Naegleria fowleri, also known as the brain-eating amoeba or brain-eating amoeboid, is a species of the genus Naegleria. It belongs to the phylum Percolozoa and is classified as an amoeboflagellate excavate, an organism capable of behaving as both an amoeba and a flagellate. This free-living microorganism primarily feeds on bacteria, but can become pathogenic in humans, causing an extremely rare, sudden, severe, and almost always fatal brain infection known as primary amoebic meningoencephalitis (PAM), also known as naegleriasis. It is typically found in warm freshwater bodies such as lakes, rivers, hot springs, warm water discharge from industrial or power plants, geothermal well water, poorly maintained or minimally chlorinated swimming pools with residual chlorine levels under 0.5 g/m3, water heaters, soil, and pipes connected to tap water. It can exist in either an amoeboid or temporary flagellate stage.
Etymology 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. The species was named after Malcolm Fowler, an Australian pathologist at Adelaide Children's Hospital, who was the first author of the original series of case reports (British Medical Journal, starting 1965) of PAM.
Life cycle
Naegleria fowleri, a thermophilic and free-living amoeba, is primarily found in warm and hot freshwater environments such as ponds, lakes, rivers, hot springs, and poorly maintained swimming pools. As temperatures rise, its population tends to increase. Although the amoeba was initially identified in Australia in the 1960s, it is believed to have evolved in the United States. N. fowleri exists in three forms - cyst, trophozoite (ameboid), and biflagellate. While it does not form cysts in solid human tissue, where only the amoeboid trophozoite stage is present, the flagellate form has been discovered in cerebrospinal fluid.
Cyst stage To endure harsh environmental conditions, trophozoites transform into microbial cysts, spherical, single-layered structures about 7–15 μm in diameter, enclosing a single cell nucleus. Acting as a resilient capsule, the cyst enables the amoeba to withstand adverse circumstances. Factors triggering cyst formation include food scarcity, overcrowding, desiccation, waste accumulation, and cold temperatures. When conditions improve, the amoeba can emerge through the pore or ostiole at the center of the cyst. N. fowleri has been observed to encyst at temperatures below 10 °C (50 °F).
Trophozoite stage The trophozoite stage is the infective phase for humans, during which the organism can actively feed and replicate. The trophozoite attaches to the olfactory epithelium, follows the axons of olfactory receptor neurons through the cribriform plate in the nasal cavity, and enters the brain. This reproductive stage of the protozoan organism transforms around 25 °C (77 °F), and thrives best around 42 °C (108 °F), multiplying through binary fission. Trophozoites are characterized by a nucleus surrounded by a flexible membrane. They move via pseudopodia, extending parts of their cell membrane (pseudopods) and filling them with protoplasm to facilitate locomotion. Pseudopods form in the direction of movement. In their free-living state, trophozoites feed on bacteria. In tissues, they appear to phagocytize (enclose and digest) red blood cells and cause tissue damage either through the release of cytolytic substances or by direct cell-to-cell contact using cytolytic membrane proteins. As trophozoites, N. fowleri may develop about one to 12 structures on their membrane known as amoebastomes, also referred to as "suckers" or "food cups", which they use for feeding via a trogocytosis-like mechanism.
Flagellate stage The flagellated stage of N. fowleri is pear-shaped and biflagellate (with two flagella). This stage can be inhaled into the nasal cavity, typically during activities such as swimming or diving. The flagellate form develops when trophozoites are exposed to a change in ionic strength in the fluid where it is, such as being placed in distilled water. The flagellated form does not exist in human tissue, but can be present in the cerebrospinal fluid. Once inside the nasal cavity, the flagellated form transforms into a trophozoite within a few hours.
Ecology Naegleria fowleri, an excavate, inhabits soil and water. It is sensitive to drying and acidic conditions, and cannot survive in seawater. The amoeba thrives at moderately elevated temperatures, making infections more likely during the summer months. N. fowleri is a facultative thermophile, capable of growing at temperatures up to 46 °C (115 °F). Warm, fresh water with an ample supply of bacteria as food provides a suitable habitat for amoebae. Locations where many amoebic infections have occurred include artificial bodies of water, disturbed natural habitats, areas with soil, and unchlorinated or unfiltered water. N. fowleri appears to flourish during periods of disturbance. The "flagellate-empty" hypothesis suggests that N. fowleri's success may stem from decreased competition when thermosensitive protozoal fauna do not survive temperature changes. In other words, N. fowleri thrives when other predators consuming its food supply are absent. This hypothesis implies that human disturbances, such as thermal pollution, increase the abundance of N. fowleri by eliminating its resource competitors. Amoeboflagellates have a motile, flagellated stage that aids in dispersal, which is advantageous in environments cleared of competing organisms.
Pathogenicity
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