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Novel Chemotherapeutic Strategies in the Management of Primary Amoebic Meningoencephalitis Due to Naegleria fowleri

Primary amoebic meningoencephalitis (PAM) due to Naegleria fowleri is a fulminating infection that can result in death within days. The disease prognosis is poor, although early diagnosis and aggressive treatment might increase survival chances [1]. Through contaminated water, N. fowleri enters nostrils and then migrates along the olfactory nerve, through the cribriform plate into the brain [2]. PAM is characterized by parosmia, rapidly progressing to anosmia (with resultant ageusia) as the nerve cells of the olfactory bulbs are destroyed leading to seizures and finally death [3]. Despite advances in antimicrobial chemotherapy and supportive case, the mortality rate associated with PAM has remained over 90% [1–3]. A high mortality is attributed to (1) delayed diagnosis, (2) our incomplete understanding of the pathogenesis and pathophysiology of the disease, (3) lack of availability of safe and effective drugs, and (4) the difficulty in delivering anti-N. fowleri drugs to the brain. So far, only three survivors of PAM have been documented [4]. These patients were treated with amphotericin B, rifampicin, fluconazole, dexamethasone, and phenytoin intravenous and/or intrathecally within first week of the infection [4,5]. A successful prognosis was attributed to early diagnosis (limited deeper tissue involvement), followed by aggressive antimicrobial chemotherapy. Both amphotericin B [5] and miltefosine [6] have been suggested as useful agents against PAM [7]. The aim of this letter is to debate whether an improved therapeutic outcome can