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Primary Amoebic Meningoencephalitis: Causes, Symptoms, Diagnosis, Treatment And Prevention

Lily Avant, a 10-year-old girl from Texas, was diagnosed with a rare brain-eating illness called 'primary amoebic meningoencephalitis' or PAM. The illness was caused after Lily was infected with the amoeba while swimming in the Brazos River in Texas in the US. Initially, she got a few symptoms like fever and headache but later, she became unresponsive and was rushed to the hospital. According to the reports, Lily died this week due to this deadly infection.

According to the CDC report, around 147 cases of Naegleria fowleri have been recorded in the US for the past 57 years and among them, only four people have survived so far. In India, the latest Naegleria fowleri infection was reported this year in Kerala in May and it had caused the death of a 10-year-old child. The mortality rate of PAM is 97% and higher and often people die within 5 days of the spread of the infection, if not given early treatment.

But the question that comes in everybody' mind is what exactly is PAM and how it affects an individual. Let's take a look.

What Is Primary Amoebic Meningoencephalitis?

Primary Amoebic Meningoencephalitis is a rare and fatal brain infection caused by a brain-eating amoeba, commonly known as Naegleria fowleri [1] . This free-living amoeba resides in freshwater lakes, soil, minimal chlorinated swimming pool, hot springs, and other warm river bodies. The PAM occurs when the amoeba present in the contaminated water enters the body through the nose of a person who swims or dives in the water. The amoeba then travels to the brain via nostrils and starts destructing the brain tissues causing inflammation [2] . PAM was first diagnosed in the year 1960.

According to medical experts, it is confusing to find out why some people get the disease why others remain healthy after swimming in the same pool. Also, the infection does not get spread just by swallowing the contaminated water as it is caused when the amoeba accidentally reaches the brain instead of the stomach. Naegleria fowleri infection is non-contagious and the amoeba is not found in the saltwater.

Causes Of Primary Amoebic Meningoencephalitis

Naegleria fowleri amoeba grows best in warm temperature (40°C) and resides in the sediment of the warm water bodies. When people go for recreational activities like diving or swimming in these water bodies, they disrupt the sediment due to which the amoeba gets stirred into the water.

During diving or swimming, water gets into the body and in the process, the amoeba also gets inside the body. In most cases, the amoeba does not enter the brain but in some cases, the water gets into the nose due to which the microorganism migrate to the brain through the olfactory nerve (located within the nasal cavity) and cause PAM [2] .

When the amoeba reaches the brain, it attacks the brain cells to use them as a food source by extracting nutrients present in them. When this happens, the immune system fights against the pathogen and in the process, inflammation occurs [3] . The inflammation affects the nerve connection of the spinal cord and other body parts causing fatal circumstances like respiratory failure.

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Necrotizing Fasciitis: Causes, Symptoms, Diagnosis, Treatment And Prevention

Symptoms Of Primary Amoebic Meningoencephalitis

The symptoms of PAM can occur within the 3-7 days after the infection. The symptoms are as follows [4] :

  • Fever
  • Vomiting
  • Nausea
  • Severe headache
  • Seizures
  • Hallucinations [5]
  • Drowsiness
  • Confusion
  • Stiffness in the neck region [6]
  • Loss of balance
  • Coma

Risk Factors Of Primary Amoebic Meningoencephalitis

The risk factors of PAM include the following:

  • Freshwater diving or swimming [1]
  • Unchlorinated swimming pools
  • Children younger than 13 [7]
  • Heatwaves
  • Organ transplant [8]

Diagnosis Of Primary Amoebic Meningoencephalitis

Infection caused by Naegleria fowleri is often mistaken to be bacterial or viral meningitis. The condition is difficult to diagnose due to its non-specific early symptoms. To diagnose the condition, the doctor uses the following tests:

  • Direct visualization: In the method, CSF (cerebrospinal fluid) is collected from the patient's body and examined under the microscope to identify the amoeba.
  • Antigen detection: This is a rapid process in which antibodies are used to detect the presence of antigens in the tissues [9] .
  • Polymerase chain reaction test: A test in which a specific molecular tool is used to amplify DNA of the amoeba to identify them easily [10] .

