Primary amoebic meningoencephalitis

Primary amoebic meningoencephalitis
Other namesNaegleriasis, amoebic encephalitis, naegleria infection, amoebic meningitis
Histopathology, direct fluorescent antibody stain.
Pronunciation
  • /ˌnɛɡlərˈaɪəsɪs/
SpecialtyInfectious disease
SymptomsFever, vomiting, stiff neck, seizures, poor coordination, confusion, coma
ComplicationsBrain damage, death
Usual onset1–12 days after exposure[1]
Duration1–18 days[1]
CausesDeep nasal inhalation of Naegleria fowleri organisms from contaminated freshwater
Risk factorsRoughly 75% of cases infect males; most cases are children or adolescents[2]
Differential diagnosisBacterial or fungal meningitis[3]
PreventionNoseclips when swimming in fresh water, or avoiding freshwater environments, and proper chlorination of swimming pools
TreatmentMiltefosine, fluconazole, amphotericin B, posaconazole, voriconazole, targeted temperature management[4][5]
Prognosis98.5% fatality rate; some, but not all, survivors have permanent neurological damage
FrequencyExtremely rare (6 in 1,000,000 human deaths, US)
Deaths381 globally from 1937–2018

Primary amoebic meningoencephalitis (PAM), also known as naegleriasis, is an almost invariably fatal infection of the brain by the free-living protozoan Naegleria fowleri. Symptoms include headache, fever, nausea, vomiting, a stiff neck, confusion, hallucinations and seizures.[6] Symptoms progress rapidly over around five days with characteristics of both meningitis and encephalitis, making it a type of meningoencephalitis. Death usually results within one to two weeks of symptom onset.[6][1]

N. fowleri is typically found in warm bodies of fresh water, such as ponds, lakes, rivers and hot springs. It is found in an amoeboid, temporary flagellate stage or microbial cyst in soil, poorly maintained municipal water supplies, water heaters, near warm-water discharges of industrial plants and in poorly chlorinated or unchlorinated swimming pools. There is no evidence of it living in salt water. As the disease is rare, it is often not considered during diagnosis.

Although infection occurs very rarely,[1] it almost inevitably results in death.[7][8]

  1. ^ a b c d "Naegleria fowleri—Primary Amoebic Meningoencephalitis (PAM)—General Information". The Centers for Disease Control and Prevention, Division of Parasitic Diseases. Archived from the original on 28 July 2018. Retrieved 26 May 2014.
  2. ^ Fortin, Jacey (25 July 2019). "Man Dies of 'Brain-Eating' Amoeba After Swimming in Lake". The New York Times. Archived from the original on 21 April 2020. Retrieved 1 April 2020.
  3. ^ Cite error: The named reference MMWR2008 was invoked but never defined (see the help page).
  4. ^ Cite error: The named reference CDC2015Tx was invoked but never defined (see the help page).
  5. ^ Cite error: The named reference Grace2015rev was invoked but never defined (see the help page).
  6. ^ a b Cite error: The named reference cdc.gov-2019 was invoked but never defined (see the help page).
  7. ^ "6 die from brain-eating amoeba after swimming". NBC News. Associated Press. 28 September 2007. Archived from the original on 2 September 2018. Retrieved 17 November 2019.
  8. ^ One death in September 2018 was the first confirmed case of the infection in the United States since 2016. Hauser, Christine (1 October 2018). "A Man Died After Being Infected With a Brain-Eating Amoeba. Here Are the Facts". The New York Times. Archived from the original on 31 July 2019.)l
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