By Robert Herriman  @bactiman63

Naegleria fowleri is a microscopic amoeba which is a single-celled living organism. It can cause a rare and devastating infection of the brain called primary amebic meningoencephalitis (PAM). The amoeba is commonly found in warm freshwater such as lakes, rivers, ponds and canals.

miltefosine
Image/Profounda

Of the 140 or so documented cases in the US since 1962, at least 35 have been reported from Florida (with another 35 cases in Texas).

Until recently, treatment of PAM was extremely unreliable but in 2013, an Arkansas girl survived the parasitic meningitis with the usual course of drugs–a combination of an antifungal medicine, antibiotics and a new experimental anti-amoeba drug doctors got directly from the CDC–miltefosine.

Today, the CDC  states that Impavido (Miltefosine) is promising for the treatment of free-living ameba (FLA) infections caused by Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba species. While they have orphan designation for its use, Impavido is seen as “off label” when treating these amoebas.

Since 2016, 21 hospitals around the country carry Impavido on-site for immediate use against the rapidly progressive and lethal amoebic infection and three of those hospitals are right here in the Tampa Bay area–James A. Haley VA Medical Center in Tampa, Johns Hopkins All Children’s Hospital in St. Petersburg and Tampa General Hospital.

In addition, seven other Florida hospitals carry the drug, including hospitals in Lakeland and Orlando.

Infections can happen when contaminated water enters the body through the nose. Once the amoeba enters the nose, it travels to the brain where it causes PAM (which destroys brain tissue) and is usually fatal. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.

Naegleria fowleri infections are rare. Most  infections occur from exposure to contaminated recreational water. Cases due to the use of neti pots and the practice of ablution have been documented.


You cannot be infected with Naegleria fowleri by drinking contaminated water and the amoeba is not found in salt water.

Initial symptoms of PAM usually start within 1 to 7 days after infection. The initial symptoms may include headache, fever, nausea, or vomiting. Other symptoms can include stiff neck, confusion, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly.