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Everything You Need to Know About Naegleria fowleri

Naegleria is a type of free-living amoeba that can only be observed under a microscope. It is commonly found in warm freshwater environments such as lakes, rivers, and hot springs, as well as in soil. The specific species of Naegleria that poses a threat to humans is called Naegleria fowleri. This amoeba is also called a brain-eating amoeba.

All About Naegleria fowleri

Here is everything you need to know about Naegleria fowleri:

How Does it Cause Infection?

The infection caused by Naegleria fowleri occurs when water containing the amoeba enters the body through the nose. This typically happens during activities such as swimming, diving, or submerging the head in freshwater bodies like lakes and rivers. Once inside the body, the amoeba travels through the nasal passages and reaches the brain. It destroys brain tissue and results in a severe infection known as primary amebic meningoencephalitis (PAM). Unfortunately, PAM is almost always fatal.

  • In addition to water-related activities, Naegleria fowleri infections can also occur when individuals use contaminated tap water for practices such as nasal cleansing during religious rituals or sinus rinsing.
  • While rare, there have been cases where people have contracted Naegleria infections from poorly maintained or inadequately chlorinated recreational water sources such as swimming pools, splash pads, or surf parks.
  • It’s important to note that there is no evidence to suggest that it can be transmitted through water vapor or aerosol droplets, such as those produced by showers or humidifiers.
  • It is also worth mentioning that consuming contaminated water does not lead to infection with Naegleria.

Where it is Present?

It can be found in warm freshwater environments and soil across the globe. In the United States, the amoeba may be present in any freshwater body, irrespective of the state, especially during the warmer months of July, August, and September. This organism thrives in warm water and is most commonly found in temperatures ranging up to 115°F (46°C). Although it is less likely to be found in water with temperatures below 80°F, the amoeba can still survive in lake or river sediment even at lower temperatures.

A properly cleaned, maintained, and disinfected swimming pool poses no risk of Naegleria infection. However, there have been extremely rare instances where the amoeba was found in swimming pools, splash pads, surf parks, or similar recreational venues that were poorly maintained or lacked sufficient chlorine levels.

Number of Cases of Naegleria fowleri infection:

Naegleria infections are considered rare. From 2013 to 2022, the United States reported an average of zero to five cases per year, totaling 29 cases over that period. These infections predominantly occur in young males, especially those aged 14 years and younger, although the reasons for this are not entirely clear. It is possible that certain activities, such as diving and playing in the sediment at the bottom of lakes and rivers, make young boys more susceptible to infection.

When Does This Infection Mostly Happen?

Infections with Naegleria are most commonly observed during hot temperatures when water temperatures are higher and water levels are lower. The summer months of July, August, and September are particularly associated with these infections.

It is important to note that Naegleria infections cannot be transmitted from one person to another.

Symptoms:

The symptoms of a Naegleria fowleri infection manifest as primary amebic meningoencephalitis (PAM), which involves the destruction of brain tissue. 

Symptoms Include: 

  • Headache
  • Fever
  • Nausea
  • Vomiting
  • Stiff neck
  • Confusion
  • Lack of attention to people and surroundings
  • Seizures
  • Hallucinations
  • Coma

Once symptoms appear, the disease rapidly worsens, and death typically occurs within approximately five days, although it can happen within a range of one to 18 days.

The cause of death resulting from a Naegleria infection is brain tissue destruction, leading to brain swelling and ultimately death.

Fatality Rate:

The fatality rate for infected individuals who exhibit signs and symptoms is over 97%. Out of the 157 known infected individuals, only four have survived.

Treatment:

Given PAM’s rarity and rapid progression, identifying effective treatments has been challenging. Some drugs, including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone, have shown potential efficacy against Naegleria and have been used in combination to treat PAM. Miltefosine, the newest among these drugs, has demonstrated effectiveness in laboratory settings and has been administered to three survivors of Naegleria infection. Ongoing research aims to further understand the best treatment options for this devastating infection.

Reported Case in Lahore:

According to a recent report from a private laboratory, a young patient has been diagnosed with Naegleria infection and was promptly transferred to Services Hospital for isolation and further evaluation. Unfortunately, the patient passed away at the hospital on Tuesday. Additionally, three other cases of Naegleria infection have been reported in Karachi.

How to Prevent Naegleria Infection:

To prevent Naegleria infection, it is important to take certain precautions. Here are some:

  • Avoid swimming, diving, or engaging in water-related activities in warm freshwater bodies such as lakes, rivers, and hot springs, especially during the warmer months.
  • Be cautious about the water quality and ensure that it is treated with appropriate levels of disinfectants, such as chlorine.
  • When participating in water activities in warm freshwater, try to keep your head above water and avoid water going up your nose.
  • If you use tap water for nasal cleansing, make sure to use water that has been properly treated and filtered, or use distilled or sterile water. Avoid using untreated tap water or water from unknown sources.
  • Be mindful of the water temperature, as Naegleria fowleri thrives in warm water. It is more likely to be present in water with temperatures above 80°F (26°C).
  • If you own or manage recreational venues like swimming pools, splash pads, or similar facilities, ensure they are well-maintained, cleaned, and disinfected regularly.

Promote awareness among family, friends, and community members about the importance of prevention.

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