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Burqi AMK, Satti L, Mahboob S, Anwar SOZ, Bizanjo M, Rafique M, Ghanchi NK. Successful Treatment of Confirmed Naegleria fowleri Primary Amebic Meningoencephalitis. Emerg Infect Dis 2024; 30:803-805. [PMID: 38526236 PMCID: PMC10977850 DOI: 10.3201/eid3004.230979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Primary amebic meningoencephalitis caused by Naegleria fowleri is a rare but nearly always fatal parasitic infection of the brain. Globally, few survivors have been reported, and the disease has no specific treatment. We report a confirmed case in Pakistan in a 22-year-old man who survived after aggressive therapy.
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Yuan A, Fong H, Nguyen JV, Nguyen S, Norman P, Cullum R, Fenical W, Debnath A. High-Throughput Screen of Microbial Metabolites Identifies F 1F O ATP Synthase Inhibitors as New Leads for Naegleria fowleri Infection. ACS Infect Dis 2023; 9:2622-2631. [PMID: 37943251 DOI: 10.1021/acsinfecdis.3c00437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Primary amebic meningoencephalitis (PAM), a brain infection caused by a free-living ameba Naegleria fowleri, leads to an extensive inflammation of the brain and death within 1-18 (median 5) days after symptoms begin. Although natural products have played a significant role in the development of drugs for over a century, research focusing on identifying new natural product-based anti-N. fowleri agents is limited. We undertook a large-scale ATP bioluminescence-based screen of about 10,000 unique marine microbial metabolite mixtures against the trophozoites of N. fowleri. Our screen identified about 100 test materials with >90% inhibition at 50 μg/mL and a dose-response study found 20 of these active test materials exhibiting an EC50 ranging from 0.2 to 2 μg/mL. Examination of four of these potent metabolite mixtures, derived from our actinomycete strains CNT671, CNT756, and CNH301, resulted in the isolation of a pure metabolite identified as oligomycin D. Oligomycin D exhibited nanomolar potency on multiple genotypes of N. fowleri, and it was five- or 850-times more potent than the recommended drugs amphotericin B or miltefosine. Oligomycin D is fast-acting and reached its EC50 in 10 h, and it was also able to inhibit the invasiveness of N. fowleri significantly when tested on a matrigel invasion assay. Since oligomycin is known to manifest inhibitory activity against F1FO ATP synthase, we tested different F1FO ATP synthase inhibitors and identified a natural peptide leucinostatin as a fast-acting amebicidal compound with nanomolar potency on multiple strains.
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Affiliation(s)
- Alice Yuan
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
| | - Hayley Fong
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
| | - Jennifer V Nguyen
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
| | - Sophia Nguyen
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
| | - Payton Norman
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
| | - Reiko Cullum
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla, California 92093, United States
| | - William Fenical
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
- Center for Marine Biotechnology and Biomedicine, Scripps Institution of Oceanography, University of California San Diego, La Jolla, California 92093, United States
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093, United States
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Nadeem A, Malik IA, Afridi EK, Shariq F. Naegleria fowleri outbreak in Pakistan: unveiling the crisis and path to recovery. Front Public Health 2023; 11:1266400. [PMID: 37927850 PMCID: PMC10620794 DOI: 10.3389/fpubh.2023.1266400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
The outbreak of Naegleria fowleri in Pakistan presents a significant public health concern due to its high fatality rate and limited treatment options. This review explores the impact of the outbreak on communities and the challenges faced in combating the disease. It evaluates available treatment options and highlights the need for early diagnosis and intervention. The study proposes recommendations to improve public health preparedness, including public awareness campaigns, enhanced healthcare infrastructure, and robust water surveillance systems. Collaboration between research institutions and public health organizations is emphasized to develop effective outbreak response strategies.
