Primary Amoebic Meningoencephalitis by Naegleria fowleri: Pathogenesis and Treatments

Güémez, Andrea; García, E.J.

doi:10.3390/biom11091320

Cited by 63 publications

(61 citation statements)

References 92 publications

(181 reference statements)

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“…N. fowleri has been identified in almost every continent, except for Antarctica [ 51 ]. The amoeba’s thermophilicity and ubiquity mean that it can be discovered in a wide variety of environments, including natural hot springs, ponds, rivers, freshwater lakes, drinking water distribution systems, untreated swimming pools, fountains, hospitals, thermal waters, untreated drinking water, and waterparks [ 52 , 53 ]. The success of determining such vital contact exposure should warrant immediate work to identify the presence of N. fowleri because PAM can progress rapidly, leading to death within just a few days.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Brain-Eating Amoeba: A Decade Update

Zamzuri

Majid

Mihat

et al. 2023

IJERPH

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Introduction: Primary amoebic meningoencephalitis (PAM) is a rare but lethal infection of the brain caused by a eukaryote called Naegleria fowleri (N. fowleri). The aim of this review is to consolidate the recently published case reports of N. fowleri infection by describing its epidemiology and clinical features with the goal of ultimately disseminating this information to healthcare personnel. Methods: A comprehensive literature search was carried out using PubMed, Web of Science, Scopus, and OVID databases until 31 December 2022 by two independent reviewers. All studies from the year 2013 were extracted, and quality assessments were carried out meticulously prior to their inclusion in the final analysis. Results: A total of 21 studies were selected for qualitative analyses out of the 461 studies extracted. The cases were distributed globally, and 72.7% of the cases succumbed to mortality. The youngest case was an 11-day-old boy, while the eldest was a 75-year-old. Significant exposure to freshwater either from recreational activities or from a habit of irrigating the nostrils preceded onset. The symptoms at early presentation included fever, headache, and vomiting, while late sequalae showed neurological manifestation. An accurate diagnosis remains a challenge, as the symptoms mimic bacterial meningitis. Confirmatory tests include the direct visualisation of the amoeba or the use of the polymerase chain reaction method. Conclusions: N. fowleri infection is rare but leads to PAM. Its occurrence is worldwide with a significant risk of fatality. The suggested probable case definition based on the findings is the acute onset of fever, headache, and vomiting with meningeal symptoms following exposure to freshwater within the previous 14 days. Continuous health promotion and health education activities for the public can help to improve knowledge and awareness prior to engagement in freshwater activities.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Brain-Eating Amoeba: A Decade Update

Zamzuri

Majid

Mihat

et al. 2023

IJERPH

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“…The parasite belongs to the free-living Amoeba family of Vahlkampfiidae, order Schizopyrenida, and class Heterolobosea (2,3,8). Naegleria fowleri has three stages which included the cyst, trophozoites, and flagellates, the reproductive stage is the trophozoit which can infect the human and can transform into the flagellate form when exposed to environmental factors like low food and hard environmental stress the trophozoit can be transformed to the cyst stage which approximately 6 microns in diameter.…”

Section: Naegleria Fowlerimentioning

confidence: 99%

Mini review: Naegleria fowleri the fatal meningoencephalitis

Hadi¹

2022

jsci

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Primary amoebic meningoencephalitis (PAM) is a fatal parasitic disease caused by a free-living amoeba called Naegleria fowleri also called a brain-eating amoeba. The parasite can invade the central nervous system causing brain damage and death in a few days. PAM is characterized by a high fatal mortality rate of 98% and the estimated time for death is less than two weeks after symptoms onset making it the most deadly parasitic infection in the world. Treatment options for PAM are still the major obstacle since the drugs cannot pass the blood-brain barrier (BBB) to kill the parasite leading to a high mortality rate. This review came to focus on the new approach and updating regarding the new treatment options and recent case reports in addition to elucidating the diagnosis process.

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“… 19 , 23 Amoebae enter the CNS following attachment to the olfactory nerve and migrate to the olfactory bulbs ( bulbus olfactorius ) of the forebrain, invading the brain, causing widespread infections, hemorrhages, and necrosis which eventually leads to death. 24 , 25 Treating brain-eating amoebae is challenging, and the current recommended treatment consists of a combination of different drugs. 12 , 13 , 26 These drugs include broad-spectrum antifungals (amphotericin B), broad-spectrum disinfectants (chlorhexidine, propamidine), an anticancer drug (miltefosine), rifampicin, dexamethasone, fluconazole, phenytoin intravenous, and other antifungals and antibacterial drugs (sulfadiazine), 27 − 30 but the prognosis remains poor.…”

Section: Introductionmentioning

confidence: 99%

Novel Antiamoebic Tyrocidine-Derived Peptide against Brain-Eating Amoebae

et al. 2022

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Acanthamoeba castellanii ( A. castellanii ) can cause Acanthamoeba keratitis, a sight-threatening infection, as well as a fatal brain infection termed granulomatous amoebic encephalitis, mostly in immunocompromised individuals. In contrast, Naegleria fowleri ( N. fowleri ) causes a deadly infection involving the central nervous system, recognized as primary amoebic encephalitis, mainly in individuals partaking in recreational water activities or those with nasal exposure to contaminated water. Worryingly, mortality rates due to these infections are more than 90%, suggesting the need to find alternative therapies. In this study, antiamoebic activity of a peptide based on the structure of the antibiotic tyrocidine was evaluated against A. castellanii and N. fowleri . The tyrocidine-derived peptide displayed significant amoebicidal efficacy against A. castellanii and N. fowleri . At 250 μg/mL, the peptide drastically reduced amoebae viability up to 13% and 21% after 2 h of incubation against N. fowleri and A. castellanii. , whereas, after 24 h of incubation, the peptide showed 86% and 94% amoebicidal activity against A. castellanii and N. fowleri . Furthermore, amoebae pretreated with 100 μg/mL peptide inhibited 35% and 53% A. castellanii and N. fowleri , while, at 250 μg/mL, 84% and 94% A. castellanii and N. fowleri failed to adhere to human cells. Amoeba-mediated cell cytopathogenicity assays revealed 31% and 42% inhibition at 100 μg/mL, while at 250 μg/mL 75% and 86% A. castellanii and N. fowleri were inhibited. Assays revealed inhibition of encystation in both A. castellanii (58% and 93%) and N. fowleri (73% and 97%) at concentrations of 100 and 250 μg/mL respectively. Importantly, tyrocidine-derived peptide depicted minimal cytotoxicity to human cells and, thus, may be a potential candidate in the rational development of a treatment regimen against free-living amoebae infections. Future studies are necessary to elucidate the in vivo effects of tyrocidine-derived peptide against these and other pathogenic amoebae of importance.

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Primary Amoebic Meningoencephalitis by Naegleria fowleri: Pathogenesis and Treatments

Cited by 63 publications

References 92 publications

Systematic Review of Brain-Eating Amoeba: A Decade Update

Systematic Review of Brain-Eating Amoeba: A Decade Update

Mini review: Naegleria fowleri the fatal meningoencephalitis

Novel Antiamoebic Tyrocidine-Derived Peptide against Brain-Eating Amoebae

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