Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Naegleria Infection Follow-up

  • Author: Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Nov 23, 2015
 

Further Inpatient Care

Patients with primary amebic meningoencephalitis (PAM) should be monitored in the ICU.

Next

Deterrence/Prevention

The only definite way to evade N fowleri infections is to abstain from water-related activities.[3]

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.[40]

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.[8]

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.[41] Intraperitoneal administration of recombinant Nfa1 protein has been found to prolong the mean survival time of mice when challenged with infection.[42]

Previous
Next

Complications

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.

Previous
Next

Prognosis

PAM carries a very poor prognosis, with a mortality rate of greater than 95%

Previous
 
Contributor Information and Disclosures
Author

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc Director-Professor of Microbiology, Head of Department of Microbiology, Jawaharlal Institute, Postgraduate Medical Education and Research, India

Subhash Chandra Parija, MBBS, MD, PhD, FRCPath, DSc is a member of the following medical societies: Royal College of Pathologists, Indian Society for Parasitology, Indian Medical Association, National Academy of Medical Sciences (India), Indian Association of Medical Microbiologists, Indian Association of Biomedical Scientists, Indian Association of Pathologists and Microbiologists, Indian Academy of Tropical Parasitology

Disclosure: Received salary from Jawaharlal Institute of Postgraduate Medical education & Research , Pondicherry , India for employment.

Coauthor(s)

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

Daniel R Lucey, MD, MPH, MD, MPH 

Daniel R Lucey, MD, MPH, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Barnett Gibbs, MD Assistant Chief, Department of Clinical Trials, Walter Reed Army Institute of Research, Infectious Disease Service, National Capital Consortium; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences

Disclosure: Nothing to disclose.

Diane H Johnson, MD Assistant Director, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Winthrop-University Hospital, State University of New York at Stony Brook School of Medicine

Diane H Johnson, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Women's Association, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References
  1. Yadav D, Aneja S, Dutta R, Maheshwari A, Seth A. Youngest survivor of naegleria meningitis. Indian J Pediatr. 2013 Mar. 80(3):253-4. [Medline].

  2. Schuster FL. Cultivation of pathogenic and opportunistic free-living amebas. Clin Microbiol Rev. 2002 Jul. 15(3):342-54. [Medline].

  3. Centers for Disease Control and Prevention. Primary amebic meningoencephalitis--Arizona, Florida, and Texas, 2007. MMWR Morb Mortal Wkly Rep. 2008 May 30. 57(21):573-7. [Medline].

  4. Parija SC. Textbook of Medical Parasitology. Protozoology and Helminthology. 4 ed. New Delhi: All India Publishers and Distributers; 2013.

  5. Cervantes-Sandoval I, Serrano-Luna Jde J, Garcia-Latorre E, Tsutsumi V, Shibayama M. Mucins in the host defence against Naegleria fowleri and mucinolytic activity as a possible means of evasion. Microbiology. 2008 Dec. 154(Pt 12):3895-904. [Medline].

  6. Jung SY, Kim JH, Song KJ, Lee YJ, Kwon MH, Kim K. Gene silencing of nfa1 affects the in vitro cytotoxicity of Naegleria fowleri in murine macrophages. Mol Biochem Parasitol. 2009 May. 165(1):87-93. [Medline].

  7. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010 Jul. 138(7):968-75. [Medline].

  8. Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012 Nov. 55(9):e79-85. [Medline].

  9. Jamerson M, Remmers K, Cabral G, Marciano-Cabral F. Survey for the presence of Naegleria fowleri amebae in lake water used to cool reactors at a nuclear power generating plant. Parasitol Res. 2009 Apr. 104(5):969-78. [Medline].

  10. Marciano-Cabral F, Jamerson M, Kaneshiro ES. Free-living amoebae, Legionella and Mycobacterium in tap water supplied by a municipal drinking water utility in the USA. J Water Health. 2010 Mar. 8(1):71-82. [Medline].

