Naegleria fowleri the parasites this is our over view figure showing the parasites you need to know for step one in this lecture we will be talking about one of the protozoa that infects the cns nigleria fowleri which you can see righ there our story of nigleria fowleri takes place in niagara falls this is where these hooligans like to go skinny dipping niagara falls is all fresh water so naegleria fowleri cases remember it.
Drains rivers and lakes not salt water which you’d find in the ocean so any ways niagara falls sounds like nigleria fowleri to sustain themselves during their naked activities these boys like to go to that protein shake shop and eat some protein every once in a while protein sounds like naegleria fowleri cases protozoa so when you think of these kids drinking protein shakes at niagara falls remember.
That niggeria falori is a protozoa unfortunately for these yahoos the water is infested by digleriafalri you can see these amoebas swimming around in the water here interestingly nigleria only exists in the amoeba form it never forms a cyst for that reason in our image we only show the amoeba form which is the only form it has now this boy was just attacked by one of those naegleria fowleri cases nigleria amoebas.
You can see it’s going up his nose this represents the fact that nigleria swims up the nose and penetrates the cribri form plate in order to reach the cns this image shows anaxial cut through the skull revealing the foramina in the base of the skull it is described in great detail within the naegleria fowleri cases neurology chapter right now just look at the cribri form plate.
Which you can see labeled right here this is where the fibers of the factory nerve cranial nerve one exit the brain and reach the nose so we can smell so nigleria amoebas will travel through the nose while someone is swimming in fresh water and then travel through this cripper form plate and then infect the brain once in the brain the patient is not going to do well take.
This poor fellow for example the amoeba has gone up his nose through his brain and then has pushed out the top of his head now he’s just walking around aimlessly naegleria fowleri cases this represents the fact that nigleria falari will reach the cns and cause a devastating meningoencephalitis infection now look at these infected fellows they’re pretty far gone their backs are stiff.
They’re vomiting and they’re walking around like zombies this represents some of the most prominent features seen in nigleria meningoencephal it is so again stiff zombies and vomiting for stiff necks and vomiting now these amoebas here have just used up their hosts they left the lifeless bodies on the ground as they departed back into the water.
This represents the fact that nigleria fowleri is lethal so dead victims for death with nigleria now you can see some amphibian frogs jumping on and off these dead bodies these naegleria fowleri cases amphibians really can’t save the humans at this point the people are long gone amphibians sounds like amphoteric in as in amphotericin bamphitarism is rarely effective intreating that glaria falari.
That’s why these dead people aren’t responding to the amphibians but just know that in a last ditch effort to try to save your patient amphoteris and b should bead ministered but you have a low expectation of it actually helping the patient now that we’ve covered naegleria fowleri cases the image let’s review with a question a 12 year old boy presents to the physician due to recent neck pain.
His mother is presentand states that soon after their recent family vacation he began acting strange today his temperature is 38.9 degrees celsius or 102.1 fahrenheit the physician appreciates decreased range of motion of the cervical spine a lumbar puncture is performed and reveals several amoebas which of the following is most likely true of the patient’s condition a the patient was swimming in the ocean during.
The vacation b the infectious organism is caused by a trematode c cis will not be found in the cerebral spinal fluid or d early administration of amphoteric in b will likely prevent death hopefully from the question stem you notice that there are amoebas in the csf and the patient naegleria fowleri cases demonstrates symptoms of meningoencephalitis because he has a fever neck pain which is confirmed by decreased range of motion of the cervical spine and examination of the csf reveals several amoebas.
This information is consistent with infection with nigleria fowleri with that in mind the correct answer is c c is will not be found in the cerebral spinal fluidrec all that nigleria fowleri only exists in the amoeba form as shown with these amoeba creatures right here it does not form cysts choice a is wrong because nigleria fowleri exists in fresh water such as niagara falls or streams naegleria fowleri cases and lakes.
It does not live in salt water like the ocean so because the ocean is mentioned we don’t think it’s negleria choice b is incorrect because negleriais not a trematode it’s a protozoa recall that naegleria fowleri cases protein shack that the hooligans go to frequently during.
Their skinny dipping adventures finally choiced is wrong naegleria fowleri cases because amphotericin b is not likely to prevent death it should still be administered just in case but nagleria is typically lethal upon reaching the cns.
the brain eating parasite
Terrifying type of infection that has been commonly labeled the brain eating parasite negleria fowleri and the reason we’re talking about this is because it has popped up in the news naegleria fowleri cases because unfortunately down in Florida a person caught this and died from it so we’re going to dive into the brain eating parasite.
Contain links for additional related that might be interesting so don’t forget to check those out and lastly a quick disclaimer none of these are intended to beacted naegleria fowleri cases upon is medical advic here and its entirety before moving on with no further Ado stay well keep learning and let’s get to the for sticking around so negleria fowleri.
