Primary amoebic meningoencephalitis: All you need to know about rare infection caused by Naegleria fowleri, a brain-eating amoeba

On Saturday, 4 July 2020, Florida’s Department of Health shared a statement on Twitter, stating that they have found a case of Naegleria fowleri infection in their city and have warned people to stay away from the warm freshwater and hot springs. Naegleria fowleri is a microscopic, single-cell amoeba which is found in freshwater, lakes and hot springs during the summer season and prefers temperatures between 25-40 degrees Celsius. It usually enters through the nose and then travels up to the brain to cause very rare but extremely fatal brain infection, primary amebic meningoencephalitis (PAM).

According to an article published in the Indian Journal of Medical Microbiology in the year 2013, only 440 cases of PAM have been reported worldwide, mostly in the United States, Australia and Europe and only 9 of those cases have been diagnosed in India.  

How does this amoeba affect the brain? This amoeba enters the body through the nose during water activities such as underwater diving, swimming or other water sports. When the amoeba enters the nasal mucosa, it attaches itself to the olfactory nerve (the nerve that helps us smell) and travels to the brain leading to PAM. In this infection, the amoeba causes inflammation and destruction of the brain and its outer layers called the meninges. What are the signs and symptoms of PAM? Usually, the symptoms of PAM start appearing 1 to 9 days (median 5 days) after getting exposed to Naegleria-containing water. If the person is not treated, they are likely to die within 1 to 18 days after the symptoms start appearing. There are two stages of PAM and the symptoms appear accordingly. In the early stages, symptoms like severe headache (in the front side of the head), fever, nausea and vomiting appear. If the person remains undiagnosed, the symptoms of the disease can worsen and signs like stiff neck, seizures, altered state of mind and hallucinations can be noted. Eventually, the person slips into the state of coma. What can be done to prevent this deadly infection? It is very difficult to treat a person with PAM as the infection spreads to not only the brain but also the fluid in the brain and spinal cord, called the cerebrospinal fluid. Even if the infected person manages to survive, they are likely to suffer permanent brain damage. Following things are needed to be done in the areas suspected with Naegleria fowleri:

• Do not dive or swim in the warm freshwater bodies and thermal pools until the officials announce it infection-free 
• Empty and clean all the small pools around you 
• Make sure that the water in the swimming pools and spas are adequately chlorinated
• The sprinklers and hoses should be flushed with stagnant water before being used.
• People who practice Neti (nasal irrigation) should boil and cool down the water first and then use it for irrigation.

For more information, read our article on Encephalitis. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health.