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1st Naegleria fowleri death of 2017 reported in Karachi

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1st Naegleria fowleri death of 2017 reported in Karachi

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Hello everyone. I just want to share an article that I read before about Naegleria fowleri. As we know that this protozoa can infect a person through water right? And usually we heard about Most  infections occur from exposure to contaminated recreational water but in Karachi, Pakistan the cases due to the use of neti pots and the practice of ablution have been documented.. So guys, be more careful and alert with your environment especially my muslim friends :)

So this is link for that article
http://outbreaknewstoday.com/pakistan-1st-naegleria-fowleri-death-2017-reported-karachi-14077/

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Introduction and History of Naegleria fowleri

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Introduction and History of Naegleria fowleri

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Naegleria fowleri belongs to the Phylum Percolozoa, which contains the characteristics of being colourless, non-photosynthetic amobae, many  species of which transform between 3 stages; amoeboid, flagellate, and cyst.  Naegleria fowleri was first discovered to be the cause of infection in men in 1965 by researchers Fowler and Carter in Australia.  Naegleria fowleri causes Primary amoebic meningoencephalitis (PAM), and must be diagnosed/ treated promptly in order to save the life of the patient. In order to help diagnose a Naegleria fowleri infection, the patient should report their history of exposure to warm bodies of water.
More detail and information can be found here:

https://www.researchgate.net/profile/Johan_De_Jonckheere/publication/241626969_A_Century_of_Research_on_the_Amoeboflagellate_Genus_Naegleria/links/5419866f0cf203f155adfa26.pdf
If you have trouble opening links, try accessing them through google schola

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So guys, bacteria is not the only one who's sneaky enough and can adapt to its environment if its unfavourable for them to live and grow. Naegleria fowleria can adapt too! Here's a link for you guys to see and read :)

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is a heat-loving (thermophilic), free-living ameba (single-celled microbe), commonly found around the world in warm fresh water (like lakes, rivers, and hot springs) and soil . Naegleria fowleri is the only species of known to infect people. Most of the time, Naegleria fowleri lives in freshwater habitats by feeding on bacteria. However, in rare instances, the ameba can infect humans by entering the nose during water-related activities. Once in the nose, the ameba travels to the brain and causes a severe brain infection called primary meningoencephalitis (PAM), which is usually fatal .

History

The first PAM infections were reported in 1965 in Australia. The ameba identified caused a fatal infection in 1961 and turned out to be a new species that has since been named Naegleria fowleri after one of the original authors of the report, M. Fowler . The first infections in the U.S., which occurred in 1962 in Florida , were reported soon after. Subsequent investigations in Virginia using archived autopsy tissue samples identified PAM infections that had occurred in Virginia as early as 1937 .

The Pathogen and Life Cycle

Naegleria fowleri has 3 stages in its life cycle: , cyst , trophozoite, and flagellate. The only infective stage of the ameba is the trophozoite. Trophozoites are 10-35 µm long with a granular appearance and a single nucleus. The trophozoites replicate by binary division during which the nuclear membrane remains intact (a process called promitosis) . Trophozoites infect humans or animals by penetrating the nasal tissue and migrating to the brain via the olfactory nerves causing primary amebic meningoencephalitis (PAM).

Trophozoites can turn into a temporary, non-feeding, flagellated stage (10-16 µm in length) when stimulated by adverse environmental changes such as a reduced food source. They revert back to the trophozoite stage when favorable conditions return . Naegleria fowleri trophozoites are found in cerebrospinal fluid (CSF) and tissue, while flagellated forms are occasionally found in CSF. Cysts are not seen in brain tissue. If the environment is not conducive to continued feeding and growth (like cold temperatures, food becomes scarce) the ameba or flagellate will form a cyst. The cyst form is spherical and about 7-15 µm in diameter. It has a smooth, single-layered wall with a single nucleus. Cysts are environmentally resistant in order to increase the chances of survival until better environmental conditions occur .

Environmental Resistance

Naegleria fowleri is normally found in the natural environment and is well adapted to surviving in various habitats, particularly warm-water environments. Although the trophozoite stage is relatively sensitive to environmental changes, the cysts are more environmentally hardy. There are no means yet known that would control natural Naegleria fowleri levels in lakes and rivers.

