A while back, I wrote about brain-eating amoebas. And it wasn’t science fiction. It was about Nagleria fowleri, a one-celled creature that is found in bodies of warm water such as lakes, rivers, streams, inadequately chlorinated swimming pools and warm water waste outflow from industrial plants. These amoebas have also been found in inadequately cleaned neti pots. In the U.S., Nagleria follow warm weather. They are more common in southern states, but can be found farther north during the summer months.
What’s the big deal about Nagleria, and some associated amoebas? For starters, they can cause primary amoebic meningitis (PAM), which is almost always fatal. To be clear, PAM is rare. There aren’t many reported cases in the U.S., but there have been some. If you swim, dive or use a neti pot, you need to be aware of it.
It is more common in men and boys, possibly due to doing more activities that stir up debris in water. You can’t get infected with PAM by drinking water containing these amoebas, but you can if the water containing the amoebas gets into your nose. The amoebas swim up to the cribiform plate (the interface between the upper part of the nose and the base of the brain), and can penetrate there through a number of tiny holes that allow nerve fibers to pass out of the brain. They then enter the brain and start eating. They set up an inflammatory process and the patient subsequently dies because, until now, there was no cure.
Enter miltefosine, a drug that was used to treat leishmaniasis, a different kind of parasitic infection. With PAM being incurable, physicians were trying other drugs that might possibly help. They gave miltefosine a try a few years ago, with some mixed results. The drugs were hard to get, as they were manufactured in Germany, and the delay — coupled with the fact that it was a last resort measure — led to the tests being unsuccessful. However, as more cases of PAM occurred, doctors in the U.S. and other countries kept trying the drug. The results improved as more people were treated.
However, even when supplies were obtained, there were no controlled studies on miltefosine that showed, conclusively, that it did work. So the CDC and FDA got together, and now the drug is available in the U.S., through the CDC, for the treatment of PAM and leishmaniasis, in hopes of showing that the disease can be cured once and for all.