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Affiliation(s)
- Abdullah Nadeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Inshal Arshad Malik
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Eesha Khan Afridi
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Fariha Shariq
- Department of Medicine, Karachi Medical and Dental College, Karachi, Sindh, Pakistan
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Rojo JU, Rajendran R, Salazar JH. Laboratory Diagnosis of Primary Amoebic Meningoencephalitis. Lab Med 2023; 54:e124-e132. [PMID: 36638160 DOI: 10.1093/labmed/lmac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a fulminant fatal human disease caused by the free-living amoeba Naegleria fowleri. Infection occurs after inhalation of water containing the amoeba, typically after swimming in bodies of warm freshwater. N. fowleri migrates to the brain where it incites meningoencephalitis and cerebral edema leading to death of the patient 7 to 10 days postinfection. Although the disease is rare, it is almost always fatal and believed to be underreported. The incidence of PAM in countries other than the United States is unclear and possibly on track to being an emerging disease. Poor prognosis is caused by rapid progression, suboptimal treatment, and underdiagnosis. As diagnosis is often performed postmortem and testing is only performed by a few laboratories, more accessible testing is necessary. This article reviews the current methods used in the screening and confirmation of PAM and makes recommendations for improved diagnostic practices and awareness.
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Affiliation(s)
- Juan U Rojo
- Department of Clinical Laboratory Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas, US
| | - Rajkumar Rajendran
- Department of Clinical Laboratory Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas, US
| | - Jose H Salazar
- Department of Clinical Laboratory Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, Texas, US
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Eger L, Pence MA. The Brief Case: A Case of Primary Amebic Meningoencephalitis (PAM) after Exposure at a Splash Pad. J Clin Microbiol 2023; 61:e0126922. [PMID: 37470480 PMCID: PMC10358179 DOI: 10.1128/jcm.01269-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Affiliation(s)
- Lynne Eger
- Department of Infectious Diseases, Cook Children’s Medical Center, Fort Worth, Texas, USA
| | - Morgan A. Pence
- Department of Pathology and Laboratory Medicine, Cook Children’s Medical Center, Fort Worth, Texas, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Joseph SJ, Park S, Kelley A, Roy S, Cope JR, Ali IKM. Comparative Genomic and Transcriptomic Analysis of Naegleria fowleri Clinical and Environmental Isolates. mSphere 2021; 6:e0063721. [PMID: 34378985 PMCID: PMC8386437 DOI: 10.1128/msphere.00637-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/21/2022] Open
Abstract
Out of over 40 species of Naegleria, which are free-living thermophilic amebae found in freshwater and soil worldwide, only Naegleria fowleri infects humans, causing primary amebic meningoencephalitis (PAM), a typically fatal brain disease. To understand the population structure of Naegleria species and the genetic relationships between N. fowleri isolates and to detect pathogenic factors, we characterized 52 novel clinical and environmental N. fowleri genomes and a single Naegleria lovaniensis strain, along with transcriptomic data for a subset of 37 N. fowleri isolates. Whole-genome analysis of 56 isolates from three Naegleria species (N. fowleri, N. lovaniensis, and Naegleria gruberi) identified several genes unique to N. fowleri that have previously been linked to the pathogenicity of N. fowleri, while other unique genes could be associated with novel pathogenicity factors in this highly fatal pathogen. Population structure analysis estimated the presence of 10 populations within the three Naegleria species, of which 7 populations were within N. fowleri. The whole-nuclear-genome (WNG) phylogenetic analysis showed an overall geographical clustering of N. fowleri isolates, with few exceptions, and provided higher resolution in identifying potential clusters of isolates beyond that of the traditional locus typing. There were only 34 genes that showed significant differences in gene expression between the clinical and environmental isolates. Genomic data generated in this study can be used for developing rapid molecular assays and to conduct future population-based global genomic analysis and will also be a valuable addition to genomic reference databases, where shotgun metagenomics data from routine water samples could be searched for the presence of N. fowleri strains. IMPORTANCE N. fowleri, the only known Naegleria species to infect humans, causes fatal brain disease. PAM cases from 1965 to 2016 showed <20 cases per year globally. Out of approximately 150 cases in North America since 1962, only four PAM survivors are known, yielding a >97% case fatality rate, which is critically high. Although the pathogenesis of N. fowleri has been studied for the last 50 years, pathogenetic factors that lead to human infection and breaching the blood-brain barrier remain unknown. In addition, little is known regarding the genomic diversity both within N. fowleri isolates and among Naegleria species. In this study, we generated novel genome sequences and performed comparative genomic and transcriptomic analysis of a set of 52 N. fowleri draft genome sequences from clinical and environmental isolates derived from all over the world in the last 53 years, which will help shape future genome-wide studies and develop sensitive assays for routine surveillance.
