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Hall AD, Kumar JE, Golba CE, Luckett KM, Bryant WK. Primary amebic meningoencephalitis: a review of Naegleria fowleri and analysis of successfully treated cases. Parasitol Res 2024; 123:84. [PMID: 38182931 DOI: 10.1007/s00436-023-08094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/12/2023] [Indexed: 01/07/2024]
Abstract
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.
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Affiliation(s)
- Ashton D Hall
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia E Kumar
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Claire E Golba
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Keith M Luckett
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Whitney K Bryant
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Baqer NN, Mohammed AS, A.AL-Aboody B, Ismail AM. Genetic Detection of Amoebic Meningoencephalitis Causing by Naegleria Fowleri in Iraq: A Case Report. IRANIAN JOURNAL OF PARASITOLOGY 2023; 18:408-413. [PMID: 37886244 PMCID: PMC10597877 DOI: 10.18502/ijpa.v18i3.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/09/2023] [Indexed: 10/28/2023]
Abstract
We diagnosed a case report of amoebic meningoencephalitis by Naegleria fowleri. This case represented the first recording in Iraq where it was not recording previously. This case was diagnosed after the death of an 18-year-old girl patient who lived in a rural area of Mosul in Iraq. Genetics detection of N. fowleri showed PCR product was 183bp for 18S rRNA gene. It was registered as the first recording of Iraqi isolate N. fowleri in GenBank with accession number OP380864.1. It is necessary to examine microscopically the cerebral spinal fluid (CSF) to observe the amoeba stages and exclude the bacterial causative. Rapid diagnosis may help in the treatment of amoebic meningoencephalitis. In addition, genetic identification can diagnose amoeba. Avoiding swimming or using freshwater contributes to prevent amoebic meningoencephalitis infection.
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Affiliation(s)
- Noor Nihad Baqer
- Water and Environment Directorate, Ministry of Science and Technology, Baghdad, Iraq
| | | | - Bassad A.AL-Aboody
- Department of Biology, College of Science, University of Thi-Qar, Nasiriyah, Iraq
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Miko S, Cope JR, Hlavsa MC, Ali IKM, Brown TW, Collins JP, Greeley RD, Kahler AM, Moore KO, Roundtree AV, Roy S, Sanders LL, Shah V, Stuteville HD, Mattioli MC. A Case of Primary Amebic Meningoencephalitis Associated with Surfing at an Artificial Surf Venue: Environmental Investigation. ACS ES&T WATER 2023; 3:1126-1133. [PMID: 37213412 PMCID: PMC10193442 DOI: 10.1021/acsestwater.2c00592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. In September 2018, a 29-year-old man died of PAM after traveling to Texas. We conducted an epidemiologic and environmental investigation to identify the water exposure associated with this PAM case. The patient's most probable water exposure occurred while surfing in an artificial surf venue. The surf venue water was not filtered or recirculated; water disinfection and water quality testing were not documented. N. fowleri and thermophilic amebae were detected in recreational water and sediment samples throughout the facility. Codes and standards for treated recreational water venues open to the public could be developed to address these novel venues. Clinicians and public health officials should also consider novel recreational water venues as a potential exposure for this rare amebic infection.
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Affiliation(s)
- Shanna Miko
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer R. Cope
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Michele C. Hlavsa
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Ibne Karim M. Ali
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Travis W. Brown
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer P. Collins
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | | | - Amy M. Kahler
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Kathleen O. Moore
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Alexis V. Roundtree
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
- Chenega Enterprise System & Solutions, 609 Independence Parkway Suite 210, Chesapeake, VA 23320
| | - Shantanu Roy
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Lacey L. Sanders
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Vaidehi Shah
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Haylea D. Stuteville
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Mia C. Mattioli
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
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Ultraviolet – Chlorine combined treatment efficiency to eliminate Naegleria fowleri in artificial surf lagoons. Heliyon 2022; 8:e11625. [PMID: 36439712 PMCID: PMC9691874 DOI: 10.1016/j.heliyon.2022.e11625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/14/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Naegleria. fowleri, a protozoa belonging to the free-living amoeba group, is the causative agent of a central nervous system affecting disease that is fatal in more than the 95% of the reported cases. This parasite can be found in warm water bodies such as lakes, rivers or inadequately disinfected swimming pools. On the other hand, chlorination and UV light treatment are two of the most extensively used disinfection methods in recreational water facilities. In this study the effect of chlorination and UV light on N. fowleri trophozoites was studied in a close water circuit with the aim to assess the efficacy of this disinfection methods in large pools. The obtained results showed that the chlorination was able to decrease the number of viable cells despite the elimination was not totally achieved. Nonetheless, the combination of the UV light with the chlorination allowed the complete removal of the N. fowleri trophozoites from the water in experimental testing conditions. Absence of an standardized water treatment protocol to eliminate N. fowleri. Treatment based only on chlorine was ineffective to eliminate N. fowleri. Combined chlorination and UV light treatment was effective to completely eliminate N.fowleri. Combination of chlorine - Uv would be a promising method for water disinfection.
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Fabros MRL, Diesta XRS, Oronan JA, Verdejo KS, Garcia JASM, Sophia Romey M, Milanez GDJ. Current report on the prevalence of free-living amoebae (FLA) in natural hot springs: a systematic review. JOURNAL OF WATER AND HEALTH 2021; 19:563-574. [PMID: 34371494 DOI: 10.2166/wh.2021.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The occurrence of potentially pathogenic free-living amoebae (FLA) in natural hot springs is considered a public health concern. FLAs are known to cause serious health outcomes to a wide spectrum of mammalian hosts. The present study aimed to provide the distribution of isolated cases of FLAs in hot springs through a systematic review process of available published articles online. Relevant studies are published between January 2010 and January 2020 involving the isolation of Naegleria spp., Acanthamoeba spp., Balamuthia spp., Sappinia spp., and Vermamoeba spp. in natural hot springs in the United States, South America, North America, Europe, Asia, and Africa. Articles were identified through a search of PubMed and Google Scholar databases. Out of 94 articles screened, a total of 20 articles are included in the study with consideration of established inclusion and exclusion criteria. The most common FLAs isolated in hot springs are Acanthamoeba spp. (134; 48.5%) and Naegleria spp. (127; 46.0%). Other FLAs isolated in hot springs include Balamuthia spp. (2; 0.7%) and Vermamoeba spp. (13; 4.7%). FLA in hot springs used for recreational and medical purposes is a potential source of infection. It is recommended that strict surveillance and maintenance of hot springs be implemented to prevent potential future infection.
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Affiliation(s)
| | | | - John Anthony Oronan
- Department of Medical Technology, Far Eastern University, Manila 1015, Philippines E-mail:
| | - Kim Sofia Verdejo
- Department of Medical Technology, Far Eastern University, Manila 1015, Philippines E-mail:
| | | | - Ma Sophia Romey
- Department of Medical Technology, Far Eastern University, Manila 1015, Philippines E-mail:
| | - Giovanni De Jesus Milanez
- Department of Medical Technology, Far Eastern University, Manila 1015, Philippines E-mail: ; Division III (Medical Sciences), National Research Council of the Philippines, Manila, Philippines
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