Naegleria –  An emerging challenge!
Infectious diseases

Naegleria – An emerging challenge!

Nov 16, 2023

What is Naegleria?

Naegleria infection, also known as primary amebic meningoencephalitis (PAM), is a rare but serious brain infection caused by the Naegleria fowleri amoeba. The amoeba is commonly found in warm freshwater environments such as lakes, hot springs, and poorly maintained swimming pools. 

Here are the main causes and risk factors associated with Naegleria infection:

Risk factors

  1. Water exposure: The primary mode of transmission is through water exposure. The amoeba enters the body through the nose when contaminated water is forcefully inhaled or when diving, jumping, or engaging in water activities that allow water to enter the nasal passages.
  2. Warm freshwater environments: Naegleria fowleri thrives in warm freshwater environments, particularly during the summer months when water temperatures are elevated. Lakes, hot springs, and poorly chlorinated or untreated swimming pools are potential sources of infection.
  3. Inhalation of contaminated water: The amoeba can be present in droplets of water, such as those generated by activities like water skiing, wakeboarding, or using water slides, where water forcefully enters the nasal passages.
  4. Poor water quality: Inadequate chlorination or disinfection of swimming pools, hot tubs, or other water systems can contribute to the growth and survival of Naegleria fowleri. Swimming in untreated or poorly maintained water increases the risk of infection.
  5. Nasal exposure: The amoeba typically infects individuals through the nasal passages. Factors that increase the likelihood of infection include nasal irrigation or rinsing with contaminated water, using contaminated neti pots, or using untreated water for sinus irrigation.
  6. Rare cases of contamination: Although extremely rare, Naegleria fowleri infections have also been associated with contaminated tap water, particularly in cases where the water supply is untreated or inadequately treated.

It’s important to note that Naegleria fowleri infections are rare, and the majority of people who are exposed to the amoeba do not develop an infection. Taking preventive measures, such as avoiding warm freshwater environments, using proper nose protection (e.g., nose clips) during water activities, and ensuring the proper maintenance and chlorination of swimming pools, can help reduce the risk of infection.

What preventive measures should I take during Neigleria

To reduce the risk of Naegleria infection, you can take the following preventive measures:

  1. Avoid warm freshwater environments: The Naegleria fowleri amoeba thrives in warm freshwater environments such as lakes, hot springs, and poorly maintained swimming pools. Avoid swimming or engaging in water activities in these environments, especially during the summer months when water temperatures are elevated.
  2. Use nose protection: When participating in water activities in freshwater environments, consider using nose protection such as nose clips or nose plugs. This can help prevent the entry of contaminated water through the nasal passages.
  3. Use properly maintained swimming pools: If you choose to swim in a pool, ensure that it is properly maintained and chlorinated. Chlorination kills the amoeba, reducing the risk of infection. Follow recommended guidelines for pool maintenance and water disinfection.
  4. Do not submerge your head underwater: To further minimize the risk of Naegleria infection, avoid activities that involve submerging your head underwater in warm freshwater sources, such as diving or jumping into lakes or hot springs.
  5. Avoid using untreated water for nasal irrigation: If you use nasal irrigation for sinus rinsing, make sure to use sterile saline solution or water that has been properly treated, such as distilled or previously boiled water. Avoid using untreated water from sources like lakes, rivers, or wells for nasal irrigation.
  6. Be cautious with tap water: While Naegleria infections from tap water are extremely rare, if you live in an area with known issues regarding water quality or your water supply is untreated or inadequately treated, you may want to take precautions such as using a point-of-use water filter or boiling tap water before using it for activities that involve nasal exposure.

It’s important to remember that Naegleria infections are very rare, and most people do not encounter any issues. By following these preventive measures, you can further reduce the already low risk of infection.

What is the treatment of Naegleria?

The treatment of Naegleria infection, also known as primary amebic meningoencephalitis (PAM), is challenging due to the rarity of the condition and its rapid progression.

