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Naegleriasis

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Naegleriasis
Other namesPrimary amoebic meningoencephalitis (PAM), amoebic encephalitis, naegleria infection, amoebic meningitis
Histopathology, Direct fluorescent antibody stain.
Pronunciation
SpecialtyInfectious disease
SymptomsFever, vomiting, stiff neck, seizures, poor coordination, confusion, death
ComplicationsBrain damage, death
Usual onset1 – 12 days after exposure[1]
Duration1 – 18 days[1]
CausesDeep nasal inhalation of Naegleria fowleri organisms from contaminated freshwater.
Risk factorsRoughly 75% of cases infect males; most cases are children or adolescents[2]
Differential diagnosisBacterial or fungal meningitis[3]
PreventionNoseclips when swimming in fresh water, or avoiding freshwater environments, and proper chlorination of swimming pools
TreatmentMiltefosine, fluconazole, amphotericin B, posaconazole, voriconazole, targeted temperature management[4][5]
Prognosis98.5% fatality rate; some, but not all, survivors have permanent neurological damage
FrequencyExtremely rare (6 in 1,000,000 human deaths, US)
Deaths381 globally from 1937–2018

Naegleriasis, also known as primary amoebic meningoencephalitis (PAM), is an almost invariably fatal infection of the brain by the free-living unicellular eukaryote Naegleria fowleri. Symptoms are meningitis-like and include headache, fever, nausea, vomiting, a stiff neck, confusion, hallucinations and seizures.[6] Symptoms progress rapidly over around five days, and death usually results within one to two weeks of symptoms.[6][1]

N. fowleri is typically found in warm bodies of fresh water, such as ponds, lakes, rivers and hot springs. It is found in an amoeboid, temporary flagellate stage or microbial cyst in soil, poorly maintained municipal water supplies, water heaters, near warm-water discharges of industrial plants and in poorly chlorinated or unchlorinated swimming pools. There is no evidence of it living in salt water. As the disease is rare, it is often not considered during diagnosis.[citation needed]

Although infection occurs very rarely,[1] it almost inevitably results in death.[7][8] Of the 128 naegleriasis US cases in the half-century to 2016, only two survived.[9]

Signs and symptoms

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Onset of symptoms begins one to twelve days following exposure (with a median of five).[6] Initial symptoms include changes in taste and smell, headache, fever, nausea, vomiting, back pain,[10] and a stiff neck. Secondary symptoms are also meningitis-like including confusion, hallucinations, lack of attention, ataxia, cramp and seizures. After the start of symptoms, the disease progresses rapidly, with death usually occurring anywhere from one to eighteen days later (with a median of five),[11] although it can take longer. In 2013, a man in Taiwan died 25 days after being infected by Naegleria fowleri.[12]

It affects healthy children or young adults who have recently been exposed to bodies of fresh water.[3] Scientists speculate that lower age groups are at a higher risk of contracting the disease because adolescents have a more underdeveloped and porous cribriform plate, through which the amoeba travels to reach the brain.[5]

Cause

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Naegleria fowleri

N. fowleri invades the central nervous system via the nose, specifically through the olfactory mucosa of the nasal tissues. This usually occurs as the result of the introduction of water that has been contaminated with N. fowleri into the nose during activities such as swimming, bathing or nasal irrigation.[13]

The amoeba follows the olfactory nerve fibers through the cribriform plate of the ethmoid bone into the skull. There, it migrates to the olfactory bulbs and subsequently other regions of the brain, where it feeds on the nerve tissue. The organism then begins to consume cells of the brain, piecemeal through trogocytosis,[14] by means of an amoebostome, a unique actin-rich sucking apparatus extended from its cell surface.[15] It then becomes pathogenic, causing primary amoebic meningoencephalitis (PAM or PAME).[citation needed]

Primary amoebic meningoencephalitis presents symptoms similar to those of relatively common bacterial and viral meningitis. Upon abrupt disease onset, a plethora of symptoms arise. Endogenous cytokines, released in response to the pathogens, affect the thermoregulatory neurons of the hypothalamus causing a rise in body temperature.[16] Additionally, the cytokines may act on the vascular organ of the lamina terminalis, leading to upregulation of Prostaglandin E2 contributing to hyperthermia.[17] Further, the release of cytokines, exotoxins released by the pathogens and an increase in intracranial pressure stimulate the nociceptors in the meninges[16] resulting in pain sensations.