The brain eating parasite it is commonly called why are we talking about nagleria fowleri today what has brought this topic kind of into the spotlight here naegleria fowleri cases and that is as we mentioned this case lots and lots of news articles about aman who got the negleria fowleri infection and unfortunately died from it and they call it the brain eating amoeba or.
The brain eating infection so today we wanted to cover all things negleria fowlerize that you better understood what this infection was what it actually does to the body if it can be treated and what to look out for how to prevent it so here’s a little animation naegleria fowleri cases we put together that’s us nigleria fowleri is most commonly seen in fresh water and as such swimmers often get this infection so the people in which they say are most at risk for an eglaria fowleri are people.
Who are actually swimming in warm and fresh water we’re going to get into this a little bit more but we often see this infection in more these Southern United States because of it’s warmer and you get this amoeba an amoeba is a parasite and it’s a single-celled organism naegleria fowleri cases and it hangs out both in fresh water as well as actually in the soil so you have nuclearia follower living in moist soil too and its life cycle rotates back and forth between the water and the soil and typically it doesn’t cause human infection.
It can infect animals and humans though and the way it does this we’re going to get into in a second but those at highest risk are those swimming in warm fresh water lakes rivers Creeks there’s been a few cases including the one in the news of people who have gotten it from naegleria fowleri cases using a Neti Pot which we’ll talk about in a little bit and the Amebic Meningoencephalitis,
Brain Invasion, Pathophysiology disease that it causes is primary amoebic meningoencephalitis so what is that exactly well you start with the parasite Nigeria fowleri and it actually has this suction cup like device on one end of it which we out lined here and what happens is naegleria fowleri cases you’re swimming in fresh water maybe it’s a lake maybe it’s a river maybe.
You’re in a hot spring some where or you’re using a Neti Pot a Neti Pot is a device where people fill it with water and it has this tube and you pour that water into your nose to the oretically clear the sinuses we don’t personally recommend that in many instances but what happens is this parasite nuclear folori enters into the nose it has to go through the nose.
If it enters into the mouth it cannot cause infection it must go through the naegleria fowleri cases nose to cause infection it can’t go through the eyes can’t go through the ears can’t go through the skin none of that will work it has to enter through the nasal passage and the reason is this is our drawing a kind of a side view of a human you know we’r every good artists as you know.
Here’s the nose here are some lips and here’s the nasal cavity so the parasite will go upthe nose because we inhaled it and it’ll get into the nasal passage and what it does is it finds these naegleria fowleri casesnerves and these nerves are known as the factory nerves those of you who have been around the channel for a while might recognize this as it’s some what involved in covid-19 pathology.
The the loss of smell that people used to get with some of the earlier covid-19 variants but these factory nerves they come off of the brain right up in the skull and they go through naegleria fowleri cases something called the cribi form plate that is this bone right here the cribiform plate and the criboform plate is a dense bone where this parasite couldn’t pass it could not pass through the criboform plate.
But the nerves go through the crippopore plate through small little holes and what this parasite does nucleariophalori is it actually invades these olfactory nerves and these are the naegleria fowleri cases nerves that allow us to smell you can imagine how that would work right you have your brain up here you have the factory nerves going through.
Naegleria fowleri
The form plate into the nasal passage and when we take a sniff in we in hale our all these particles into our nose these particles go onto the factory nerves which send messages to the brain and allow us to smell unfortunately nagleria follera uses this to its naegleria fowleri cases advantage and it invades these nerves and as such travels through the criboform plate into the brain because otherwise.
Our brains protected pretty good by something called the blood-brain barrier as well as bone it’s en cased in the skull so it’s not easy for bacteria or parasites or fungus or anything or viruses to get to the brain but the Nigeria fowleride parasite developed This brilliant tactic naegleria fowleri cases which it didn’t do intentionally but this brilliant tactic to use the nerves going through the bone to get to the brain and unfortunately.
Once the parasite is on the brain tissue it quite literally does eat away the brain tissue so it uses its little suction device here and it starts to digest the brain tissue burrowing deeper naegleria fowleri cases and deeper into the brain itself so as we talked about it first enters the nose it then Burrows into the factory nerves taking those nerves into the brain.
The suction cup then attaches to the brain and consumes brain tissue bearing deeper and deeper and then an important thing we wanted to point out was actually this right here naegleria fowleri cases and we’ll highlight it you actually then get a large immune response to your central nervous system and this is really important because although it’s meant to try to kill this parasite.
