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Primary Amebic Meningoencephalitis: What Have We Learned in the Last 5 Years?
1Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA. jcope@cdc.gov.
Abstract:
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 years, 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.
Insights
Primary amebic meningoencephalitis (PAM), a severe brain infection caused by Naegleria fowleri, is expanding its geographic range. Early diagnosis and treatment offer hope for survivors of this rare but deadly amebic infection.
Area of Science:
- Neurology
- Infectious Diseases
- Parasitology
Background:
- Primary amebic meningoencephalitis (PAM) is a rare but fatal brain infection.
- Naegleria fowleri, a thermophilic ameba, causes PAM, typically contracted through nasal exposure to warm freshwater.
- Historically, cases concentrated in southern US states.
Purpose of the Study:
- To review recent changes in PAM epidemiology.
- To highlight the potential for improved outcomes with early diagnosis and treatment.
- To emphasize the utility of advanced molecular tools for understanding N. fowleri.
Main Methods:
- Review of epidemiological data on Naegleria fowleri infections.
- Analysis of recent trends in PAM cases and water exposures.
- Discussion of clinical management and diagnostic considerations.
Main Results:
- PAM cases show a northward expansion in the USA.
- New water exposure routes are emerging.
- Two recent survivors demonstrate the possibility of improved outcomes.
Conclusions:
- Clinicians should consider PAM in meningitis cases with freshwater exposure.
- Early diagnosis and aggressive treatment are crucial for patient survival.
- Genome sequencing may elucidate N. fowleri pathogenicity and inform future strategies.
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