The following treatment approaches may be used, although their effectiveness is limited:

  1. Anti-amebic medications: Drugs such as amphotericin B and miltefosine are commonly used to treat Naegleria infection. These medications have some activity against the amoeba and are typically administered intravenously or intrathecally (directly into the cerebrospinal fluid). However, their effectiveness in improving outcomes is uncertain, and they may have significant side effects.
  2. Supportive care: Due to the aggressive nature of Naegleria infection, supportive care is crucial. This may involve measures such as maintaining hydration, managing seizures, controlling fever, and providing respiratory support if necessary.
  3. Experimental treatments: In some cases, experimental treatments may be considered. These may include the use of investigational drugs or combination therapies. However, their efficacy and safety have not been established, and they may only be available through compassionate use or clinical trials.

It’s important to note that the prognosis for Naegleria infection is generally poor, with a high mortality rate. The disease progresses rapidly, typically leading to severe brain damage and death within a week or two of symptom onset. Early diagnosis and prompt initiation of treatment are critical, although even with treatment, the prognosis remains uncertain.

Prevention is the best approach to avoid Naegleria infection. By following the preventive measures outlined earlier, such as avoiding warm freshwater environments and using proper nose protection during water activities, you can significantly reduce the risk of infection.

Who is most at risk of contracting Naegleria?

While Naegleria infection is rare, certain individuals may be at a higher risk of contracting the infection. 

The following groups are considered to be more susceptible:

  1. Age: Naegleria infection primarily affects individuals between the ages of 10 and 30. Children and young adults tend to have a higher incidence of infection, possibly due to their increased participation in water-related activities.
  2. Recreational water activities: People who frequently engage in water activities, particularly in warm freshwater environments, are at an increased risk. This includes activities such as swimming, diving, water sports, or using water slides where water can forcefully enter the nasal passages.
  3. Location and climate: The risk of Naegleria infection is higher in regions with warm climates. Countries with hot and humid weather, especially during the summer months, provide favorable conditions for the growth and survival of Naegleria fowleri in freshwater sources.
  4. Water exposure: Individuals who have a history of water exposure, especially in warm freshwater environments, may be at an increased risk. This includes activities like swimming or diving in lakes, hot springs, or poorly maintained swimming pools.
  5. Immune status and health conditions: People with weakened immune systems may be more susceptible to Naegleria infection. This includes individuals with conditions such as HIV/AIDS, cancer, organ transplantation, or certain medications that suppress the immune system.

It’s important to note that the overall risk of Naegleria infection remains very low, even for individuals in these high-risk groups. Taking preventive measures, such as avoiding warm freshwater environments and using proper nose protection during water activities, can help further reduce the risk of infection

How to make water safe from Naegleria at home?

To ensure the safety of water from Naegleria fowleri, a brain-eating amoeba, there are several steps you can take at home:

  1. Use a Reliable Water Source: Obtain water from a safe and reliable source, such as tap water from a municipal supply, a well-maintained private well, or bottled water from a reputable brand.
  2. Boiling Water: Boiling water is an effective method to kill the Naegleria amoeba. Bring the water to a rolling boil for at least one minute, then allow it to cool before using it for drinking, cooking, or brushing teeth.
  3. Chlorination: If you’re using water from a well or another untreated source, you can disinfect it by using chlorine bleach. Add 1/8 teaspoon (or 8 drops) of unscented chlorine bleach (containing 5–6% sodium hypochlorite) per gallon of water. Mix well and let it stand for at least 30 minutes before using. The water should have a slight chlorine odor; if it doesn’t, repeat the dosage and let it stand for an additional 15 minutes.
  4. Water Filters: Certain types of water filters can help remove or reduce the risk of Naegleria contamination. Look for filters certified to remove or reduce protozoan cysts, and follow the manufacturer’s instructions for installation and maintenance.
  5. Nasal Irrigation Safety: If you use a neti pot or perform nasal irrigation, it’s crucial to use water that is safe. Use only distilled or sterile water, or water that has been previously boiled and cooled. Ensure the device and water are clean and properly maintained to prevent any potential contamination.
  6. Swimming and Recreational Activities: When engaging in activities like swimming, water sports, or using a backyard pool, ensure that the water is properly chlorinated and maintained. Follow local health guidelines and recommendations to ensure the safety of the water.

Remember that these precautions reduce the risk of Naegleria fowleri, but they cannot guarantee complete safety. If you have concerns about the water quality in your area, it’s advisable to contact your local health department for specific recommendations.

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