Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems

Primary Amoebic (Naegleria fowleri) Meningoencephalitis Presenting as Status Epilepticus

Primary amebic meningoencephalitis (PAM) is a rare entity. Usual presenting features are fever, headache and seizures with meningeal signs and this disease carries high mortality rate. We present a case report of PAM presenting as status epilepticus

Emerg Infect Dis

Primary amebic meningoencephalitis is an acute, rare, typically fatal disease. We used epidemiologic risk factors and multiple cause-of-death mortality data to estimate the number of deaths that fit the typical pattern for primary amebic meningoencephalitis; we estimated an annual average of 16 deaths (8 male, 8 female) in the United States.201829260676PMC5749439702

PROTEOMIC ANALYSIS OF TWO DIFFERENT STATES OF NAEGLERIA FOWLERI

Naegleria fowleri are free-living ameboflagellates found in soil and freshwater habitats throughout the world that cause a fatal disease in humans called Primary Amoebic Meningoencephalitis (PAM). Mechanisms of host resistance or susceptibility to infection have not been fully elucidated, and possible treatment methods are still sub optimal. The disease is diagnosed using specific laboratory tests available in only a few laboratories in the United States. Because of the rarity of infection and difficulty in initial detection, more than often PAM is misdiagnosed. Therefore, it is very important to find causative marker for early detection of an infection. The purpose of this study is to create a proteomic signature map using two-dimensional gel electrophoresis (2-D gel) and recommend a subset of proteins that may be directly linked to the pathogenic state of N. fowleri. Replicates of 2-D Gels were created for both strains of N. fowleri and the proteomic templates from these gels were compared with each other. Scatter Plots were generated measuring the density of protein spots from 2-D gels being analyzed for each study. For each strains of N. fowleri, the 2-D gels from each study were compared within and compared between the two studies for reproducibility in data. The resulting correlation values for all of the Scatter Plots were greater or equal to 0.90. Finally, the representative proteomic template for axenically grown N. fowleri and mouse passaged N. fowleri were compared and the correlation value of 0.60 was observed. This confirmed our theory that these two strains or states of N. fowleri have very different protein expressions, and we were able to identify a subset of proteins, both over expressed and newly synthesized, that may be linked to the highly pathogenic state of N. fowleri

Primary amebic meningoencephalitis

PAM je akutna infektivna bolest uzrokovana Neglerijom fowleri i karakterizirana je nekrotizirajućom, hemoragijskom upalom mozga i moždanih ovojnica. N. fowleri je ameba koja živi u slatkim vodama, a čovjek se može zaraziti udisanjem kontaminirane vode prilikom plivanja ili ispiranjem nosnih puteva neprokuhanom ili nefiltriranom vodovodnom vodom. Do sada je prijavljeno više od četiristo slučajeva zaraze N. fowleri diljem svijeta, od čega je samo desetak preživjelih. Od PAM-a obolijevaju uglavnom djeca i mladi u vrućim ljetnim mjesecima. N. fowleri putem olfaktornih živaca i bulbusa prodire u moždano tkivo gdje izaziva upalu s predominantno prisutnim neutrofilima, makrofagima i malobrojnim eozinofilima. Klinički simptomi su neraspoznatljivi od simptoma bakterijskog ili virusnog meningoencefalitisa i uključuju jaku glavobolju, visoku vrućicu, ukočenost vrata i mučninu i povraćanje. Kasnije se javljaju i razdražljivost, fotofobija, diplopija, letargija, konfuzija, a povećanje IKT-a dovodi do konvulzivnih napada, hernijacije mozga, kome i naposljetku smrti. Dijagnostika se zasniva na pronalasku pokretnih trofozoita u nativnom razmazu CSL-a pod svjetlosnim mikroskopom i potvrdi dijagnoze PCR-om i pronalaskom DNA N. fowleri. Liječi se kombiniranom antimikrobnom terapijom koja uključuje amfotericin B koji djeluje sinergistički s azitromicinom i mikonazolom. Terapiji se mogu pridodati i kotrimazol, itrakonazol, flukonazol i ketokonazol, kloramfenikol i miltefozin. Povišeni IKT potrebno je agresivno snižavati lijekovima, a po potrebi i kirurškom intervencijom. U prevenciji PAM-a preporuča se adekvatno kloriranje bazena, nadzor slatkih voda ljeti u područjima u kojima je dokazano postojanje N. fowleri, te oprez svakog pojedinca pri kupanju u prirodnim vodama i pri ispiranju nazalnih puteva bilo u terapijske ili religijske svrhe.PAM is an acute infective disease caused by Naegleria fowleri and characterized by a necrotic, hemorrhaging inflammation of the brain and leptomeninges. N. fowleri is an ameba that lives in natural freshwater and infects humans via the inhalation of contaminated water during swimming or by rinsing nasal passages with unboiled or unfiltered tap water. To this date, there have been more than four hundred reported cases of N. fowleri worldwide, of which there are only a dozen survivors. PAM targets mostly children and young adults during hot summer months. N. fowleri invades the brain tissue via the olfactory nerves and bulbs, where it causes inflammation with predominance of neutrophils, macrophages and few eosinophils. Clinical symptoms are unrecognizable from symptoms of bacterial or viral meningoencephalitis, such as headache, high fever, nuchal rigidity, vomiting and nausea. Agitation, photophobia, diplopy, lethargy and confusion occur in later stages, while the rise of ICP leads to convulsions, brain herniation, coma and, finally, death. The diagnosis is based on the detection of motile trophozoites in the sample of wet-mount CSF under a light microscope and the confirmation of the diagnosis via PCR and the detection of N. fowleri DNA. Treatment is based on multimodal antimicrobial therapy that includes amphotericin B which shows synergistic activity with azithromycin and miconazole. Clotrimazole, itraconazole, fluconazole and ketoconazole, chloramphenicol and miltefosine can also be included in the therapy. Elevated ICP should be aggressively treated by medication and, if needed, by surgical intervention. Prevention of PAM requires adequate pool chlorination, monitoring of freshwater inhabited by N. fowleri and caution of every individual while swimming in freshwater or rinsing nasal passages in therapeutic or religious purposes

