primary amebic

meningoencephalitis (PAM)

BY: Sandy D. Banag

PN-IA (Group 2)

Three genera of free-living

amebas, Naegleria,
Acanthamoeba, and B
mandrillaris are known to infect
humans. Naegleria fowleri causes
an acute and almost invariably
fatal encephalitis, which,
fortunately, is rare.

Pathogenic Free-Living Amebae

Naegleria fowleri

primary amebic meningoencephalitis (PAM)

Acanthamoeba spp.

granulomatous amebic encephalitis (GAE)

granulomatous skin and lung lesions (primarily
immunocompromised)
amebic keratitis

Balamuthia mandrillaris

GAE + granulomatous skin and lung lesions

(primarily healthy)

Primary Amebic Meningoencephalitis

(PAM)
1-14 days incubation period
symptoms usually within a few days after
swimming in warm still waters
infection believed to be introduced through
nasal cavity and olfactory bulbs
symptoms include headache, lethargy,
disorientation, coma
rapid clinical course, death in 4-5 days after
onset of symptoms
trophozoites can be detected in spinal fluid, but
diagnosis is usually at autopsy
4 known survivors treated with Amphotericin B

Naegleria fowleri
ubiquitous genus found in fresh water
lakes and ponds
PAM first recognized by Fowler (1965)
initially thought to be Acanthamoeba
Naegleria fowleri is only species
associated with PAM
~ 200 documented cases worldwide
81 in U.S.
14 cases from same lake in Virginia
16 cases from same stream feed pool in
Czech Republic

Naegleria fowleri causes primary

amebic meningoencephalitis, a
rare, rapidly fatal disease with
sudden onset of headache, fever,
stiff neck, lethargy, and coma in
otherwise healthy people.

Kingdom:
Subkingdom:
Phylum:
Subphylum:
Superclass:
Class:
Order:
Family:
Genus:
Species:

Protista
Protozoa
Sarcomastigophora
Sarcodina
Rhizopodia
Acarpomyxea
Schizopyrenida
Vahlkampfiidae
Naegleria
fowleri

The trophozoites are 10 to 15 m

in diameter and produce broadly
rounded lobopodia. Cysts are
single-walled, spherical and 8 to
12 m in diameter. The
trophozoites can also transform
to a flagellated form.

The trophozoites are free-living

inhabitants of soil and warm fresh
water. They reproduce by binary
fission.
Naegleria fowleri is thermophilic,
preferring warm water and
reproducing successfully at
temperatures up to 46C.

Naegleria Life Cycle

low nutrients

desiccation

feeding and
Trophozoite = replicating form
Cyst = dormant form

In a warm, high nutrient, aquatic environment

the trophozoite stage predominates. This is
the reproductive stage and a trophozoite that
undergoes promitosis results in two
trophozoites. If pH or ionic changes occur
surrounding the organism, the trophozoite
can transition to the more mobile flagellated
form. If the environment becomes depleted
of nutrients, cold, or dry the trophozoite can
encyst to survive the unfavorable conditions.

Amebas splashed or inhaled onto

the olfactory epithelium migrate
up the olfactory nerve to the brain
and spread via the subarachnoid
space.

None are known since It is not yet clear

whether N fowleri can elicit a protective
cellular or humoral immune response.

PAM due to Naegleria fowleri has a

worldwide distribution and occurs most
frequently in tropical areas and during hot
summer months. The majority of the
reported cases, 121 from 1937-2007,
occurred in the United States (Primary
Amebic Meningoencephalitis, 2008).

Diagnosis relies on identifying trophozoites

by microscopic examination of fresh
cerebrospinal fluid specimens or histologic
sections of CNS tissue, and on culturing, if
necessary.

Early, aggressive treatment with

amphotericin B and miconazole may be
effective, but almost all patients die.

Currently, if N. fowleri infection is

diagnosed or suspected treatment
Amphotericin B is the standard of care.
Amphotericin B is a polyene compound
that disrupts selective permeability of
plasma membranes. It is administered
intravaneously and is something of a last
resort drug as it has high toxicity. While
not particularly effective, every one of the 4
documented survivors of PAM have been
treated with Amphotericin B.