Naegleria fowleri outbreak in Pakistan: unveiling the crisis and path to recovery

Effectiveness of phytoproducts against pathogenic free-living amoebae - A scoping and critical review paving the way toward plant-based pharmaceuticals

Infections caused by free-living amoebae (FLA) have increased worldwide and are expected to worsen. The lack of drugs that are effective (especially against cysts), affordable, and safe to treat these infections exacerbates the concern. Plants present a promising source of bioactive compounds for developing effective drugs; however, the scientific literature on this topic has yet to be adequately synthesized. This work provides a critical scoping review summarizing the amoebicidal performance of plant-derived products and their potential for developing effective drugs to treat FLA infections. Out of 5889 articles retrieved from multiple databases, 119 articles were selected, from which data on 180 plant species belonging to 127 genera and 62 families were extracted. The extracts, essential oils, and compounds from these plants exhibited a diverse range of potency against cysts and trophozoites. Among the compounds studied, periglaucine A, kolavenic acid, and (+)-elatol are promising cysticidal drug candidates due to their high potency, as well as their known low toxicity to non-target cells. Tovophillin A, gartinin, 8-deoxygartinin, garcinone E, 9-hydroxycalabaxanthone, γ-mangostin, and borneol also exhibit high cysticidal potency, but their selectivity profile is unknown. Resveratrol, rosmarinic acid, β-amyrin, and vanillic acid stand out for their high potency against trophozoites and low toxicity to mammalian cells. Another group of compounds with similarly high trophocidal potency includes (-)-epicatechin, (-)-epigallocatechin, apigenin, costunolide, demethoxycurcumin, kaempferol, methyl-β-orcinolcarboxylate, sakuraetin, (+)-elatol, debromolaurinterol, luteolin, (-)-rogiolol, cystomexicone B, epigallocatechin gallate, quercetin, and α-bisabolol. These compounds are priority candidates for further studies on in vivo efficacy, safety, pharmacokinetics, and pharmacodynamics.

Advancing the understanding of Naegleria fowleri: Global epidemiology, phylogenetic analysis, and strategies to combat a deadly pathogen

Naegleria fowleri is a rare but deadly pathogen that has emerged as an important global public health concern. The pathogen induces primary amoebic meningoencephalitis (PAM), a rapidly progressive and almost always fatal life-threatening brain infection. The devastating impact of N. fowleri and the high mortality rate underscores a deeper understanding and the development of innovative strategies to tackle this issue. Despite various studies that have been conducted on N. fowleri, a comprehensive review that integrates recent findings and addresses critical gaps in understanding remains lacking. This review provides a detailed overview of N. fowleri epidemiology, transmission dynamics, phylogenetic diversity, state-of-the-art diagnostic techniques, therapeutic approaches, and preventive measures. We identified 488 PAM cases globally, reported since 1962, with the highest numbers in the US, Pakistan, and Australia. A phylogenetic analysis of 41 N. fowleri ITS-1, 5.8S, ITS-2 region-based sequences showed genotypic diversity, with genotypes II and III being the most prevalent in Asia, North America, and Europe. Effective approaches to preventing N. fowleri transmission include applying free chlorine to water in storage tanks, taking precautions while swimming, and performing ablution with sterilized water (e.g., boiled or distilled) while avoiding deep inhalation of water, especially in regions with high water contamination. This review highlights the global impact of N. fowleri, future surveillance strategies, prompt diagnosis, potential therapeutic options, and vaccine development to prevent PAM outbreaks. It highlights the importance of joint government and public health efforts to combat this deadly pathogen.

Identification of Naegleria fowleri antigens recognized by serum antibodies from people of Mexicali Valley, México

Naegleria fowleri is an amoeba that causes a fatal disease in the central nervous system known as primary amoebic meningoencephalitis (PAM) in humans. Most of the infections are acquired by people who practice recreational activities in water contaminated with trophozoites. Swimming and wading in irrigation channels of Mexicali are common practices for local people. Although there are some warning signposts in the surrounding sites, people continue using these channels for recreational purposes. In that region, cases of PAM have been reported; however, not everyone who comes into contact with contaminated water containing trophozoites becomes infected, and the factors influencing their immune response to N. fowleri remain unknown. We analyzed the levels of antibodies against N. fowleri in two groups: local individuals, including visitors who swam in the Mexicali channels, and a group from Mexico City (CDMX). In both groups, specific antibody responses were analyzed using immunoassays, including Western blot, ELISA, and cytochemistry. The highest levels of both IgG and IgA were found in samples from Mexicali, compared to those from CDMX. In both groups, IgG recognized polypeptide bands from N. fowleri at molecular weights of 100, 50, and 19 kDa, bands that we have already reported as immunogenic. Moreover, the IgG subjects recognized trophozoite structures such as membrane, pseudopodia, food cups, and even small like-vesicles. This antibody immune response directed against these polypeptide bands and trophozoite structures along with other factors could be participating in the defense of these people against PAM.