What it does is it causes a bunch of inflammation on the brain which leads to a huge amount of brain swelling in that huge amount of brain swelling you can imagine here if we drew the rest of the skull onto this body pretend that that’s the skull if the brain is to swell and it goes towards the skull there’s actually not a lot of room for the brain to swell and it runs into.
The skull and it can’t go any further unfortunately though down by the brain stem right here there’s a hole a cavity that the brain stem sits in and as the brain swells outwards it naegleria fowleri cases eventually runs into the skull and when it can’t swell outwards any more that tissue gets herniated downwards and when it herniates downwards.
It all herniates towards this hole and starts to compress some of the critical critical functions of our brain breathing movement regulation of our kind of cardio vascular system and that swelling of the brain is what leads to dea thin these cases of primary naegleria fowleri cases amoebic meningoencephalitis if we think about the name itself primary means that it’s the original infection amoebic is the amoeba Nigeria faleri as we talked about is.
An amoeba which is a parasite and then meningo Encephalitis meningo stands for meninges and meninges are the covering of the brain the brains covered by meninges and then Encephalitis and ceph stands for the part of the brain it’s kind of another word fore brain naegleria fowleri cases and then it is inflammation so it is essentially inflammation of the brain and covering of the brain caused by an amoebicprimary infection that’s.
cases
Why it’s called primary amoebic meningoencephalitisall right and in these cases unfortunately they’re almost all universally fatal there’s been very very few people that have survived this Florida Case, Total Cases, Geographic Locations, Mortality Rate infection which we’ll get into a little bit naegleria fowleri cases more in a second so the recent case the case that everyone’s talking about was in Charlotte County South west Florida.
It happened around February 23rd so just about one week ago and we know it was a man we don’t know much about him or his symptoms but he succumbed to his illness he did naegleria fowleri cases pass away he did die and unfortunately that is not that un common so this is from the CDC it is their graphic and in the United States between 1962 and 2022.
There have been 157 cases reported of nagleria faleri so it’s it’s massively uncommon this is in 60 years right so in 60 years 157 cases which translates to about two to three cases per naegleria fowleri cases year not a lot of cases at all what you have here is a map of the United States though and it has color coding for how many cases have occurred in each state since they started tracking them.
In 1962 and you can see the blue here is eight plus cases and California has had a plus cases ArizonaTexas Florida where the current case was and South Carolina so a lot of these naegleria fowleri cases southern states have had the most cases and that is because as we talked about negliophile likes warm and fresh water and obviously the most southern United States are going to be the warmer places and there’s plenty of fresh water down.
There you can see bordering that there’s four to seven cases in a lot of places things like Oklahoma Arkansas Louisiana Georgia North Carolina Virginia and then one to three cases Nevada New Mexico Nebraska Kansas Missouri we’re starting to kind of travel a little bit north most of the North east hasn’t had any cases at least reported you can see none there most of the Pacific naegleria fowleri cases North west and just Northern United States have not there has been a case reported in Minnesota though and that’s as far north.
That’s the farthest north that’s been reported which is the very top of the country so it can be in northern areas but it’s much more common in the Southern United States naegleria fowleri cases beyond the United States itself there actually have been 300 cases reported world wide so it’s not just in the United States there’s been cases reported on almost every continent obviously North America USA.
Mexico’s reported cases as well Australia has Europe has Asia has and Africa has but if we look at the total number reported cases and maybe this is just because we and we being the United States tests or tracks these cases most most closely I I don’t know that for sure but naegleria fowleri cases you can see a majority157 of the 300 cases worldwide are from the United States and whether that’s because we track and report them more or because.
They occur more commonly in the United States is unclear probably the former18:03: Symptoms the symptoms that people get are related both to the infection and the immune naegleria fowleri cases response right because we talked about how the amoeba itself does actually invade the brain it invades brain tissue it consumes and breaks down brain tissue but then there’s also this huge immune response that can cause brain swelling and the CDC puts.
The symptoms into two stages stage one is a severe front alheadache fever nausea and vomiting and this is alot like mening it is if you’ve heard about mening it is mening it is remember naegleria fowleri cases meninges are the covering of the brain it is is inflammation so inflammation of the covering of the brain mening it is can be caused by bacteria it can be caused by viruses there’s actually something known as aseptic mening it is it can actually be caused by fungi although.
It’s very rare viruses and bacteria are more common this would be like niceria meningitis meningitis from a niceria bacteria that commonly is in things like college students naegleria fowleri cases and Military recruits people in close quarters there’s West Nilemeningoencephalitis which is meningitis and Encephalitis there’s HSV herpes simplex virus.
