Tuesday, July 17, 2012

Naegleria fowleri: Think before you leap



By Jeannie A. DeVane

Think before you leap into warm fresh water this summer! Lakes, rivers, hot springs and even soil can contain an ameba, which is a single celled organism. This organism is called Naegleria fowleri that infects humans. Naegleria fowleri is considered to be a thermophilic, meaning that it is warmth loving and occurs in the environment naturally and is worldwide.

Naegleria fowleri has three stages: The three stages of Naegleria fowleri consists of cysts, trophozoites, and flagellated forms in its life cycle.

Infection of Naegleria fowleri: Infection occurs when Naegleria fowleri enters the body through the nose and travels to the brain destroying brain tissue. The trophozoite stage is where the nasal mucosa is penetrated and migration to the brain occurs. Naegleria fowleri can cause a brain infection, and is almost always fatal. This usually occurs when someone goes swimming or diving, water gets sucked up the nose giving the ameba an advantage to make its way to the brain. Drinking contaminated water cannot lead to this infection and the infection does not spread through person to person contact. These infections are rare, but they do happen and as the environment warms up, lakes and rivers tend to warm causing this to be a problem due to the hot temperature air and low water levels.

Symptoms of Naegleria fowleri: Naegleria fowleri infection causes a fatal acute central nervous system disease known as PAM (primary amebic meningoencephalitis). PAM results in inflammation of the brain, inflammation of the lining of the brain, and inflammation of the spinal cord leading to destruction of brain tissue in the human body. Symptoms of Naegleria fowleri: Initial symptoms start one to seven days after infection including fever, headache, stiff neck, and nausea and vomiting. Later symptoms include loss of appetite, lack of attention to people and surroundings, loss of balance and bodily control, hallucinations, seizures, and coma. Death can result within 1 to 12 days and depends on the rate of the infection. 

Treatment of Naegleria fowleri: The treatment of Naegleria fowleri is still unclear for this infection. Laboratory drugs have been used to attempt to treat Naegleria fowleri, but their effectiveness is unknown due to the fact almost all infections tend to be fatal against Naegleria fowleri even when the patient is being treated. 

Diagnosis of Naegleria fowleri: Naegleria fowleri is diagnosed through the use of identifying the organisms, nucleic acid, and antigens in CSF, biopsy, and tissue specimens. Cysts are not seen in brain tissue.

Naegleria fowleri infection prevention: Avoid diving or jumping into freshwater when water temperatures are hot and the water levels are low. When diving or jumping into freshwater hold your nose closed. Use a nose plug or clip to prevent water from being forced up into the nasal passages. While you are swimming try to hold your head up above the water. Try not to dig or stir up the sediment while swimming in shallow freshwater.

References

1. Virginia Department of Health (VDH). Naegleria fowleri. Updated 08/18/2011 http://www.vdh.state.va.us/epidemiology/DEE/factsheets/pdf/Naegleria%20fowleri%20fact%20sheet.pdf

2. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/parasites/naegleria/biology.html

3. Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F, Ali F, Visvesvara GS, Zafar A. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011 Feb;17(2):258-61.

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