Cryptic presentation: primary amoebic meningoencephalitis mimicking a high-grade malignancy resulting in surgical fatality within 48 hours. Illustrative case

BACKGROUND

A 71-year-old male presented with weakness of the right upper limb and headache for the past 3 months. Brain magnetic resonance imaging (MRI) with contrast showed a left frontal space-occupying lesion, suggestive of a high-grade malignancy. Awake craniotomy with complete excision of the lesion was performed under immunofluorescence guidance. On postoperative day 2, the patient developed signs of meningoencephalitis and died. The histopathology report showed an abscess with parasitic infection, suggestive of primary amoebic meningoencephalitis (PAM), an infection caused by Naegleria fowleri.

OBSERVATIONS

The patient presented with the above symptoms. Intraoperatively, the lesion exhibited fluorescence uptake and had a firm consistency. The patient did not exhibit any new neurological deficits during surgery, but on postoperative day 2, signs of meningitis emerged, and his condition deteriorated, ultimately leading to his death.

LESSONS

PAM typically manifests with nonspecific symptoms of meningitis, progressing to a rapidly developing, severe form of meningitis that has a high mortality rate. The patient displayed obscure symptoms, and brain MRI revealed a space-occupying lesion with fluorescence uptake during surgery, suggestive of a high-grade malignancy. The diagnosis of PAM as a high-grade malignant space-occupying lesion was confirmed postmortem through histopathological analysis, a presentation considered exceedingly rare and unprecedented in the literature. https://thejns.org/doi/10.3171/CASE24358.

Transcriptomic profiling of "brain-eating amoeba" Naegleria fowleri infection in mice: the host and the protozoa perspectives

The free-living amoeba Naegleria fowleri (NF) causes a rare but lethal parasitic meningoencephalitis (PAM) in humans. Currently, this disease lacks effective treatments and the specific molecular mechanisms that govern NF pathogenesis and host brain response remain unknown. To address some of these issues, we sought to explore naturally existing virulence diversity within environmental NF isolates. Herein, we purified two new NF environmental isolates (NF45 and NF1) and tested their in vivo virulence using experimental infection in mice. We found that NF45 was highly virulent (NF45_HV) compared with NF1 (low virulence, NF1_LV), based on in vivo amoeba growth kinetics and mouse survival. To identify underlying differences, we conducted RNA-seq and bioinformatics analyses from the infected mouse brains. Our results showed that NF1_LV and NF45_HV modulated the expression of their genes during mouse brain infection. Differentially expressed genes (DEGs) in NF1_LV were mostly involved in Translational protein, Protein-binding activity modulator, Protein modifying enzyme, while DEGs in NF45_HV were related to DNA metabolism, Cytoskeletal protein, Protein-binding activity modulator. Proteases (namely the virulence factor Cathepsin B) were upregulated in NF1_LV, while downregulated in NF45_HV. When analyzing the host response against infection by these two NF strains, enrichment analyses uncovered genes and mechanisms related to the host immune responses and nervous systems. We detected more DEGs in NF1_LV infected mice compared to NF45_HV, related to blood brain barrier leakage, immune cell recruitment, cytokine production (including IL-6, IFN-Ɣ and TNFα), inflammation of astrocytes and microglia, and oligodendrocyte and neurons degeneration. Increased expression of neuromotor-related genes such as Adam22, Cacnb4 and Zic1 (activated by NF1_LV infection) and ChAt (activated by NF45_LV infection) could explain PAM symptoms such as muscle weakness and seizures. Globally, our results showed that NF isolated from the environment can have different levels of virulence and differentially modulate their gene expression during brain infection. We also provided, for the first time, a comprehensive information for the molecular mechanisms of neuro-immune and host-pathogen interactions during PAM disease. As the host and the protozoa are strongly implicated in PAM lethality, new therapies targeting both the parasite, and the host should be considered to treat PAM infection.

Food Webs and Feedbacks: The Untold Ecological Relevance of Antimicrobial Resistance as Seen in Harmful Algal Blooms

Antimicrobial resistance (AMR) has long been framed as an epidemiological and public health concern. Its impacts on the environment are unclear. Yet, the basis for AMR is altered cell physiology. Just as this affects how microbes interact with antimicrobials, it can also affect how they interact with their own species, other species, and their non-living environment. Moreover, if the microbes are globally notorious for causing landscape-level environmental issues, then these effects could alter biodiversity and ecosystem function on a grand scale. To investigate these possibilities, we compiled peer-reviewed literature from the past 20 years regarding AMR in toxic freshwater cyanobacterial harmful algal blooms (HABs). We examined it for evidence of AMR affecting HAB frequency, severity, or persistence. Although no study within our scope was explicitly designed to address the question, multiple studies reported AMR-associated changes in HAB-forming cyanobacteria (and co-occurring microbes) that pertained directly to HAB timing, toxicity, and phase, as well as to the dynamics of HAB-afflicted aquatic food webs. These findings highlight the potential for AMR to have far-reaching environmental impacts (including the loss of biodiversity and ecosystem function) and bring into focus the importance of confronting complex interrelated issues such as AMR and HABs in concert, with interdisciplinary tools and perspectives.