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Affiliation(s)
- Sandeep J. Joseph
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Subin Park
- Eagle Medical Services, Atlanta, Georgia, USA
| | | | - Shantanu Roy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer R. Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ibne Karim M. Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Harris GR, Karmarkar EN, Quenelle R, Chaille L, Madhok J, Tien V, Gupta J, Jain S, Liu M, Roy S, Narasimhan S, Kimura A, Cope JR, Ali IKM. Death From Primary Amebic Meningoencephalitis After Recreational Water Exposure During Recent Travel to India-Santa Clara County, California, 2020. Open Forum Infect Dis 2021; 8:ofab322. [PMID: 34395708 DOI: 10.1093/ofid/ofab322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background In February 2020, a man returned to the United States after an 11-day trip to India and died of primary amebic meningoencephalitis (PAM), caused by nasal exposure to the free-living ameba Naegleria fowleri found in warm water. We identified potential exposures, confirmed etiology, and described the molecular epidemiology of the infection. Methods We reviewed medical records to describe his clinical course and interviewed his family to determine water exposures. Genotyping was performed on the N. fowleri strain and compared with North American strains through repetitive nonpolymorphic nuclear loci analysis to identify differences. We reviewed N. fowleri strains in the National Center for Biotechnology Information database (GenBank) to determine genotypes present in India. Results The patient became acutely encephalopathic 3 days after returning; the only known nasal water exposure was at an indoor swimming pool in India 5 days earlier. Cerebrospinal fluid (CSF) testing demonstrated neutrophil-predominant pleocytosis and low glucose, but negative gram stain and culture. CSF microscopy revealed trophozoites; N. fowleri was detected by real-time polymerase chain reaction. Classical genotyping confirmed genotype I, common in the United States and among Indian strains in GenBank. The North American N. fowleri strains and the patient's strain varied at 5 nonpolymorphic loci. Conclusions A man died from PAM after likely exposure at a vacation rental pool in India. We recommend including PAM in the differential diagnosis when CSF studies suggest bacterial meningitis but gram stain is negative. Genotyping can advance our understanding of N. fowleri molecular epidemiology and support future investigations.
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Affiliation(s)
- Glenn R Harris
- Santa Clara Valley Medical Center, San Jose, California, USA
| | - Ellora N Karmarkar
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,California Department of Public Health, Richmond, California, USA
| | - Rebecca Quenelle
- County of Santa Clara Public Health Department, San Jose, California, USA
| | - Lyndsey Chaille
- California Department of Public Health, Richmond, California, USA
| | - Jai Madhok
- Stanford University School of Medicine, Stanford, California, USA
| | - Vivian Tien
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jyoti Gupta
- Santa Clara Valley Medical Center, San Jose, California, USA
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA
| | - Maria Liu
- California Department of Public Health, Richmond, California, USA
| | - Shantanu Roy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Akiko Kimura
- California Department of Public Health, Richmond, California, USA
| | - Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ibne Karim M Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gharpure R, Bliton J, Goodman A, Ali IKM, Yoder J, Cope JR. Epidemiology and Clinical Characteristics of Primary Amebic Meningoencephalitis Caused by Naegleria fowleri: A Global Review. Clin Infect Dis 2021; 73:e19-e27. [PMID: 32369575 DOI: 10.1093/cid/ciaa520] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary amebic meningoencephalitis (PAM) is a rapidly progressive and often fatal condition caused by the free-living ameba Naegleria fowleri. To estimate the global occurrence, characterize the epidemiology, and describe the clinical features of PAM, we report a series of PAM cases published in the international literature and reported to the Centers for Disease Control and Prevention (CDC). METHODS We performed a literature search of PAM case reports published through 2018. Additionally, we included cases reported through the CDC's Free-Living Ameba surveillance or diagnosed via CDC's Free-Living and Intestinal Amebas Laboratory. Cases were classified as confirmed, probable, or suspect on the basis of confirmatory testing, presentation, exposure, and disease course. RESULTS A total of 381 PAM cases were identified. Seven reported survivors were classified as confirmed. The most commonly reported exposure associated with PAM was swimming/diving, and the most common class of water source was lakes/ponds/reservoirs. Patients were predominantly male (75%), with a median age of 14 years. Confirmed and probable cases were similar in their survival, course of illness, and cerebrospinal fluid (CSF) findings. CONCLUSIONS PAM is a rare but deadly disease with worldwide occurrence. Improved clinician awareness, resulting in earlier diagnosis and treatment, may contribute to increased survival among PAM patients. The case definition of probable used in this study appears to capture cases of PAM, as evidenced by similarities in outcomes, clinical course, and CSF profile to confirmed cases. In the absence of confirmatory testing, clinicians could use this case definition to identify cases of PAM.