Primary amebic meningoencephalitis

PAM je akutna infektivna bolest uzrokovana Neglerijom fowleri i karakterizirana je nekrotizirajućom, hemoragijskom upalom mozga i moždanih ovojnica. N. fowleri je ameba koja živi u slatkim vodama, a čovjek se može zaraziti udisanjem kontaminirane vode prilikom plivanja ili ispiranjem nosnih puteva neprokuhanom ili nefiltriranom vodovodnom vodom. Do sada je prijavljeno više od četiristo slučajeva zaraze N. fowleri diljem svijeta, od čega je samo desetak preživjelih. Od PAM-a obolijevaju uglavnom djeca i mladi u vrućim ljetnim mjesecima. N. fowleri putem olfaktornih živaca i bulbusa prodire u moždano tkivo gdje izaziva upalu s predominantno prisutnim neutrofilima, makrofagima i malobrojnim eozinofilima. Klinički simptomi su neraspoznatljivi od simptoma bakterijskog ili virusnog meningoencefalitisa i uključuju jaku glavobolju, visoku vrućicu, ukočenost vrata i mučninu i povraćanje. Kasnije se javljaju i razdražljivost, fotofobija, diplopija, letargija, konfuzija, a povećanje IKT-a dovodi do konvulzivnih napada, hernijacije mozga, kome i naposljetku smrti. Dijagnostika se zasniva na pronalasku pokretnih trofozoita u nativnom razmazu CSL-a pod svjetlosnim mikroskopom i potvrdi dijagnoze PCR-om i pronalaskom DNA N. fowleri. Liječi se kombiniranom antimikrobnom terapijom koja uključuje amfotericin B koji djeluje sinergistički s azitromicinom i mikonazolom. Terapiji se mogu pridodati i kotrimazol, itrakonazol, flukonazol i ketokonazol, kloramfenikol i miltefozin. Povišeni IKT potrebno je agresivno snižavati lijekovima, a po potrebi i kirurškom intervencijom. U prevenciji PAM-a preporuča se adekvatno kloriranje bazena, nadzor slatkih voda ljeti u područjima u kojima je dokazano postojanje N. fowleri, te oprez svakog pojedinca pri kupanju u prirodnim vodama i pri ispiranju nazalnih puteva bilo u terapijske ili religijske svrhe.PAM is an acute infective disease caused by Naegleria fowleri and characterized by a necrotic, hemorrhaging inflammation of the brain and leptomeninges. N. fowleri is an ameba that lives in natural freshwater and infects humans via the inhalation of contaminated water during swimming or by rinsing nasal passages with unboiled or unfiltered tap water. To this date, there have been more than four hundred reported cases of N. fowleri worldwide, of which there are only a dozen survivors. PAM targets mostly children and young adults during hot summer months. N. fowleri invades the brain tissue via the olfactory nerves and bulbs, where it causes inflammation with predominance of neutrophils, macrophages and few eosinophils. Clinical symptoms are unrecognizable from symptoms of bacterial or viral meningoencephalitis, such as headache, high fever, nuchal rigidity, vomiting and nausea. Agitation, photophobia, diplopy, lethargy and confusion occur in later stages, while the rise of ICP leads to convulsions, brain herniation, coma and, finally, death. The diagnosis is based on the detection of motile trophozoites in the sample of wet-mount CSF under a light microscope and the confirmation of the diagnosis via PCR and the detection of N. fowleri DNA. Treatment is based on multimodal antimicrobial therapy that includes amphotericin B which shows synergistic activity with azithromycin and miconazole. Clotrimazole, itraconazole, fluconazole and ketoconazole, chloramphenicol and miltefosine can also be included in the therapy. Elevated ICP should be aggressively treated by medication and, if needed, by surgical intervention. Prevention of PAM requires adequate pool chlorination, monitoring of freshwater inhabited by N. fowleri and caution of every individual while swimming in freshwater or rinsing nasal passages in therapeutic or religious purposes