  11. Laseke I, Korte J, Lamendella R, Kaneshiro ES, Marciano-Cabral F, Oerther DB. Identification of Naegleria fowleri in warm ground water aquifers. J Environ Qual. 2010 Jan-Feb. 39(1):147-53. [Medline].

  12. Herriman R. California reports 7th ever Naegleria fowleri case in Inyo County woman. Outbreak News Today. 2015.

  13. Kaushal V, Chhina DK, Ram S, Singh G, Kaushal RK, Kumar R. Primary amoebic meningoencephalitis due to Naegleria fowleri. J Assoc Physicians India. 2008 Jun. 56:459-62. [Medline].

  14. Khanna V, Khanna R, Hebbar S, Shashidhar V, Mundkar S, Munim F. Primary Amoebic Meningoencephalitis in an Infant due to Naegleria fowleri. Case Rep Neurol Med. 2011. 2011:782539. [Medline].

  15. Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011 Feb. 17(2):258-61. [Medline].

  16. Herriman R. Sindh Naegleria fowleri death toll reaches a dozen in 2015. Outbreak News Today. 2015.

  17. Phu NH, Hoang Mai NT, Nghia HD, Chau TT, Loc PP, Thai le H. Fatal consequences of freshwater pearl diving. Lancet. 2013 Jan 12. 381(9861):176. [Medline].

  18. Ithoi I, Ahmad AF, Nissapatorn V, Lau YL, Mahmud R, Mak JW. Detection of Naegleria species in environmental samples from Peninsular Malaysia. PLoS One. 2011. 6(9):e24327. [Medline].

  19. Tung MC, Hsu BM, Tao CW, Lin WC, Tsai HF, Ji DD. Identification and significance of Naegleria fowleri isolated from the hot spring which related to the first primary amebic meningoencephalitis (PAM) patient in Taiwan. Int J Parasitol. 2013 May 9. [Medline].

  20. Ozçelik S, Coskun KA, Yunlu O, Alim A, Malatyali E. The prevalence, isolation and morphotyping of potentially pathogenic free-living amoebae from tap water and environmental water sources in Sivas. Turkiye Parazitol Derg. 2012. 36(4):198-203. [Medline].

  21. Shin HJ, Im KI. Pathogenic free-living amoebae in Korea. Korean J Parasitol. 2004 Sep. 42(3):93-119. [Medline].

  22. Vargas-Zepeda J, Gomez-Alcala AV, Vasquez-Morales JA, Licea-Amaya L, De Jonckheere JF, Lares-Villa F. Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin. Arch Med Res. 2005 Jan-Feb. 36(1):83-6. [Medline].

  23. Rai R, Singh DK, Srivastava AK, Bhargava A. Primary amebic meningoencephalitis. Indian Pediatr. 2008 Dec. 45(12):1004-5. [Medline].

  24. Gautam PL, Sharma S, Puri S, Kumar R, Midha V, Bansal R. A rare case of survival from primary amebic meningoencephalitis. Indian J Crit Care Med. 2012 Jan. 16(1):34-6. [Medline].

  25. Diaz J. Seasonal primary amebic meningoencephalitis (PAM) in the south: summertime is PAM time. J La State Med Soc. 2012 May-Jun. 164(3):148-50, 152-5. [Medline].

  26. Cabanes PA, Wallet F, Pringuez E, Pernin P. Assessing the risk of primary amoebic meningoencephalitis from swimming in the presence of environmental Naegleria fowleri. Appl Environ Microbiol. 2001 Jul. 67(7):2927-31. [Medline].

  27. Visvesvara GS, Sriram R, Qvarnstrom Y, Bandyopadhyay K, Da Silva AJ, Pieniazek NJ, et al. Paravahlkampfia francinae n. sp. masquerading as an agent of primary amoebic meningoencephalitis. J Eukaryot Microbiol. 2009 Jul-Aug. 56 (4):357-66. [Medline].

  28. Parija SC, Dinoop K, Venugopal H. Management of granulomatous amebic encephalitis: Laboratory diagnosis and treatment. Trop Parasitol. 2015 Jan-Jun. 5 (1):23-8. [Medline].