The release of cytotoxic molecules in the central nervous system leads to extensive tissue damage and necrosis, such as damage to the olfactory nerve through lysis of nerve cells and demyelination.[18] Specifically, the olfactory nerve and bulbs become necrotic and hemorrhagic.[19] Spinal flexion leads to nuchal rigidity, or stiff neck, due to the stretching of the inflamed meninges.[16] The increase in intracranial pressure stimulates the area postrema to create nausea sensations which may lead to brain herniation and damage to the reticular formation.[16] Ultimately, the increase in cerebrospinal fluid from inflammation of the meninges increases intracranial pressure to an extent which leads to the destruction of the central nervous system. Although the exact pathophysiology behind the seizures caused by PAM is unknown, it is speculated that the seizures arise from altered meningeal permeability[16] caused by increased intracranial pressure.

Pathogenesis

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Roman Baths in Bath, Somerset, closed for bathing since 1978 due to presence of N. fowleri[20]

Naegleria fowleri propagates in warm, stagnant bodies of fresh water (typically during the summer months), and enters the central nervous system after insufflation of infected water by attaching itself to the olfactory nerve.[3] It then migrates through the cribriform plate and into the olfactory bulbs of the forebrain,[21] where it rapidly multiplies by feeding on nerve tissue.

Diagnosis

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N. fowleri can be grown in several kinds of liquid axenic media or on non-nutrient agar plates coated with bacteria. Escherichia coli can be used to overlay the non-nutrient agar plate and a drop of cerebrospinal fluid sediment is added to it. Plates are then incubated at 37 °C and checked daily for clearing of the agar in thin tracks, which indicate the trophozoites have fed on the bacteria.[22]

Detection in water is performed by centrifuging a water sample with E. coli added, then applying the pellet to a non-nutrient agar plate. After several days, the plate is microscopically inspected and Naegleria cysts are identified by their morphology. Final confirmation of the species' identity can be performed by various molecular or biochemical methods.[23]

Confirmation of Naegleria presence can be done by a so-called flagellation test, where the organism is exposed to a hypotonic environment (distilled water). Naegleria, in contrast to other amoebae, differentiates within two hours into the flagellate state. Pathogenicity can be further confirmed by exposure to high temperature (42 °C): Naegleria fowleri is able to grow at this temperature, but the nonpathogenic Naegleria gruberi is not.[citation needed]

Prevention

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Michael Beach, a recreational waterborne illness specialist for the Centers for Disease Control and Prevention, stated in remarks to the Associated Press that wearing of nose clips to prevent insufflation of contaminated water would be effective protection against contracting PAM, noting that "You'd have to have water going way up in your nose to begin with".[24]

Advice stated in the press release from Taiwan's Centers for Disease Control recommended people prevent fresh water from entering the nostrils and avoid putting their heads down into fresh water or stirring mud in the water with feet. When starting to suffer from fever, headache, nausea, or vomiting subsequent to any kind of exposure to fresh water, even in the belief that no fresh water has traveled through the nostrils, people with such conditions should be carried to hospital quickly and make sure doctors are well-informed about the history of exposure to fresh water.[25]

Treatment

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On the basis of laboratory evidence and case reports, heroic doses[26] of amphotericin B have been the traditional mainstay of PAM treatment since the first reported survivor in the United States in 1982.[5]

Treatment has often also used combination therapy with multiple other antimicrobials in addition to amphotericin, such as fluconazole, miconazole, rifampicin and azithromycin. They have shown limited success only when administered early in the course of an infection.[27]

While the use of rifampicin has been common, including in all four North American cases of survival, its continued use has been questioned.[5] It only has variable activity in vitro and it has strong effects on the therapeutic levels of other antimicrobials used by inducing cytochrome p450 pathways.[5] Fluconazole is commonly used as it has been shown to have synergistic effects against naegleria when used with amphotericin in vitro.[5]


In 2013–2016, three successfully treated cases in the United States utilized the medication miltefosine.[4] In one of the cases, a 12-year-old female, was given miltefosine and targeted temperature management to manage cerebral edema which is secondary to the infection. She survived with no neurological damage. The targeted temperature management coupled with early diagnosis and the medication has been attributed with her survival. On the other hand, another survivor, an 8-year-old male, was diagnosed several days after symptoms appeared and was not treated with targeted temperature management although he was administered miltefosine. He suffered apparent permanent neurological damage.[4] In 2016, a 16-year-old male also survived PAM. He was treated with the same protocols as of the 12-year-old female in 2013. He recovered with a near-complete neurological recovery; however, the patient has mentioned difficulties with learning post-recovery.[4][28] As of 2015 the U.S. CDC offered miltefosine to doctors for the treatment of diseases caused by free-living amoebas including Naegleria,[4] despite a lack of any data on how well the drug reaches the central nervous system.[5]

In 2018, a 10-year-old girl in the Spanish city of Toledo became the first person to contract the disease in Spain, and was successfully treated using intravenous and intrathecal amphotericin B.[29]

A 2023 study on mice has showed that treatment that included usage of benzoxaboroles, significantly prolonged survival and showed a 28% recovery rate without relapse.[30][31]

Prognosis

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Since its first description in the 1960s, only seven people worldwide have been reported to have survived PAM out of 450 cases diagnosed, implying a fatality rate of about 98.5%.[3] The survivors include four in the United States, one in Mexico and one in Spain. One of the US survivors had brain damage that is likely permanent, but there are two documented surviving cases in the United States who made a full recovery with no neurological damage; they were both treated with the same protocols.

There is also a fourth survivor in the United States. However, he had a different strain.[4][5]

Epidemiology

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The disease is rare and highly lethal: there had only been 381 cases as of 2018.[32] Drug treatment research at Aga Khan University in Pakistan has shown that in vitro drug susceptibility tests with some FDA approved drugs used for non-infectious diseases (digoxin and procyclidine were shown to be most effective of the drugs studied) have proved to kill Naegleria fowleri with an amoebicidal rate greater than 95%.[33] The same source has also proposed a device for drug delivery via the transcranial route to the brain.[34]

In the US, the most common states with cases reported of PAM from N. fowleri are the southern states, with Texas and Florida having the highest prevalence. The most commonly affected age group is 5–14-year olds (those who play in water).[35] The number of cases of infection could increase due to climate change, which was posited as the reason for three cases in Minnesota in 2010, 2012, and 2015.[36][37]

As of 2013, the numbers of reported cases were expected to increase simply because of better-informed diagnoses being made both in ongoing cases and in autopsy findings.[38]

History

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In 1899, Franz Schardinger first discovered and documented an amoeba he called Amoeba gruberi that could transform into a flagellate.[39] The genus Naegleria was established by Alexis Alexeieff in 1912, who grouped the flagellate amoeba. He coined the term Naegleria after Kurt Nägler, who researched amoebae.[40] It was not until 1965 that doctors Malcolm Fowler and Rodney F. Carter in Adelaide, Australia, reported the first four-human cases of amoebic meningoencephalitis. These cases involved four Australian children, one in 1961 and the rest in 1965, all of whom had succumbed to the illness.[41][42][43] Their work on amebo-flagellates has provided an example of how a protozoan can effectively live both freely in the environment, and in a human host.[44]

