Don’t Go into Lakes. Here’s Why

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Naegleria Fowleri and why it’s a problem NOW.

The tranquil depths of a hot summer lake inspire a culmination of activities within its emerald waters: A mudslide receding into the sodden banks of the river, a canoeing escapade or sunset dives, and morning swims basking in the soft embrace of nature. Yet the loving arms of mother nature, for many, disguise her wrath; for hiding in the depths of this stunning backdrop of green and blue, hidden in the swirling sediment of the lake bed lies a microscopic killer: the Naegleria Fowleri.

Seen only through light microscopy, and unable to be detected by rapid test kits, this brain-eating amoeba thrives in warm, humid conditions (up to 115F or 46C- freshwater bodies and sediment) deterred only by chlorine-treated bodies of water- yet even that may not fully evade this clandestine predator. Entering through nasal passages and other openings of the body, the pathogen causes a fatal, notorious “brain-eating” infection called Primary Amebic Meningoencephalitis (PAM) with symptoms including Fever, Headache, Nausea, Vomiting, stiff neck, photophobia, hallucinations, altered mental state, and seizures among others. Once in its clutches, it is almost always fatal. Once in the body, the amoeba travels up to the olfactory nerve of the brain and triggers an immune and inflammatory response (causing swelling to nearby tissue). Then, by feeding on the brain and secreting enzymes to destroy neural components, it causes increased intracranial pressure, compressing brain structures and disrupting neural transmission contributing to brain dysfunction and eventual death.

Only a total of 4 out of 154 people have made full recovery.

From the years 1962 to 2021, only 154 people have contracted Naegleria Fowleri, and yet, only 4 have survived. Despite its extreme rarity, recent studies have indicated a concerning factor: Global Warming. Regardless of humanity’s preparedness, rising temperatures have posed an increased risk by heating freshwater bodies, and increasing the number of habitable places in the United States where this amoeba can thrive. No longer is this amoeba constricted to lakes, now, they spread into community pools, and poorly maintained facilities, climbing farther and farther north. According to the CDC, cases have been recorded in Maryland, Minnesota, Nebraska, and Indiana among other northern states.

Even worse, traditional methods of prevention and detection may not be safe any longer and should be performed with caution.

1. Signs: The first instinct if naegleria fowleri has been detected in a freshwater body, is to put a sign to let the public know. However, on a superficial level, while this does compensate in the long term, many may think that ONLY lakes that have this pathogen warning have Naegleria Fowleri in them, when unmarked freshwater areas may still contain them. While promoting awareness, a more detrimental problem might arise.
2. Using Neti Pots: Using Neti pots to rinse water out of the sinuses is beneficial, but specific precautions must be taken to ensure maximum efficiency and safety (following the guidelines set by the CDC).

Furthermore, due to its rarity, many physicians are not aware of PAM, and can be misdiagnosed with its more common cousin, bacterial meningitis. Consulting various doctors, and paying attention to swimming habits and upkeep of freshwater bodies are among the more safe solutions.

Even better, refrain from swimming in such conditions completely.

These circumstances and high fatality figures are, admittedly, both disturbing and disappointing considering the golden age of science we live in today. However, in recent years, as the prevalence of this deadly pathogen has increased, scientists have worked to create effective solutions from newer drugs and various therapies.

This drug discovery process has been compressed into two main categories: In Vitro and Silico drug testing. *In Vitro, drug testing involves whole organism screenings, while In Silico* involves a target-based system using genomes and proteomic databases. According to NIH, while In Silico testing has largely been preferred among scientists, it has little yield or effectiveness in treating PAM compared to In Vitro testing. Furthermore, Debnath, author of “Drug discovery for primary amebic meningoencephalitis: from screen to identification of lead” has even stated the efficiency of repurposing antifungal medicines from both a health and economic perspective.

NIH diagram comparing In Vitro vs In Silico Drug Discovery Methods

However, contrary to drugs like Rifampin and Fluconazole, whose ability to treat PAM outside of laboratories remains debatable, a newer drug, Miltefosine, used originally to treat leishmaniasis, and Amphotericin B, has shown promise through amoeba-killing activity in laboratories, as well as successful combination therapy trials on PAM patients.

Let’s explore them.

1. Miltefosine: Miletsofine, described as a “miracle drug” repurposed to treat PAM, has been used in successful PAM patients in Combination Therapy to help mitigate this amoeba. This drug works to target Naegleria Fowleri membranes to disrupt function and slow down the progression of this pathogen. As physicians look to the future to treat this deadly infection, Miltesofine has shown promising results, inspiring hope for this aggressive amoeba.
2. Amphotericin B: In similarity to Miltfosine, this drug has been used in Combination Therapy to attack Naegleria Fowleri Amoeba. Specifically, it binds to ergosterol (the main sterol in the Naegleria Folwer cell membrane), resulting in the impairment of cell barrier function, loss of cell constituents, and metabolic disruption. However, it must be stated that this information pertains to all fungal infections that Amphotericin B battles, not just Naegleria Fowleri. But, it does use similar methods.

However, while these drugs can be useful in handling Naegleria Fowleri, prevention remains a priority in a time where full neurological recovery is slim to none.

As ongoing research is being conducted to help mitigate Naegleria Fowleri and similar amoebas, special attention should be given to help target the source of these pathogens. The development of rapid tests, chemical treatment, and stricter facilitation of freshwater bodies are all imperative in fostering a safe living environment, yet, just as humans are both stubborn and persevering, these bacteria are too, posing the question of:

What treatments can be made to help aggressively attack the spread of Naegleria Fowleri, and how can we prevent ecological dysfunction for both surrounding bacteria and wildlife while doing so?

Therefore, through this article, I seek to shed light on nature’s deadliest, but often most forgotten organisms: bacteria, and how neglecting these organisms may lead to unforeseen consequences.

This being stated, I strongly encourage all readers to stay informed, practice necessary precautions, and advocate for research facilities and stronger water quality mandates to help stay safe against mother nature’s silent killer.

Works Cited

“Amphotericin B: Uses, Interactions, Mechanism of Action | DrugBank Online.” DrugBank, go.drugbank.com/drugs/DB00681.

Debnath, A. (2021). Drug discovery for primary amebic meningoencephalitis: from screen to identification of leads. Expert Review of Anti-infective Therapy, 19(9), 1099–1106.

General Information | Naegleria Fowleri | CDC. www.cdc.gov/parasites/naegleria/general.html.

Grace, E. E., et al. “Naegleria Fowleri: Pathogenesis, Diagnosis, and Treatment Options.” Antimicrobial Agents and Chemotherapy, vol. 59, no. 11, Nov. 2015, pp. 6677–81. https://doi.org/10.1128/aac.01293-15.

Hurt, Avery. “Naegleria Fowleri: The Brain-Eating Amoeba.” Discover Magazine, 3 Oct. 2023, www.discovermagazine.com/health/naegleria-fowleri-the-brain-eating-amoeba.

Naveed, Muhammad, et al. “Development and Immunological Evaluation of an mRNA-based Vaccine Targeting Naegleria Fowleri for the Treatment of Primary Amoebic Meningoencephalitis.” Scientific Reports, vol. 14, no. 1, Jan. 2024, https://doi.org/10.1038/s41598-023-51127-8.

“Repurposed Drug Battles ‘Brain-eating’ Amoeba.” Science | AAAS, 1 Apr. 2024, www.science.org/content/article/repurposed-drug-battles-brain-eating-amoeba.

Treatment | Naegleria Fowleri | CDC.

www.cdc.gov/parasites/naegleria/treatment.html.