Drying: Drying appears to make trophozoites nonviable instantaneously and cysts nonviable in <5 min .

Temperature: Naegleria fowleri is a heat-loving (thermophilic) ameba able to grow and survive at higher temperatures, such as those found in hot springs and in the human body, even under fever temperatures. Naegleria fowleri grows best at higher temperatures up to 115°F (46°C) . Although the amebae may not be able to grow well, Naegleria fowleri can still survive at higher temperatures for short periods of time. The trophozoites and cysts can survive from minutes to hours at 122-149°F (50-65°C) with the cysts being more resistant at these temperatures . Although trophozoites are killed rapidly by refrigeration, cysts can survive for weeks to months at cold temperatures above freezing, although they appear to be sensitive to freezing . As a result, colder temperatures are likely to cause Naegleria fowleri to encyst in lake and river sediment where the cyst offers more protection from freezing water temperatures.

Disinfection: Naegleria fowleri trophozoites and the more resistant cysts are sensitive to disinfectants like chlorine , and monochloramine , . Chlorine is the most common disinfectant used to treat drinking water and swimming pools. The chlorine sensitivity of Naegleria fowleri is moderate and in the same range as the cysts from Giardia intestinalis, another waterborne pathogen , . The inactivation data for Naegleria is limited but recent CT values (concentration of disinfectant [mg/l] X contact time [in minutes]) have been developed . Under laboratory conditions, chlorine at a concentration of 1 ppm (1 mg/L) added to 104.4°F (38°C) clear (non-turbid) well water at a pH of 8.01 will reduce the number of viable and more resistant Naegleria fowleri cysts by 99.99% (4 logs) in 56 minutes (CT of 56) . Cloudy (turbid) water requires longer disinfection times or higher concentrations of disinfectant.

Salinity: Naegleria fowleri does not survive in sea water and has not been detected in sea water .

Environmental Testing

In general, CDC does not recommend testing rivers and lakes for Naegleria fowleri because the ameba is naturally occurring and there is no established relationship between detection or concentration of Naegleria fowleri and risk of infection. Environmental testing may be warranted for investigations in which Naegleria fowleri detection may be useful for establishing geographical distribution in new environments , survival in disinfected water bodies, or in household water systems .

References

1. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. [PDF - 13 pages] J Neuroparasitol. 2010;1.

2. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138:968-75.

3. Butt CG. Primary amebic meningoencephalitis. N Engl J Med. 1966;274:1473-6.

4. Gustavo dos Santos Neto. Fatal primary amebic meningoencephalitis. A retrospective study in Richmond, Virginia. Am J Clin Pathol. 1970;54:737-42.

5. Visvesvara G, Yoder J, Beach MJ. (2012) Primary amebic meningoencephalitis Chapter 73, pgs 442-447. In: Netter's Infectious Diseases, Eds. Yong EC, Stevens DL. Elsevier Saunders. Philadelphia, PA.

6. Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea. FEMS Immunol Med Microbiol. 2007;50:1-26.

7. Griffin JL. Temperature tolerance of pathogenic and nonpathogenic free-living amoebas. Science.1972;178(63):869-70.

8. De Jonckheere J, van de Voorde H. Differences in destruction of cysts of pathogenic and nonpathogenic Naegleria and Acanthamoeba by chlorine. [PDF - 4 pages] Appl Environ Microbiol. 1976;31:294-7. (1mg/l for an hour for cysts)

9. Cursons RT, Brown TJ, Keys EA. Effect of disinfectants on pathogenic free-living amoebae: in axenic conditions. [PDF - 5 pages] Appl Environ Microbiol. 1980;40:62-6.

10. Robinson BS, Christy PE. Disinfection of water for control of amoebae. Water. 1984;September:21-4.

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Information about the brain eating ameba Naegleria fowleri that causes encephalitis and death including frequently asked questions, biology, sources of infection, diagnosis, treatment, prevention and control, and other publications and pertinent information for the public and medical professionals.

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This site is about the source of infection (where Naegleria fowleri is found) and the risk factors of getting the infection from Nagleria fowleri.