In 1966, Butt termed the infection resulting from N. fowleri primary amoebic meningoencephalitis (PAM) to distinguish this central nervous system (CNS) invasion from other secondary invasions made by other amoebae such as Entamoeba histolytica.[44] A retrospective study determined the first documented case of PAM possibly occurred in Britain in 1909.[42] In 1966, four cases were reported in the US. By 1968 the causative organism, previously thought to be a species of Acanthamoeba or Hartmannella, was identified as Naegleria. This same year, occurrence of sixteen cases over a period of three years (1962–1965) was reported in Ústí nad Labem, Czechoslovakia.[45] In 1970, Carter named the species of amoeba N. fowleri, after Malcolm Fowler.[46][47]

Society and culture

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Naegleria fowleri is also known as the "brain-eating amoeba". The term has also been applied to Balamuthia mandrillaris, causing some confusion between the two; Balamuthia mandrillaris is unrelated to Naegleria fowleri, and causes a different disease called granulomatous amoebic encephalitis. Unlike naegleriasis, which is usually seen in people with normal immune function, granulomatous amoebic encephalitis is usually seen in people with poor immune function, such as those with HIV/AIDS or leukemia.[48]

Naegleriasis was the topic in Season 2 of the medical mystery drama House, M.D. in the two-part episode titled "Euphoria".[49][50] It is also the topic of the episode "39 Differences" of season 6 of The Good Doctor.[citation needed]

Research

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The U.S. National Institutes of Health budgeted $800,000 for research on the disease in 2016.[51] Phenothiazines have been tested in vitro and in animal models of PAM.[52] Improving case detection through increased awareness, reporting, and information about cases might enable earlier detection of infections, provide insight into the human or environmental determinants of infection, and allow improved assessment of treatment effectiveness.[3]