  29. Schuster FL. Cultivation of pathogenic and opportunistic free-living amebas. Clin Microbiol Rev. 2002 Jul. 15 (3):342-54. [Medline].

  30. Reveiller FL, Cabanes PA, Marciano-Cabral F. Development of a nested PCR assay to detect the pathogenic free-living amoeba Naegleria fowleri. Parasitol Res. 2002. 88:443-50.

  31. Marciano-Cabral F, MacLean R, Mensah A, LaPat-Polasko L. Identification of Naegleria fowleri in domestic water sources by nested PCR. Appl Environ Microbiol. 2003 Oct. 69(10):5864-9. [Medline].

  32. Johnson PE, Deromedi AJ, Lebaron P, Catala P, Havens C, Pougnard C. High throughput, real-time detection of Naegleria lovaniensis in natural river water using LED-illuminated Fountain Flow Cytometry. J Appl Microbiol. 2007 Sep. 103(3):700-10. [Medline].

  33. Flores BM, Garcia CA, Stamm WE, Torian BE. Differentiation of Naegleria fowleri from Acanthamoeba species by using monoclonal antibodies and flow cytometry. J Clin Microbiol. 1990 Sep. 28(9):1999-2005. [Medline].

  34. Madarova L, Trnkova K, Feikova S, Klement C, Obernauerova M. A real-time PCR diagnostic method for detection of Naegleria fowleri. Exp Parasitol. 2010 Sep. 126(1):37-41. [Medline].

  35. Visvesvara GS. Amebic meningoencephalitides and keratitis: challenges in diagnosis and treatment. Curr Opin Infect Dis. 2010 Dec. 23(6):590-4. [Medline].

  36. Qvarnstrom Y, Visvesvara GS, Sriram R, da Silva AJ. Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. J Clin Microbiol. 2006 Oct. 44 (10):3589-95. [Medline].

  37. Kim JH, Jung SY, Lee YJ, Song KJ, Kwon D, Kim K. Effect of therapeutic chemical agents in vitro and on experimental meningoencephalitis due to Naegleria fowleri. Antimicrob Agents Chemother. 2008 Nov. 52(11):4010-6. [Medline].

  38. Investigational Drug Available Directly from CDC for the Treatment of Infections with Free-Living Amebae. MMWR Morb Mortal Wkly Rep. 2013 Aug 23. 62(33):666. [Medline].

  39. Debnath A, Tunac JB, Galindo-Gomez S, Silva-Olivares A, Shibayama M, McKerrow JH. Corifungin, a new drug lead against Naegleria, identified from a high-throughput screen. Antimicrob Agents Chemother. 2012 Nov. 56(11):5450-7. [Medline].

  40. Garcia A, Goni P, Cieloszyk J, Fernandez MT, Calvo-Beguería L, Rubio E. Identification of free-living amoebae and amoeba-associated bacteria from reservoirs and water treatment plants by molecular techniques. Environ Sci Technol. 2013 Apr 2. 47(7):3132-40. [Medline].

  41. Carrasco-Yepez M, Rojas-Hernandez S, Rodriguez-Monroy MA, Terrazas LI, Moreno-Fierros L. Protection against Naegleria fowleri infection in mice immunized with Cry1Ac plus amoebic lysates is dependent on the STAT6 Th2 response. Parasite Immunol. 2010 Sep-Oct. 32(9-10):664-70. [Medline].

  42. Kim JH, Lee SH, Sohn HJ, Lee J, Chwae YJ, Park S. The immune response induced by DNA vaccine expressing nfa1 gene against Naegleria fowleri. Parasitol Res. 2012 Dec. 111(6):2377-84. [Medline].

 
Previous
Next
 
Hematoxin and eosin (H&E)-stained photomicrograph (125X) that shows the cytoarchitectural histopathology found in a case of primary amoebic meningoencephalitis (PAM), caused by Naegleria gruberi. Courtesy of the US Centers for Disease Control and Prevention and Dr. George R. Healy.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.