionally, there are investigational
drug protocols for the use of miltefosine in treating diseases caused by free living amoebas.3
Despite this, naegleriasis is an extremely deadly disease with only 9 individuals out of over 150
cases surviving.1
Naegleria fowleri-Abstract

In conclusion, Naegleria fowleri, although rare, is an incredibly deadly pathogen due to the
rapid progression of the disease making it hard to catch before it is too late, and the lack of
understanding when it comes to effective treatment, so it is best to practice preventative
measures instead. To prevent infection it is best to avoid swimming in warm freshwater, avoid
doing activities such as jumping or splashing that would cause water to enter the nose, or wear a
nose clip to help prevent the entry of water into the nose if the other options are unavoidable.3
Sources:

1. Centers for Disease Control and Prevention. (2023, May 3). Naegleria fowleri - primary
Amebic Meningoencephalitis (PAM) - amebic encephalitis. Centers for Disease Control
and Prevention. https://www.cdc.gov/parasites/naegleria/index.html

2. Gompf, S. G., & Garcia, C. (2019). Lethal encounters: The evolving spectrum of
Amoebic Meningoencephalitis. IDCases, 15. https://doi.org/10.1016/j.idcr.2019.e00524

3. Grace, E., Asbill, S., & Virga, K. (2015). Naegleria fowleri: Pathogenesis, diagnosis, and
treatment options. Antimicrobial Agents and Chemotherapy, 59(11), 6677–6681.
https://doi.org/10.1128/aac.01293-15