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is a heat-loving (thermophilic) ameba found around the world . Naegleria fowleri grows best at higher temperatures up to 115°F (46°C; see Pathogen and Environment page) and can survive for short periods at higher temperatures . is naturally found in warm freshwater environments such as lakes and rivers , naturally hot (geothermal) water such as hot springs , warm water discharge from industrial or power plants , geothermal well water , poorly maintained or minimally chlorinated swimming pools , water heaters , and soil , where it lives by feeding on bacteria and other microbes in the environment. Sampling of lakes in the southern tier of the U.S. indicates that Naegleria fowleri is commonly present in many southern tier lakes in the U.S. during the summer but infections have also recently occurred in northern states . Naegleria is not found in salt water, like the ocean.

References

1. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. J Neuroparasitol. 2010;1.

2. Griffin JL. Temperature tolerance of pathogenic and nonpathogenic free-living amoebas. Science. 1972;178(4063):869-70.

3. John DT, Howard MJ. Seasonal distribution of pathogenic free-living amebae in Oklahoma waters. Parasitol Res. 1995;81(3):193-201.

4. Duma RJ. Study of pathogenic free-living amebas in fresh-water lakes in Virginia. EPA Publication. 1980;EPA-PB-126369, Summary, 1981 is EPA-600/S1-80-037.

5. Ettinger MR, Webb SR, Harris SA, McIninch SP, C Garman G, Brown BL. Distribution of free-living amoebae in James River, Virginia, USA. Parasitol Res. 2003;89(1):6-15.

6. Stevens AR, Tyndall RL, Coutant CC, Willaert E. Isolation of the etiological agent of primary amoebic meningoencephalitis from artificially heated waters. Appl Environ Microbiol. 1977;34(6):701-5.

7. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.

PAM infections have been reported from around the world , . Infections have primarily occurred in southern-tier states in the U.S., but infections were documented in Minnesota in 2010 and 2012 and other northern states since that time. Over half of all reported infections have occurred in Florida and Texas. In the United States and the rest of the world, PAM is primarily spread via swimming in warm freshwater lakes and rivers (about 3 out of 4 U.S. infections from 1962-2016) . Other recreational water types like hot springs and canals have also been linked to PAM infections .

Six infections in the U.S. have been associated with using water from drinking water systems to swim or use a slip-n-slide , immerse the head in a bathtub , mix solutions for nasal irrigation using a neti pot , or perform ritual nasal rinsing or ablution . PAM infections also occurred in the 1970s and 1980s in Australia , that were linked to showering, swimming, or having other nasal exposure to contaminated drinking water. The infections were linked to piping drinking water overland, sometimes for hundreds of kilometers, that resulted in the water being heated and having low to zero disinfectant levels that resulted in the water and pipes becoming colonized by Naegleria fowleri. Several water systems in the states of Western Australia and South Australia continue to monitor regularly for Naegleria fowleri colonization in drinking water distribution systems . Infections due to contaminated water being used for religious practices , have also been reported.

References

1. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. J Neuroparasitol. 2010;1.

2. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.

3. CDC. Primary amebic meningoencephalitis associated with ritual nasal rinsing - St. Thomas, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013;62(45):903.

4. Anderson K, Jamieson A. Primary amoebic meningoencephalitis. Lancet. 1972;1:902-3.

5. Dorsch MM, Cameron AS, Robinson BS. The epidemiology and control of primary amoebic meningoencephalitis with particular reference to South Australia. Trans R Soc Trop Med Hyg. 1983;77:372-7.

Number of case reports of PAM by year, United States, 1962-2016.

PAM is a rare* disease. From 1962-2016, 143 infections in the U.S. have been reported to CDC. Other infections have been diagnosed in stored autopsy samples dating back to 1937 . The annual number of U.S. infections ranges from 0 to 8, with higher numbers appearing to occur in heat wave years when air and water temperatures are higher. It does not appear that the number of infections has increased since CDC established its Free-living Ameba (FLA) Laboratory and PAM registry in 1978.

References

SN Gustavo. Fatal primary amebic meningoencephalitis. A retrospective study in Richmond, Virginia. Am J Clin Pathol. 1970;54:737-42.

You cannot get infected from drinking water contaminated with Naegleria. You can only be infected when contaminated water goes up into your nose.

