Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases

• Published in: Parasitology research (1987) 2024-01, Vol.123 (1), p.84-84, Article 84
• Main Authors: Hall, Ashton D., Kumar, Julia E., Golba, Claire E., Luckett, Keith M., Bryant, Whitney K.
• Format: Article
• Language: English
• Subjects: Biomedical and Life Sciences; Biomedicine; Brain; Central Nervous System Protozoal Infections - diagnosis; Central Nervous System Protozoal Infections - drug therapy; Cerebrospinal fluid; Child; Climate Change; Climatic changes; Clinical trials; Complications; complications (disease); Development and progression; Disease Progression; Encephalitis; Fresh water; freshwater; Health aspects; Humans; Immunology; inflammation; Literature reviews; Medical colleges; Medical Microbiology; Meninges; Meningitis; Meningoencephalitis; Microbiology; Mortality; Naegleria fowleri; Neuroprotection; neuroprotective effect; North America; patients; Primary amebic meningoencephalitis; Review; temperature; therapeutics; viral encephalitis; Virus diseases
• ISSN: 0932-0113; 1432-1955
• DOI: 10.1007/s00436-023-08094-w

Primary amebic meningoencephalitis (PAM) is a necrotizing and hemorrhagic inflammation of the brain and meninges caused by Naegleria fowleri , a free-living thermophilic ameba of freshwater systems. PAM remains a neglected disease that disproportionately affects children in tropical and subtropical climates, with an estimated mortality rate of 95–98%. Due to anthropogenic climate change, the average temperature in the USA has increased by 0.72 to 1.06 °C in the last century, promoting the poleward spread of N. fowleri . PAM is often misdiagnosed as bacterial meningitis or viral encephalitis, which shortens the window for potentially life-saving treatment. Diagnosis relies on the patient’s history of freshwater exposure and the physician’s high index of suspicion, supported by cerebrospinal fluid studies. While no experimental trials have been conducted to assess the relative efficacy of treatment regimens, anti-amebic therapy with adjunctive neuroprotection is standard treatment in the USA. We performed a literature review and identified five patients from North America between 1962 and 2022 who survived PAM with various degrees of sequelae.