Other tests include CT scan and MRI to detect the swelling in the brain.

Treatment Of Primary Amoebic Meningoencephalitis

As mentioned before, diagnosing PAM is very hard and that's why many people die when the treatment gets delayed. The best way to treat PAM is early diagnosis and treatment. When PAM is detected, an antifungal drug like amphotericin B is injected intravenously or around the spinal cord to stop the spread of the infection by killing the amoeba.

Another method for emergency treatment includes using an investigational drug to manage the inflammation of the brain parts.

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Prevention Of Primary Amoebic Meningoencephalitis

Preventive measures for PAM include the following:

  • Avoid scraping the sediment present below the warm water bodies while swimming or diving [1] .
  • While jumping in water bodies, use a nose clip to prevent the entry of water in the nostrils.
  • Don't dive into the swimming pools which are not chlorinated for days.
  • Avoid diving in stagnant water bodies.
  • Let your shower or taps run for a few minutes till the warm water passes off.
  • Prefer swimming in seawater [11] or cold water.
View Article References
  1. [1] Chomba, M., Mucheleng'anga, L. A., Fwoloshi, S., Ngulube, J., & Mutengo, M. M. (2017). A case report: primary amoebic meningoencephalitis in a young Zambian adult. BMC infectious diseases, 17(1), 532. doi:10.1186/s12879-017-2638-8
  2. [2] Wang, Q., Li, J., Ji, J., Yang, L., Chen, L., Zhou, R., … Liu, Y. (2018). A case of Naegleria fowleri related primary amoebic meningoencephalitis in China diagnosed by next-generation sequencing. BMC infectious diseases, 18(1), 349. doi:10.1186/s12879-018-3261-z
  3. [3] Cervantes-Sandoval, I., de Jesús Serrano-Luna, J., García-Latorre, E., Tsutsumi, V., & Shibayama, M. (2008). Characterization of brain inflammation during primary amoebic meningoencephalitis. Parasitology international, 57(3), 307-313.
  4. [4] Cope, J. R., & Ali, I. K. (2016). Primary Amebic Meningoencephalitis: What Have We Learned in the Last 5 Years?. Current infectious disease reports, 18(10), 31. doi:10.1007/s11908-016-0539-4
  5. [5] Gompf, S. G., & Garcia, C. (2019). Lethal encounters: The evolving spectrum of amoebic meningoencephalitis. IDCases, 15, e00524. doi:10.1016/j.idcr.2019.e00524
  6. [6] Tuppeny, M. (2011). Primary amoebic meningoencephalitis with subsequent organ procurement: a case study. Journal of Neuroscience Nursing, 43(5), 274-279.
  7. [7] Stowe, R. C., Pehlivan, D., Friederich, K. E., Lopez, M. A., DiCarlo, S. M., & Boerwinkle, V. L. (2017). Primary amebic meningoencephalitis in children: a report of two fatal cases and review of the literature. Pediatric neurology, 70, 75-79.
  8. [8] Roy, S. L., Metzger, R., Chen, J. G., Laham, F. R., Martin, M., Kipper, S. W., ... & Rye, A. K. (2014). Risk for transmission of Naegleria fowleri from solid organ transplantation. American Journal of Transplantation, 14(1), 163-171.
  9. [9] Movahedi, Z., Shokrollahi, M. R., Aghaali, M., & Heydari, H. (2012). Primary amoebic meningoencephalitis in an Iranian infant. Case reports in medicine, 2012, 782854. doi:10.1155/2012/782854
  10. [10] Kang, H., Seong, G. S., Sohn, H. J., Kim, J. H., Lee, S. E., Park, M. Y., ... & Shin, H. J. (2015). Effective PCR-based detection of Naegleria fowleri from cultured sample and PAM-developed mouse. European journal of protistology, 51(5), 401-408.
  11. [11] Pervin, N., & Sundareshan, V. (2018). Naegleria. In StatPearls [Internet]. StatPearls Publishing.
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