Primary amoebic meningoencephalitis: fifteen years later

Area of Science:

• Infectious Diseases
• Neuroscience
• Parasitology

Background:

• Primary amoebic meningoencephalitis (PAM) is a rare but devastating infection of the central nervous system.
• The disease is caused by the free-living amoeba Naegleria fowleri, commonly found in warm freshwater environments.
• PAM primarily affects children and young adults, often leading to rapid fatality.

Purpose of the Study:

• To provide an overview of Primary amoebic meningoencephalitis (PAM).
• To discuss the causative agent, Naegleria fowleri, its habitat, and mode of transmission.
• To outline diagnostic approaches and therapeutic strategies for PAM.

Main Methods:

• Diagnosis is suspected in cases of purulent meningitis/meningoencephalitis without bacterial evidence in cerebrospinal fluid (CSF).
• Microscopic examination of fresh CSF or stained specimens (Wright's or Gram's stain) aids diagnosis.
• Review of current treatment protocols and preventive measures.

Main Results:

• Naegleria fowleri enters the brain via the nasopharynx, penetrating the olfactory mucosa and cribriform plate.
• Combination chemotherapy, including amphotericin B with tetracycline or rifamycin, administered via various routes, shows potential therapeutic benefit.
• Preventive strategies involve water supply surveillance and public education.

Conclusions:

• Early suspicion and prompt diagnosis are critical for managing PAM.
• Aggressive combination chemotherapy offers a potential treatment avenue.
• Public health measures, including awareness and avoidance of contaminated water, are essential for prevention.