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Ahmad Zamzuri M‘AI, Abd Majid FN, Mihat M, Ibrahim SS, Ismail M, Abd Aziz S, Mohamed Z, Rejali L, Yahaya H, Abdullah Z, Hassan MR, Dapari R, Mohd Isa AM. Systematic Review of Brain-Eating Amoeba: A Decade Update. Int J Environ Res Public Health 2023; 20:3021. [PMID: 36833715 PMCID: PMC9964342 DOI: 10.3390/ijerph20043021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Primary amoebic meningoencephalitis (PAM) is a rare but lethal infection of the brain caused by a eukaryote called Naegleria fowleri (N. fowleri). The aim of this review is to consolidate the recently published case reports of N. fowleri infection by describing its epidemiology and clinical features with the goal of ultimately disseminating this information to healthcare personnel. METHODS A comprehensive literature search was carried out using PubMed, Web of Science, Scopus, and OVID databases until 31 December 2022 by two independent reviewers. All studies from the year 2013 were extracted, and quality assessments were carried out meticulously prior to their inclusion in the final analysis. RESULTS A total of 21 studies were selected for qualitative analyses out of the 461 studies extracted. The cases were distributed globally, and 72.7% of the cases succumbed to mortality. The youngest case was an 11-day-old boy, while the eldest was a 75-year-old. Significant exposure to freshwater either from recreational activities or from a habit of irrigating the nostrils preceded onset. The symptoms at early presentation included fever, headache, and vomiting, while late sequalae showed neurological manifestation. An accurate diagnosis remains a challenge, as the symptoms mimic bacterial meningitis. Confirmatory tests include the direct visualisation of the amoeba or the use of the polymerase chain reaction method. CONCLUSIONS N. fowleri infection is rare but leads to PAM. Its occurrence is worldwide with a significant risk of fatality. The suggested probable case definition based on the findings is the acute onset of fever, headache, and vomiting with meningeal symptoms following exposure to freshwater within the previous 14 days. Continuous health promotion and health education activities for the public can help to improve knowledge and awareness prior to engagement in freshwater activities.
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Affiliation(s)
| | - Farah Nabila Abd Majid
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
| | - Massitah Mihat
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Siti Salwa Ibrahim
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Muhammad Ismail
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Suriyati Abd Aziz
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Zuraida Mohamed
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Lokman Rejali
- Negeri Sembilan State Health Department, Jalan Rasah, Seremban 70300, Malaysia
| | - Hazlina Yahaya
- Public Health Division, Ministry of Health Malaysia, Putrajaya 62000, Malaysia
| | - Zulhizzam Abdullah
- Public Health Division, Ministry of Health Malaysia, Putrajaya 62000, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Rahmat Dapari
- Department of Community Health, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Abd Majid Mohd Isa
- Faculty of Education and Liberal Arts, INTI International University, Persiaran Perdana BBN Putra Nilai, Nilai 71800, Malaysia
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Chen S, Che C, Lin W, Chen B, Huang X, Liu C, Huang H. Case Report: Recognition of Devastating Primary Amoebic Meningoencephalitis (PAM) Caused by Naegleria fowleri: Another Case in South China Detected via Metagenomics Next-Generation Sequencing Combined With Microscopy and a Review. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.899700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionPrimary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri is seldom reported in mainland China.MethodsOne case from South China was presented, and the clinical features of the PAM, especially the early CT features, were compared to those in the literatures from PubMed/Web of Science/China National Knowledge internet (CNKI).Case Presentation and ResultsA 47-year-old man with a high fever came to the fever clinic. Twelve hours later, the man lost consciousness and exhibited generalized tonic-clonic seizures and needed ventilator-controlled ventilation. Then, he was admitted to the neurology intensive care unit (NICU). The opening pressure of his cerebrospinal fluid (CSF) was over 500 mm H2O with highly increased leukocyte/protein levels and very low glucose levels. Three days after admission, high copy numbers of Naegleria fowleri amoebae were detected by metagenomics next-generation sequencing (mNGS) and cysts were visible with wet mount microscopy. Four days after admission, the patient experienced brain death. However, the relatives of the patient did not want to give up, and he received amphotericin B (AmB). During hospitalization, he suffered from severe damage to the liver and kidneys and electrolyte disorders that required continuous renal replacement therapy (CRRT).ReviewAll 20 included PAM patients suffered from fever. Seventeen of them had headache and neck stiffness. Ten of them showed generalized brain edema. To date, 7 cases of PAM have been reported in China. Only one patient survived. Most of the patients showed generalized brain edema. Only the surviving patient showed focal edema. He died three months later.ConclusionRapidly progressive meningoencephalitis in which the CSF results are similar to those suffered from a bacterial infection should be considered a possible case of PAM. It can be rapidly detected with microscopy in CSF wet mounts but needs further molecular investigation for confirmation, and mNGS should be a new method used for rapid and precise identification. Moreover, CRRT may prolong the survival time of PAM patients with multiple organ failure.
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Bellini NK, Santos TM, da Silva MTA, Thiemann OH. The therapeutic strategies against Naegleria fowleri. Exp Parasitol 2018; 187:1-11. [DOI: 10.1016/j.exppara.2018.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 12/13/2022]
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Ghanchi NK, Jamil B, Khan E, Ansar Z, Samreen A, Zafar A, Hasan Z. Case Series of Naegleria fowleri Primary Ameobic Meningoencephalitis from Karachi, Pakistan. Am J Trop Med Hyg 2017; 97:1600-1602. [PMID: 29016297 DOI: 10.4269/ajtmh.17-0110] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Naegleria fowleri causes primary amoebic meningoencephalitis (PAM) which is almost always fatal. Naegleria fowleri is waterborne, and its infections are usually associated with aquatic activities but it can also be transmitted via the domestic water supply. An increasing number of N. fowleri cases have been reported from Pakistan. Improved methods for diagnosis are required. We report the utility of polymerase chain reaction (PCR) for the diagnosis of N. fowleri in patients suspected of PAM. One hundred and sixteen cases suspected of having PAM were examined. Cerebrospinal fluid (CSF) specimens were tested at the Aga Khan University Hospital, Karachi. Nineteen CSF specimens were positive for N. fowleri using PCR. Naegleria fowleri positive patients had a median age of 28 years and were 84% male and 16% female. Overall, CSF wet preparation microscopy was performed in 85 (73%) cases and identified that seven specimens were positive for motile trophozoites. The CSF wet preparation results were available for 15 of the 19 N. fowleri PCR positive CSF samples; seven (40%) wet preparations were positive. Our data highlight the threat of N. fowleri infection as a cause of PAM. It also emphasizes the utility of the PCR-based diagnosis of the amoeba for early diagnosis and management of the disease.
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Affiliation(s)
- Najia K Ghanchi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Erum Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zeeshan Ansar
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Azra Samreen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zahra Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Chomba M, Mucheleng'anga LA, Fwoloshi S, Ngulube J, Mutengo MM. A case report: primary amoebic meningoencephalitis in a young Zambian adult. BMC Infect Dis 2017; 17:532. [PMID: 28764655 PMCID: PMC5540533 DOI: 10.1186/s12879-017-2638-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background Primary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri. Although the disease is rare, the case fatality rate is very high. In this report, we describe the first case of PAM in Zambia. Case presentation The patient presented with sudden onset of seizures and fever on admission. On physical examination he was febrile, comatose and with a stiff neck. Cerebral spinal fluid (CSF) collected on admission did not reveal any organism on microscopy or culture but showed elevated white cell count. A working diagnosis of severe septicemia with acute meningoencephalitis was then made and the patient was started on IV Cephtriaxone (2 g) twice daily. Despite receiving treatment, his condition deteriorated. A second CSF sample collected on day 3 was also negative for bacteria and other organisms. However, a repeat CSF sample collected on day 8 revealed numerous motile organisms that were identified as Naegleria on microscopy and confirmed to be N. fowleri on polymerase chain reaction. The patient died on day 8 of hospital admission after having received one dose of Amphotericin B (50 mg). Features consistent with PAM were detected on autopsy. Conclusion The isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2638-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Luchenga A Mucheleng'anga
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Joseph Ngulube
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia
| | - Mable M Mutengo
- Department of Pathology and Microbiology, University Teaching Hospital and University of Zambia- School of Medicine, Lusaka, Zambia.
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Stowe RC, Pehlivan D, Friederich KE, Lopez MA, DiCarlo SM, Boerwinkle VL. Primary Amebic Meningoencephalitis in Children: A Report of Two Fatal Cases and Review of the Literature. Pediatr Neurol 2017; 70:75-79. [PMID: 28389055 DOI: 10.1016/j.pediatrneurol.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary amebic meningoencephalitis is a rare, almost uniformly fatal disease of cerebral invasion by Naegleria fowleri, occurring most commonly after swimming in warm fresh water in summer months. Treatment using the experimental medication miltefosine demonstrated improved survival and favorable neurocognitive outcome in a 2013 North American patient. There is little information about the electroencephalographic findings of such patients, and our understanding of factors predicting survival is limited. METHODS AND RESULTS We describe two children, aged four and 14 years, who both presented with seizures and altered mental status after recent fresh water swimming exposures. With evidence of pyogenic meningitis and examination of cerebrospinal fluid demonstrating motile trophozoites on wet mount, N. fowleri meningoencephalitis was diagnosed. Amebicidal antibiotic regimens with miltefosine were administered. Continuous electroencephalography monitoring demonstrated evolution from diffuse slowing to seizures, status epilepticus, and eventually global attenuation and absence of activity. Both patients ultimately died after complications of progressive increasing intracranial pressure and hemodynamic compromise. CONCLUSIONS Primary amebic meningoencephalitis is a serious, sporadic infection. We describe two fatal pediatric patients, the evolution of their electroencephalography findings, and compare their findings with the 13 reported pediatric survivors.
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Affiliation(s)
- Robert C Stowe
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.
| | - Davut Pehlivan
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Katie E Friederich
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Michael A Lopez
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Shannon M DiCarlo
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
| | - Varina L Boerwinkle
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
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