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Affiliation(s)
- Radhika Gharpure
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Bliton
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alexandra Goodman
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ibne Karim M Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gharpure R, Gleason M, Salah Z, Blackstock AJ, Hess-Homeier D, Yoder JS, Ali IKM, Collier SA, Cope JR. Geographic Range of Recreational Water-Associated Primary Amebic Meningoencephalitis, United States, 1978-2018. Emerg Infect Dis 2021; 27:271-274. [PMID: 33350926 PMCID: PMC7774533 DOI: 10.3201/eid2701.202119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Naegleria fowleri is a free-living ameba that causes primary amebic meningoencephalitis (PAM), a rare but usually fatal disease. We analyzed trends in recreational water exposures associated with PAM cases reported during 1978–2018 in the United States. Although PAM incidence remained stable, the geographic range of exposure locations expanded northward.
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Abstract
Introduction: Naegleria fowleri is responsible for primary amebic meningoencephalitis (PAM) which has a fatality rate of >97%. Because of the rarity of the disease, pharmaceutical companies do not pursue new drug discovery for PAM. Yet, it is possible that the infection is underreported and finding a better drug would have an impact on people suffering from this deadly infection.Areas covered: This paper reports the efforts undertaken by different academic groups over the last 20 years to test different compounds against N. fowleri. The drug discovery research encompassed synthesis of new compounds, development and use of high-throughput screening methods and attempts to repurpose clinically developed or FDA-approved compounds for the treatment of PAM.Expert opinion: In absence of economic investment to develop new drugs for PAM, repurposing the FDA-approved drugs has been the best strategy so far to identify new leads against N. fowleri. Increasing use of high-throughput phenotypic screening has the potential to accelerate the identification of new leads, either in monotherapy or in combination treatment. Since phase II clinical trial is not possible for PAM, it is critical to demonstrate in vivo efficacy of a clinically safe compound to translate the discovery from lab to the clinic.
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Affiliation(s)
- Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
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Abstract
Naegleria fowleriis a thermophilic free-living ameba that is found in warm, fresh water and causes primary amebic meningoencephalitis (PAM) in humans with high mortality rate. Here we report a case of newborn admitted with destructive clinical features of PAM after having bath with unchlorinated well water on a summer day.
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Affiliation(s)
- Yalcin Celik
- Department of Pediatrics, Mersin University School of Medicine, Mersin 33120, Turkey
| | - Ali Ertuğ Arslankoylu
- Department of Pediatrics, Mersin University School of Medicine, Mersin 33120, Turkey
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Abstract
Primary amebic meningoencephalitis (PAM), caused by the free-living ameba Naegleria fowleri, has a fatality rate of over 97%. Treatment of PAM relies on amphotericin B in combination with other drugs, but few patients have survived with the existing drug treatment regimens. Therefore, development of effective drugs is a critical unmet need to avert deaths from PAM. Since ergosterol is one of the major sterols in the membrane of N. fowleri, disruption of isoprenoid and sterol biosynthesis by small-molecule inhibitors may be an effective intervention strategy against N. fowleri. The genome of N. fowleri contains a gene encoding HMG-CoA reductase (HMGR); the catalytic domains of human and N. fowleri HMGR share <60% sequence identity with only two amino acid substitutions in the active site of the enzyme. Considering the similarity of human and N. fowleri HMGR, we tested well-tolerated and widely used HMGR inhibitors, known as cholesterol-lowering statins, against N. fowleri. We identified blood-brain-barrier-permeable pitavastatin as a potent amebicidal agent against the U.S., Australian, and European strains of N. fowleri. Pitavastatin was equipotent to amphotericin B against the European strain of N. fowleri; it killed about 80% of trophozoites within 16 h of drug exposure. Pretreatment of trophozoites with mevalonate, the product of HMGR, rescued N. fowleri from inhibitory effects of statins, demonstrating that HMGR of N. fowleri is the target of statins. Because of the good safety profile and availability for both adult and pediatric uses, consideration should be given to repurposing the fast-acting pitavastatin for the treatment of PAM.