Humans become infected when water containing Naegleria fowleri enters the nose, usually while swimming. People do not get infected by drinking contaminated water. The ameba migrates to the brain along the olfactory nerve, through a bony plate in the skull called the cribriform plate, where it reaches the brain and begins to destroy the brain tissue . Naegleria fowleri has not been shown to spread via water vapor or aerosol droplets (such as shower mist or vapor generated from a humidifier). The ameba has never been shown to have spread from one person to another.

Transplantation of organs from donors infected by Naegleria fowleri has been recorded, although none of the organ recipients became infected . However, the occurrence of Naegleria fowleri outside the brain has been observed; Naegleria fowleri has been documented in tissue sections of lung, kidney, heart, spleen, and thyroid from two deceased PAM cases . As a result, although the risk of transmission of Naegleria fowleri by donor organs is still unknown, it is unlikely to be zero so the risks of transplantation with an organ possibly harboring Naegleria fowleri should be carefully weighed for each individual organ recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. This warrants continued study of the benefits and risks of transplanting organs or tissues from people infected by Naegleria fowleri.

References

1. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. J Neuroparasitol. 2010;1.

2. Tuppeny M. Primary amoebic meningoencephalitis with subsequent organ procurement: a case study. J Neurosci Nurs. 2011;43(5):274-9.

Number of case-reports of PAM by age group and gender, United States, 1962-2016.

PAM infections have been reported from around the world . From 1962 through 2016, 143 infections have been documented in the U.S. Infections have occurred in all age groups, but 120 cases (84%) have occurred in children and adolescents (median age of 12 years; range 8 months to 66 years). Over three-quarters (>75%) of infections have been in males. Infected people were often reported to have participated in water-related activities such as swimming underwater, diving, and head dunking that could have caused water to go up the nose .

Naegleria fowleri has also been documented to infect animals such as cattle and a South American tapir . Experimental infection can be induced in other species including mice, which are used as the model system for studying Naegleria fowleri infections resulting from swimming .

References

1. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. J Neuroparasitol. 2010;1.

2. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.

Number of case reports of PAM by month of illness onset and probable water exposure, United States, 1962-2016.

Infections linked to freshwater swimming mostly occur during the heat of summer in July and August in the northern hemisphere when water temperatures peak and water levels are low . Infections can increase during heat wave years as water temperatures increase.

References

Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.

No data exist to accurately estimate the true risk of PAM. Hundreds of millions of visits to swimming venues occur each year in the U.S. that result in 0-8 infections per year. The extremely low occurrence of PAM makes epidemiologic study difficult. It is unknown why certain persons become infected with the amebae while millions of others exposed to warm recreational fresh waters, including those who were swimming with people who became infected, do not. Attempts have been made to determine what concentration of Naegleria fowleri in the environment poses an unacceptable risk . However, no method currently exists that accurately and reproducibly measures the numbers of amebae in the water. This makes it unclear how a standard might be set to protect human health and how public health officials would measure and enforce such a standard.

References

US Census Bureau. Statistical Abstract of the United States: 2012. Arts, Recreation, and Travel: Participation in Selected Sports Activities 2009. [XLS - 1 MB] 2012.

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Information about risk factors for Naegleria fowleri, who gets infected, and how they get infected. Education and information about the brain eating ameba Naegleria fowleri that causes encephalitis and death including frequently asked questions, biology, sources of infection, diagnosis, treatment, prevention and control, and other publications and pertinent information for the public and medical professionals.

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Miltefosine (drug)for treatment

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Information about the treatment of Naegleria fowleri. Education and information about the brain eating ameba Naegleria fowleri that causes encephalitis and death including frequently asked questions, biology, sources of infection, diagnosis, treatment, prevention and control, and other publications and pertinent information for the public and medical professionals.

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This site explain how Naegleria fowleri is detected and diagnosed in the laboratory.

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Diagnosis & Detection | Naegleria fowleri | CDC

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Education and information about the brain eating ameba Naegleria fowleri that causes encephalitis and death including frequently asked questions, biology, sources of infection, diagnosis, treatment, prevention and control, and other publications and pertinent information for the public and medical professionals. Diagnosis and detection of Naegleria fowleri.

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Current Research and Contribution to other field:

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Current Research and Contribution to other field:

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https://www.statnews.com/2016/07/22/brain-eating-amoeba/
http://ifithappendtoyou.weebly.com/current-research-and-treatment.html