Naegleria Infection Follow-up
- Author: Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc; Chief Editor: Mark R Wallace, MD, FACP, FIDSA more...
Further Inpatient Care
Patients with primary amebic meningoencephalitis (PAM) should be monitored in the ICU.
The only definite way to evade N fowleri infections is to abstain from water-related activities.
Since N fowleri trophozoites and cysts are susceptible to chlorine, swimming pools should be adequately chlorinated. Case clusters have been reported in association with poorly chlorinated pools. Strongly consider closure of a site if a case of PAM occurs. Warm water is known to be more at risk of harboring these organisms. Thus, avoiding activities in bodies of warm fresh water, hot springs, and water around power plants, which may be thermally polluted, may be advisable. In addition, when taking part in such activities, it would be better to avoid the accidental entry of water into the nose. There are no public health criteria established for what levels of amebae present are acceptable or unacceptable.
People with the habit of using neti pots should use distilled, boiled, or filtered water. The neti pots must be thoroughly washed before and after use.
No vaccine is currently available for the prevention of PAM due to N fowleri. However, owing to the rise in the number of infections, vaccine research is being carried out. Through animal experiments using mice, the efficacy 2 vaccine candidate proteins have been recognized. Intranasal administration of Cry1Ac protoxin along with amoebic lysates has been found to elicit a protective Th2 response against N fowleri infection. Intraperitoneal administration of recombinant Nfa1 protein has been found to prolong the mean survival time of mice when challenged with infection.
PAM is typically fatal. Death is due to pulmonary edema or cardiorespiratory arrest within a week of appearance of the first symptoms. Persistent seizures may occur in patients who have otherwise recovered.
PAM carries a very poor prognosis, with a mortality rate of greater than 95%
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