Analysis of virulence factors in extracellular vesicles secreted by Naegleria fowleri

Naegleria fowleri is the etiological agent of primary amebic meningoencephalitis (PAM), a rapidly progressive acute and fulminant infection that affects the central nervous system, particularly of children and young adults, which has a mortality rate greater than 95%, and its symptomatologic similarity with other meningitis caused by virus or bacteria makes it difficult to make a quick and timely diagnosis that prevents the progression of the infection. It is necessary to know the antigenic determinants as well as the pathogenicity mechanisms of this amoeba to implement strategies that allow for better antiamoebic therapeutic and diagnostic targets that directly impact the health sector. Therefore, the aim of this work was to analyze some virulence factors as part of extracellular vesicle (EV) cargo secreted by N. fowleri. The EV secretion to the extracellular medium was evaluated in trophozoites fixed and incubated with anti-N. fowleri antibody while molecular identification of EV cargo was performed by SDS-PAGE, Western blot, and RT-PCR. Our results showed that N. fowleri secretes a wide variety of vesicle sizes ranging from 0.2 to > 2 μm, and these EVs were recognized by antibodies anti-Naegleropore B, anti-19 kDa polypeptide band, anti-membrane protein Mp2CL5, anti-protease cathepsin B, and anti-actin. Furthermore, these vesicles were localized in the trophozoites cytoplasm or secreted into the extracellular medium. Specifically in relation to small vesicles, our purified exosomes were recognized by CD63 and Hsp70 markers, along with the previously mentioned proteins. RT-PCR analysis was made through the isolation of EVs from N. fowleri trophozoite culture by concentration, filtration, and ultracentrifugation. Interestingly, we obtained PCR products for Nfa1, NPB, Mp2CL5, and CatB genes as part of exosomes cargo. This suggests that the molecules identified in this work could play an important role in communication as well as in infectious processes caused by this amoeba. Therefore, the study and characterization of the pathogenicity mechanisms, as well as the virulence factors released by N. fowleri remains a key point to provide valuable information for the development of therapeutic treatments, vaccine design, or biomarkers for a timely diagnosis against infections caused by protozoa.

Exploring the extrachromosomal plasmid rDNA of Naegleria fowleri AY27 genotype II: A human brain-eating amoeba via high-throughput sequencing

Naegleria fowleri, also known as brain-earing amoeba, causes severe and rapidly fatal CNS infection in humans called primary amebic meningoencephalitis (PAM). The DNA from the N. fowleri clinical isolate was sequenced for circular extrachromosomal ribosomal DNA (CERE - rDNA). The CERE contains 18 S, 5.8 S, and 28 S ribosomal subunits separated by internal transcribed spacers, 5 open reading frames (ORFs), and mostly repeat elements comprising 7268 bp out of 15,786 bp (46%). A wide variety of variations and recombination events were observed. Finally, the ORFs that comprised only 4 hypothetical proteins were modeled and screened against Zinc drug-like compounds. Two compounds [ZINC77564275 (ethyl 2-(((4-isopropyl-4 H-1,2,4-triazol-3-yl) methyl) (methyl)amino) oxazole-4-carboxylate) and ZINC15022129 (5-(2-methoxyphenoxy)-[2,2'-bipyrimidine]-4,6(1 H,5 H)-dione)] were finalized as potential druggable compounds based on ADME toxicity analysis. We propose that the compounds showing the least toxicity would be potential drug candidates after laboratory experimental validation is performed.

Noninvasive diagnostic biomarkers, genomic profiling, and advanced microscopic imaging in the early detection and characterization of Naegleria fowleri infections leading to primary amebic meningoencephalitis (PAM)

This review delves into the strategies for early detection and characterization of Naegleria fowleri infections leading to primary amoebic meningoencephalitis (PAM). The study provides an in-depth analysis of current diagnostic approaches, including cerebrospinal fluid analysis, brain tissue examination, immunostaining techniques, and culture methods, elucidating their strengths and limitations. It explores the geographical distribution of N. fowleri, with a focus on regions near the equator, and environmental factors contributing to its prevalence. The review emphasizes the crucial role of early detection in PAM management, discussing the benefits of timely identification in treatment, personalized care, and prevention strategies. Genomic profiling techniques, such as conventional PCR, nested PCR, multiplex PCR, and real-time PCR, are thoroughly examined as essential tools for accurate and prompt diagnosis. Additionally, the study explores advanced microscopic imaging techniques to characterize N. fowleri's morphology and behavior at different infection stages, enhancing our understanding of its life cycle and pathogenic mechanisms. In conclusion, this review underscores the potential of these strategies to improve our ability to detect, understand, and combat N. fowleri infections, ultimately leading to better patient outcomes and enhanced public health protection.