See also

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References

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  1. ^ a b c d "The Centers for Disease Control and Prevention, Division of Parasitic Diseases – Naegleria fowleri—Primary Amoebic Meningoencephalitis (PAM)—General Information". Archived from the original on 28 July 2018. Retrieved 26 May 2014.
  2. ^ Fortin, Jacey (25 July 2019). "Man Dies of 'Brain-Eating' Amoeba After Swimming in Lake". The New York Times. Archived from the original on 21 April 2020. Retrieved 1 April 2020.
  3. ^ a b c d e Centers for Disease Control and Prevention (CDC) (2008). "Primary amebic meningoencephalitis – Arizona, Florida, and Texas, 2007". MMWR. Morbidity and Mortality Weekly Report. 57 (21): 573–7. PMID 18509301. Archived from the original on 2 April 2020. Retrieved 10 September 2017.
  4. ^ a b c d e f "Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM) – Amebic Encephalitis". 23 April 2015. Archived from the original on 14 February 2015. Retrieved 17 January 2016.
  5. ^ a b c d e f g h Grace, Eddie; Asbill, Scott; Virga, Kris (1 November 2015). "Naegleria fowleri: Pathogenesis, Diagnosis, and Treatment Options". Antimicrobial Agents and Chemotherapy. 59 (11): 6677–6681. doi:10.1128/AAC.01293-15. ISSN 0066-4804. PMC 4604384. PMID 26259797.
  6. ^ a b c "Illness & Symptoms | Naegleria fowleri | CDC". cdc.gov. 4 April 2019. Archived from the original on 11 May 2020. Retrieved 13 April 2017.
  7. ^ "6 die from brain-eating amoeba after swimming". NBC News. Associated Press. 28 September 2007. Archived from the original on 2 September 2018. Retrieved 17 November 2019.
  8. ^ one death in September 2018 was the first confirmed case of the infection in the United States since 2016 (nytimes.com: A Man Died After Being Infected With a Brain-Eating Amoeba. Here Are the Facts Archived 31 July 2019 at the Wayback Machine)
  9. ^ Cohen, Elizabeth (23 August 2016). "Kali Hardig, brain-eating amoeba survivor, to begin school next week". CNN. Archived from the original on 23 December 2019.
  10. ^ Talaro, Kathleen (2015). Foundations in microbiology. New York, NY: McGraw-Hill Education. p. 695. ISBN 978-0-07-352260-9.
  11. ^ "Illness and Symptoms". 12 October 2022. Archived from the original on 11 May 2020. Retrieved 28 March 2023.
  12. ^ Su MY, Lee MS, et al. (April 2013). "A fatal case of Naegleria fowleri meningoencephalitis in Taiwan". Korean J Parasitol. 51 (2): 203–6. doi:10.3347/kjp.2013.51.2.203. PMC 3662064. PMID 23710088.
  13. ^ "Safe Ritual Nasal Rinsing" (PDF). Centers for Disease Control and Prevention. Archived (PDF) from the original on 18 June 2019. Retrieved 28 September 2020.
  14. ^ Gilmartin, Allissia A.; Petri, Jr, William A. (2018). "Exploring the mechanism of amebic trogocytosis: the role of amebic lysosomes". Microbial Cell. 5 (1): 1–3. doi:10.15698/mic2018.01.606. ISSN 2311-2638. PMC 5772035. PMID 29354646.
  15. ^ Marciano-Cabral, F; John, DT (1983). "Cytopathogenicity of Naegleria fowleri for rat neuroblastoma cell cultures: scanning electron microscopy study". Infection and Immunity. 40 (3): 1214–7. doi:10.1128/IAI.40.3.1214-1217.1983. PMC 348179. PMID 6852919.
  16. ^ a b c d e Montgomery, Katherine (22 October 2012). "Meningitis". McMaster Pathophysiology Review. Archived from the original on 12 December 2017. Retrieved 29 March 2020.
  17. ^ Walter, Edward James; Hanna-Jumma, Sameer; Carraretto, Mike; Forni, Lui (14 July 2016). "The pathophysiological basis and consequences of fever". Critical Care. 20 (1): 200. doi:10.1186/s13054-016-1375-5. ISSN 1364-8535. PMC 4944485. PMID 27411542.
  18. ^ Pugh, J. Jeffrey; Levy, Rebecca A. (21 September 2016). "Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments". ACS Chemical Neuroscience. 7 (9): 1178–1179. doi:10.1021/acschemneuro.6b00232. PMID 27525348..