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Affiliation(s)
- Hye Jee Hahn
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093-0756, United States
| | - Ruben Abagyan
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093-0756, United States
| | - Larissa M. Podust
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093-0756, United States
| | - Shantanu Roy
- Free-Living and Intestinal Amebas (FLIA) Laboratory, Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329-4018, United States
| | - Ibne Karim M. Ali
- Free-Living and Intestinal Amebas (FLIA) Laboratory, Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329-4018, United States
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California 92093-0756, United States
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Escrig JI, Hahn HJ, Debnath A. Activity of Auranofin against Multiple Genotypes of Naegleria fowleri and Its Synergistic Effect with Amphotericin B In Vitro. ACS Chem Neurosci 2020; 11:2464-2471. [PMID: 32392039 DOI: 10.1021/acschemneuro.0c00165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Primary amebic meningoencephalitis, caused by brain infection with a free-living ameba, Naegleria fowleri, leads to extensive inflammation of the brain and death within 3-7 days after symptoms begin. Treatment of primary amebic meningoencephalitis relies on amphotericin B in combination with other drugs, but use of amphotericin B is associated with severe adverse effects. Despite a fatality rate of over 97%, economic incentive to invest in development of antiamebic drugs by the pharmaceutical industry is lacking. Development of safe and rapidly acting drugs remains a critical unmet need to avert future deaths. Since FDA-approved anti-inflammatory and antiarthritic drug auranofin is a known inhibitor of selenoprotein synthesis and thioredoxin reductase and the genome of N. fowleri encodes genes for both selenocysteine biosynthesis and thioredoxin reductases, we tested the effect of auranofin against N. fowleri strains of different genotypes from the USA, Europe, and Australia. Auranofin was equipotent against all tested strains with an EC50 of 1-2 μM. Our growth inhibition study at different time points demonstrated that auranofin is fast-acting, and ∼90% growth inhibition was achieved within 16 h of drug exposure. A short exposure of N. fowleri to auranofin led to the accumulation of intracellular reactive oxygen species. This is consistent with auranofin's role in inhibiting antioxidant pathways. Further, combination of auranofin and amphotericin B led to 95% of growth inhibition with 2-9-fold dose reduction for amphotericin B and 3-20-fold dose reduction for auranofin. Auranofin has the potential to be repurposed for the treatment of primary amebic meningoencephalitis.
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Affiliation(s)
- Jose Ignacio Escrig
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California 92093-0756, United States
| | - Hye Jee Hahn
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California 92093-0756, United States
| | - Anjan Debnath
- Center for Discovery and Innovation in Parasitic Diseases, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California 92093-0756, United States
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16
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Cope JR, Murphy J, Kahler A, Gorbett DG, Ali I, Taylor B, Corbitt L, Roy S, Lee N, Roellig D, Brewer S, Hill VR. Primary Amebic Meningoencephalitis Associated With Rafting on an Artificial Whitewater River: Case Report and Environmental Investigation. Clin Infect Dis 2019; 66:548-553. [PMID: 29401275 DOI: 10.1093/cid/cix810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background 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. 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. Methods We conducted an epidemiologic and environmental investigation to determine the water exposure that led to the death of this patient. Results The 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 approximately 11.5 million gallons of water in the whitewater facility were partially filtered, subjected to ultraviolet 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. Conclusions This 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 created a challenging environment to control the growth of N. fowleri.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Kahler
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ibne Ali
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lisa Corbitt
- Mecklenburg County Health Department, Charlotte, North Carolina
| | - Shantanu Roy
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Lee
- North Carolina Department of Health and Human Services, Raleigh
| | - Dawn Roellig
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Vincent R Hill
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Vareechon C, Tarro T, Polanco C, Anand V, Pannaraj PS, Dien Bard J. Eight-Year-Old Male With Primary Amebic Meningoencephalitis. Open Forum Infect Dis 2019; 6:ofz349. [PMID: 31660390 PMCID: PMC6735792 DOI: 10.1093/ofid/ofz349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022] Open
Abstract
Naegleria fowleri is a thermophilic free-living amoeba that is found in warm, fresh water and causes primary amebic meningoencephalitis (PAM). The following report demonstrates the rapid and destructive clinical features of PAM in an 8-year-old male who presented with severe headaches approximately 12 days after swimming in a hot spring.
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Affiliation(s)
- Chairut Vareechon
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California
| | - Thomas Tarro
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Claudia Polanco
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California
| | - Vikram Anand
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Pia S Pannaraj
- Department of Infectious Disease, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, California.,Keck School of Medicine, University of Southern California, Los Angeles
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18
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Abstract
Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.
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Affiliation(s)
- Minhua Chen
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang, China
| | - Wei Ruan
- Department of Communicable Diseases of Control and Prevention, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou 310000, Zhejiang, China
| | - Lingling Zhang
- Department of Communicable Diseases of Control and Prevention, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou 310000, Zhejiang, China
| | - Bangchuan Hu
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang, China
| | - Xianghong Yang
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang, China
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19
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Matanock A, Mehal JM, Liu L, Blau DM, Cope JR. Estimation of Undiagnosed Naegleria fowleri Primary Amebic Meningoencephalitis, United States 1. Emerg Infect Dis 2018; 24:162-164. [PMID: 29260676 PMCID: PMC5749439 DOI: 10.3201/eid2401.170545] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
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20
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Cope JR, Conrad DA, Cohen N, Cotilla M, DaSilva A, Jackson J, Visvesvara GS. Use of the Novel Therapeutic Agent Miltefosine for the Treatment of Primary Amebic Meningoencephalitis: Report of 1 Fatal and 1 Surviving Case. Clin Infect Dis 2016; 62:774-6. [PMID: 26679626 PMCID: PMC4775347 DOI: 10.1093/cid/civ1021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/07/2015] [Indexed: 11/15/2022] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a fulminant central nervous system infection caused by the thermophilic free-living ameba Naegleria fowleri. Few survivals have been documented and adequate treatment is lacking. We report 2 PAM cases, 1 fatal and 1 surviving, treated with the novel antiparasitic agent miltefosine.
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Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Alexandre DaSilva
- Centers for Disease Control and Prevention, Atlanta, Georgia US Food and Drug Administration, Laurel, Maryland
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21
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Linam WM, Ahmed M, Cope JR, Chu C, Visvesvara GS, da Silva AJ, Qvarnstrom Y, Green J. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics 2015; 135:e744-8. [PMID: 25667249 PMCID: PMC4634363 DOI: 10.1542/peds.2014-2292] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Naegleria fowleri is a thermophilic, free-living ameba that causes primary amebic meningoencephalitis. The infections are nearly always fatal. We present the third well-documented survivor of this infection in North America. The patient's survival most likely resulted from a variety of factors: early identification and treatment, use of a combination of antimicrobial agents (including miltefosine), and management of elevated intracranial pressure based on the principles of traumatic brain injury.
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Affiliation(s)
- W. Matthew Linam
- Pediatric Infectious Diseases Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Mubbasheer Ahmed
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | - Jennifer R. Cope
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Craig Chu
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
| | | | | | - Yvonne Qvarnstrom
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jerril Green
- Pediatric Critical Care Section, Arkansas Children’s Hospital, Little Rock, AR, United States
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22
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Cope JR, Ratard RC, Hill VR, Sokol T, Causey JJ, Yoder JS, Mirani G, Mull B, Mukerjee KA, Narayanan J, Doucet M, Qvarnstrom Y, Poole CN, Akingbola OA, Ritter JM, Xiong Z, da Silva AJ, Roellig D, Van Dyke RB, Stern H, Xiao L, Beach MJ. The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a US treated public drinking water system. Clin Infect Dis 2015; 60:e36-42. [PMID: 25595746 DOI: 10.1093/cid/civ017] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old boy died of meningoencephalitis of unknown etiology in a Louisiana hospital. METHODS Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures. RESULTS Based on testing of cerebrospinal fluid and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri was identified in water samples from both the home and the water distribution system. CONCLUSIONS This case is the first reported PAM death associated with culturable N. fowleri in tap water from a US treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern states, with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures.