Primary amoebic meningoencephalitis

This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of primary amoebic meningoencephalitis

Clin Infect Dis

BackgroundNaegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. Patient exposure to water containing the ameba typically occurs in warm freshwater lakes and ponds during recreational water activities. In June 2016, an 18-year-old woman died of PAM after traveling to North Carolina, where she participated in rafting on an artificial whitewater river.MethodsWe conducted an epidemiologic and environmental investigation to determine the water exposure that led to the death of this patient.ResultsThe case-patient's most probable water exposure occurred while rafting on an artificial whitewater river during which she was thrown out of the raft and submerged underwater. The 3c11.5 million gallons of water in the whitewater facility were partially filtered, subjected to UV light treatment, and occasionally chlorinated. Heavy algal growth was noted. Eleven water-related samples were collected from the facility; all were positive for N. fowleri. Of 5 samples collected from the nearby natural river, 1 sediment sample was positive for N. fowleri.ConclusionsThis investigation documents a novel exposure to an artificial whitewater river as the likely exposure causing PAM in this case. Conditions in the whitewater facility (warm, turbid water with little chlorine and heavy algal growth) rendered the water treatment ineffective and provided an ideal environment for N. fowleri to thrive. The combination of natural and engineered elements at the whitewater facility create a challenging environment to control the growth of N. fowleri.CC999999/Intramural CDC HHS/United States2019-02-01T00:00:00Z29401275PMC5801760vault:2616

Curr Infect Dis Rep

Primary amebic meningoencephalitis (PAM) is a devastating infection of the brain caused by the thermophilic free-living ameba, Naegleria fowleri. Infection can occur when water containing the ameba enters the body through the nose, usually during recreational water activities such as swimming or diving. Historically, in the USA, cases were mostly reported from the warmer southern-tier states. In the last 5\uc2\ua0years, several notable changes have been documented in PAM epidemiology including a northward expansion of infections and new types of water exposures. The recent reports of two PAM survivors provide hope for improved outcomes with early diagnosis and aggressive treatment. Advanced molecular laboratory tools such as genome sequencing might provide more insight into the pathogenicity of N. fowleri. Clinicians treating patients with meningitis and warm freshwater exposure are encouraged to consider PAM in their differential diagnoses.CC999999/Intramural CDC HHS/United States2017-09-01T00:00:00Z27614893PMC510000

Can clinical staging of primary amoebic meningoencephalitis be of any therapeutic benefit

Naegleria fowleri, is a free-living amoeba (FLA) known to infect humans and cause a fatal disease called primary amoebic meningoencephalitis (PAM). All of the patients are commonly admitted to the emergency room (ER). Often, treatment in the ER is delayed due to the rarity of disease leading to a delay in the diagnosis and late arrival of patients to the ER. The attempts to reduce raised intracranial pressure and subsequent herniation of the brain stem are challenging and become the cause of death in the affected patients during their stay in ER. Use of drugs like mannitol to reduce raised intra-cerebral pressure (ICP) could prove dangerous in the presence of cerebral haemorrhage and this fact could be overlooked during the management of patients with PAM. No precise therapy is followed for PAM, and most often a course of broad spectrum anti-protozoal drugs is employed. A CDC recommended drug miltefosine has show success in early diagnosed cases. So far, there is no clinical staging of PAM, and patients are managed for the complications that develop while their stay in the ER. Given the health scare associated with N. fowleri in countries with tropical climates, and its potential ability to cause severe meningoencephalitis that often progresses to lethal outcomes, we believe it is imperative to stage PAM into clear progressive stages to help its management in the ER and debate its therapeutic gains. Such a clinical staging could aid in efforts to diagnose and treat PAM. Furthermore, it will help in raising public awareness, in educating healthcare and allied personne