  19. ^ Fero, Kelly. "Naegleria fowleri". web.stanford.edu. Archived from the original on 28 December 2019. Retrieved 29 March 2020.
  20. ^ Gallois, R.W. (2006). "The geology of the hot springs at Bath Spa, Somerset". Geoscience in South-west England. 11 (3): 170. Archived from the original on 20 April 2021. Retrieved 6 December 2021.
  21. ^ Cervantes-Sandoval I, Serrano-Luna Jde J, García-Latorre E, Tsutsumi V, Shibayama M (September 2008). "Characterization of brain inflammation during primary amoebic meningoencephalitis". Parasitol. Int. 57 (3): 307–13. doi:10.1016/j.parint.2008.01.006. PMID 18374627.
  22. ^ Donald C. Lehman; Mahon, Connie; Manuselis, George (2006). Textbook of Diagnostic Microbiology (3rd ed.). Philadelphia: Saunders. ISBN 978-1-4160-2581-8.[page needed]
  23. ^ Pougnard, C.; Catala, P.; Drocourt, J.-L.; Legastelois, S.; Pernin, P.; Pringuez, E.; Lebaron, P. (2002). "Rapid Detection and Enumeration of Naegleria fowleri in Surface Waters by Solid-Phase Cytometry". Applied and Environmental Microbiology. 68 (6): 3102–7. Bibcode:2002ApEnM..68.3102P. doi:10.1128/AEM.68.6.3102-3107.2002. PMC 123984. PMID 12039772.
  24. ^ "6 die from brain-eating amoeba in lakes", Chris Kahn/Associated Press, 9/28/07
  25. ^ "福氏內格里阿米巴腦膜腦炎感染病例罕見，但致死率高，籲請泡溫泉及從事水上活動之民眾小心防範". 衛生福利部疾病管制署 (in Chinese). 26 October 2013. Archived from the original on 14 June 2020. Retrieved 14 October 2017.Public Domain This article incorporates text from this source, which is in the public domain.
  26. ^ The American Heritage Stedman's Medical Dictionary. Houghton Mifflin Company. 2004. ISBN 9780618428991.
  27. ^ Bauman, Robert W. (2009). "Microbial Diseases of the Nervous System and Eyes". Microbiology, With Diseases by Body System (2nd ed.). San Francisco: Pearson Education. p. 617.
  28. ^ Diaz, Johnny (21 July 2018). "Teen who survived brain-eating amoeba says sickness gave him more positive outlook". Sun-Sentinel. Archived from the original on 3 August 2020. Retrieved 15 April 2020.
  29. ^ Güell, Oriol (12 October 2018). "Una niña de Toledo sobrevive al primer caso en España de la ameba comecerebros". El País. Archived from the original on 2 November 2019. Retrieved 11 November 2018.
  30. ^ Ženíšková, Kateřina; Mach, Jan; Arbon, Dominik; Štursa, Jan; Werner, Lukáš; Zoltner, Martin; Sutak, Robert (16 February 2023). "The 4-Aminomethylphenoxy-Benzoxaborole AN3057 as a Potential Treatment Option for Primary Amoebic Meningoencephalitis". Antimicrobial Agents and Chemotherapy. 67 (2): e01506–22. doi:10.1128/aac.01506-22. ISSN 0066-4804. PMC 9933681. PMID 36688657.
  31. ^ University, Charles. "A potential drug in the fight against a fatal brain-eating amoeba". phys.org. Archived from the original on 20 February 2023. Retrieved 20 February 2023.
  32. ^ Caruzo G, Cardozo J (October 2008). "Primary amoebic meningoencephalitis: a new case from Venezuela". Trop Doct. 38 (4): 256–7. doi:10.1258/td.2008.070426. PMID 18820207. S2CID 20958778. Archived from the original on 10 January 2023. Retrieved 10 January 2023.
  33. ^ Mannan Baig Abdul; Kulsoom Huma; Ahmed Khan Naveed (2014). "Primary amoebic meningoencephalitis: amoebicidal effects of clinically approved drugs against Naegleria fowleri". Journal of Medical Microbiology. 63 (Pt 5): 760–762. doi:10.1099/jmm.0.072306-0. PMID 24493160. S2CID 206195489.
  34. ^ Baig Abdul M., Khan Naveed A. (2014). "Novel Chemotherapeutic Strategies in the Management of Primary Amoebic Meningoencephalitis Due to Naegleria fowleri". CNS Neuroscience & Therapeutics. 20 (3): 289–290. doi:10.1111/cns.12225. PMC 6493040. PMID 24456292.
  35. ^ "Number of Case-Reports of Primary Amebic Meningoencephalitis Caused by Naegleria Fowleri (N=133) by State of Exposure*— United States, 1962–2014". CDC.gov, CDC, www.cdc.gov/parasites/naegleria/pdf/naegleria-state-map-2014.pdf.