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Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raoult C Ratard
- Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge
| | - Vincent R Hill
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Sokol
- Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge
| | | | | | - Gayatri Mirani
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Bonnie Mull
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Meggie Doucet
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Charla N Poole
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Jana M Ritter
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zhenggang Xiong
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Dawn Roellig
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Harlan Stern
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Lihua Xiao
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J Beach
- Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Roy SL, Metzger R, Chen JG, Laham FR, Martin M, Kipper SW, Smith LE, Lyon GM, Haffner J, Ross JE, Rye AK, Johnson W, Bodager D, Friedman M, Walsh DJ, Collins C, Inman B, Davis BJ, Robinson T, Paddock C, Zaki SR, Kuehnert M, DaSilva A, Qvarnstrom Y, Sriram R, Visvesvara GS. Risk for transmission of Naegleria fowleri from solid organ transplantation. Am J Transplant 2014; 14:163-71. [PMID: 24279908 PMCID: PMC4676565 DOI: 10.1111/ajt.12536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/16/2013] [Accepted: 09/30/2013] [Indexed: 01/25/2023]
Abstract
Primary amebic meningoencephalitis (PAM) caused by the free-living ameba (FLA) Naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (CNS) affecting predominantly young, previously healthy persons. No effective chemotherapeutic prophylaxis or treatment has been identified. Recently, three transplant-associated clusters of encephalitis caused by another FLA, Balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-CNS solid organ transplantation from donors with PAM. During 1995-2012, 21 transplant recipients of solid organs donated by five patients with fatal cases of PAM were reported in the United States. None of the recipients developed PAM, and several recipients tested negative for N. fowleri by serology. However, historical PAM case reports and animal experiments with N. fowleri, combined with new postmortem findings from four patients with PAM, suggest that extra-CNS dissemination of N. fowleri can occur and might pose a risk for disease transmission via transplantation. The risks of transplantation with an organ possibly harboring N. fowleri should be carefully weighed for each individual recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. In this article, we present a case series and review existing data to inform such risk assessments.
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Affiliation(s)
- S L Roy
- Centers for Disease Control and Prevention, Atlanta, GA
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24
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Abstract
Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri are mitochondria-bearing, free-living eukaryotic amebae that have been known to cause infections of the central nervous system (CNS) of humans and other animals. Several species of Acanthamoeba belonging to several different genotypes cause an insidious and chronic disease, granulomatous amebic encephalitis (GAE), principally in immunocompromised hosts including persons infected with HIV/AIDS. Acanthamoeba spp., belonging to mostly group 2, also cause infection of the human cornea, Acanthamoeba keratitis. Balamuthia mandrillaris causes GAE in both immunocompromised and immunocompetent hosts mostly in the very young or very old individuals. Both Acanthamoeba spp. and B. mandrillaris also cause a disseminated disease including the lungs, skin, kidneys, and uterus. Naegleria fowleri, on the other hand, causes an acute and fulminating, necrotizing infection of the CNS called primary amebic meningoencephalitis (PAM) in children and young adults with a history of recent exposure to warm fresh water. Additionally, another free-living ameba Sappinia pedata, previously described as S. diploidea, also has caused a single case of amebic meningoencephalitis. In this review the biology of these amebae, clinical manifestations, molecular and immunological diagnosis, and epidemiological features associated with GAE and PAM are discussed.
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Affiliation(s)
- Govinda S Visvesvara
- Division of Foodborne, Waterborne & Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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25
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Abstract
Primary amebic meningoencephalitis (PAM) is a rare and fatal disease of central nervous system (CNS) caused by Naegleria fowleri, an ameba found in soils and warm waters. It enters the CNS after insufflation of infected water by attaching itself to the olfactory nerves. The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics.
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Affiliation(s)
- Parshotam Lal Gautam
- From: Intensivist, Critical Care Division, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shruti Sharma
- From: Intensivist, Critical Care Division, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Puri
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Raj Kumar
- Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rajinder Bansal
- Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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