  36. ^ Kemble SK, Lynfield R, et al. (March 2012). "Fatal Naegleria fowleri infection acquired in Minnesota: possible expanded range of a deadly thermophilic organism". Clin Infect Dis. 54 (6): 805–9. doi:10.1093/cid/cir961. PMID 22238170.
  37. ^ Lorna Benson (9 July 2015). "Has deadly water amoeba found a home in Minnesota?". Archived from the original on 25 November 2021. Retrieved 5 September 2016.
  38. ^ Kanwal Farooqi M, Ali S, Ahmed SS (May 2013). "The paradox of primary amoebic meningoencephalitis—a rare disease, but commonly misdiagnosed". J Pak Med Assoc. 63 (5): 667. PMID 23758009.
  39. ^ Jonckheere, Johan F. De (November 2014). "What do we know by now about the genus Naegleria?". Experimental Parasitology. 145 (Supplement): S2-9. doi:10.1016/j.exppara.2014.07.011. PMID 25108159.
  40. ^ Walochnik, Julia; Wylezich, Claudia; Michel, Rolf (September 2010). "The genus Sappinia: History, phylogeny and medical relevance". Experimental Parasitology. 126 (1): 5, 7–8. doi:10.1016/j.exppara.2009.11.017. PMID 20004196.
  41. ^ Fowler, M.; Carter, R. F. (September 1965). "Acute pyogenic meningitis probably due to Acanthamoeba sp.: a preliminary report". British Medical Journal. 2 (5464): 740–2. doi:10.1136/bmj.2.5464.734-a. PMC 1846173. PMID 5825411.
  42. ^ a b Symmers, W. S. C. (November 1969). "Primary amoebic meningoencephalitis in Britain". British Medical Journal. 4 (5681): 449–54. doi:10.1136/bmj.4.5681.449. PMC 1630535. PMID 5354833.
  43. ^ Martinez, Augusto Julio; Visvesvara, Govinda S. (1997). "Free-living, Amphizoic and Opportunistic Amebas". Brain Pathology. 7 (1): 584. doi:10.1111/j.1750-3639.1997.tb01076.x. PMC 8098488. PMID 9034567.
  44. ^ a b Butt, Cecil G. (1966). "Primary Amebic Meningoencephalitis". New England Journal of Medicine. 274 (26): 1473–6. doi:10.1056/NEJM196606302742605. PMID 5939846.
  45. ^ Červa, L.; Novák, K. (April 1968). "Ameobic meningoencephalitis: sixteen fatalities". Science. 160 (3823): 92. Bibcode:1968Sci...160...92C. doi:10.1126/science.160.3823.92. PMID 5642317. S2CID 84686553.
  46. ^ Gutierrez, Yezid (15 January 2000). "Chapter 6: Free Living Amebae". Diagnostic Pathology of Parasitic Infections with Clinical Correlations (2 ed.). USA: Oxford University Press. pp. 114–115. ISBN 978-0-19-512143-8.
  47. ^ De Jonckheere, Johan F. (August 2011). "Origin and evolution of the worldwide distributed pathogenic amoeboflagellate Naegleria fowleri". Infection, Genetics and Evolution. 11 (7): 1520–1528. Bibcode:2011InfGE..11.1520D. doi:10.1016/j.meegid.2011.07.023. PMID 21843657.
  48. ^ Shadrach, WS; Rydzewski, K; Laube, U; Holland, G; Ozel, M; Kiderlen, AF; Flieger, A (May 2005). "Balamuthia mandrillaris, free-living ameba and opportunistic agent of encephalitis, is a potential host for Legionella pneumophila bacteria". Applied and Environmental Microbiology. 71 (5): 2244–9. Bibcode:2005ApEnM..71.2244S. doi:10.1128/AEM.71.5.2244-2249.2005. PMC 1087515. PMID 15870307.
  49. ^ "IMDb, Euphoria: Part 1". IMDb. Archived from the original on 12 November 2022. Retrieved 14 June 2014.
  50. ^ "IMDb, Euphoria: Part 2". IMDb. Archived from the original on 12 November 2022. Retrieved 14 June 2014.
  51. ^ Wessel, Lindzi (22 July 2016). "Scientists hunt for drug to kill deadly brain-eating amoeba". STAT News. Archived from the original on 6 October 2020. Retrieved 24 July 2016.
  52. ^ Kim, J.-H.; Jung, S.-Y.; Lee, Y.-J.; Song, K.-J.; Kwon, D.; Kim, K.; Park, S.; Im, K.-I.; Shin, H.-J. (2008). "Effect of Therapeutic Chemical Agents In Vitro and on Experimental Meningoencephalitis Due to Naegleria fowleri". Antimicrobial Agents and Chemotherapy. 52 (11): 4010–6. doi:10.1128/AAC.00197-08. PMC 2573150. PMID 18765686.
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