There’s strep pneumonia meningitis lots of bacteria and virus can cause meningitis and these are the generic symptoms of meningitis and this happens because of a couple things one the nause a vomiting in the front alheadache are related and that is from naegleria fowleri cases the inflammation in the brain believe it or not when your intracranial pressure or your ICP your intracranial pressure starts to increase because of the inflammation on the brain.
causes
It causes nausea vomiting and frontal headaches those are symptoms of high intracranial pressure now nausea vomiting can be related to a lot of other things so confrontal headaches so those naegleria fowleri cases symptoms don’t necessarily mean you have higher intracranial pressure but it can be a symptom of that and then fevers because you have something infecting.
You stage two is then reported to be mostly stiff neck which is from inflammation of those meninges because believe it or not let’s see if we’re going to have trouble drawing this let’s see if we can draw a brain this is going to be a brain and you know it’s got all squiggles on it it goes into this brain stem and then it goes down into the spinal cord and if there’s a human with naegleria fowleri cases this brain you know you’d have some arms branching off around here you have legs down here.
This would be their back right that’s their back and then this would be their head they got a head in here so terrible drawing of a human but you get what I mean the neck is written in this region and if you have inflammation of the meninges the lining of the brain that actually travels all the way down the spinal cord there’s meninges on the spinal cord so.
If you were to bend your neck forward you would stretch these meninges and that would lead to pain so you could actually get neck stiffness because of the inflammation naegleria fowleri cases of those meninges if that makes sense and then these symptoms start to be because of the inflammation on the brain leading to more brain swelling you’ll start to get seizures confusion oraltered mental status you can hallucinate and eventually coma is the end stage preceding death.
The incubation period how long it takes from when you’re infected to when you show symptoms is pretty variable 1 to 12 days so if you were tobe infected it can be one to twelve days before you’d show any symptoms at all and after you show symptoms most people die within 1 to 18 days after symptomon set so still some variability with that being said the infection typically does move pretty quickly and that’s why it’s tough.
Because it’s so rare it’s not the first thing any doctor is probably going to think of so it takes a minuteto diagnose it and it moves really quickly so you have to start treatment super early if you want any chance of surviving but the diagnosis is often delayed because it’s such a rare disease how do you treat it do we have Treatment Of Parasite And Brain Swelling medications that can treat it do we have medications to help with the brain swelling well this is what’s currently out.
There the challenge with this as we said is it is such a rare disease with just those 157 cases in 60 years that there hasn’t been like a robust number of patients to figure out what treatments do work best but as we talked about the parasite and glorify with this suction cupsuctions onto the brain it invades the brain it causes inflammation the inflammation leads to brain swelling so there’s two separate kind of treatment approaches.
The first is actually trying to kill the parasite to kill the actual thing infecting the body and that uses these medications the names probably aren’t important but amphotericin B is a extremely potent drug that has a lot of side effects azithromycin is most classically known as an antibiotic although it has some anti-inflammatory properties fluconazoleis actually an anti-fungal Rifampin can be an antibiotic Milt ethazine we are unfamiliar with because you know luckily.
We’ve never had to treat an aggleriafaleri but per research it’s a newer part of the regimen and some people say that there’s been a few people who have survived in recent years and they often say that those that have survived it’s because of this meltophosine although unclear if that’s true if we scroll back up we’re going back up excuse us.
Here we go the four survivors so a 97 mortality rate with four survivors and a few of those survivors have been more recently I think two or three of them has been survivors have been in the last decade some also said sir thy verse that there might be a different strains of nuclear folarize some more serious than others just like Omicron covid-19 there’s different strains different variants same thing with parasites and nuclear to follower.
So maybe different strains have different levels of severity and then the second part of the management is the management of the actual inflammation and resulting brain swelling because that’s the most fatal complication is once the brain starts to swell as we talked about dexamethasone many of you are probably familiar with this is a steroid that theoretically will decrease inflammation and then this is really aggressive management of cerebral edema or brain swelling socerebral.
naegleria fowleri symptoms
Which is synonym for the brain and the nedema which is swelling so cerebraledema is you know what we would say at the hospital on round sum which means brain swelling and there’s lots of management strategies for cerebral edema that includes keeping your carbon dioxide levels a certain amount keeping your sodium your salt levels a certain amount different strategies with kind of decreasing metabolic activity et cetera et cetera beyond.
The levels of of this blog but there are medications even a newer medication that’s miltophosine that if given early enough May save someone’s life although again the mortality rate is still massively high at like 97 percent Pictures And Stages so here are just some pictures we thought this was interesting this is from the CDC website so this here is nakleria and fowleri and it’s taken from a sample of blood cells.
That’s what we see here we see these are all blood cells these to us look like neutrophils which are immune cells because that’s segmented nucleus that you can see righ there these are probably lymphocytes maybe B cells another type of immune cell although if anyone’s a pathologist out there you could correct us.
If we’re wrong and then this here is the parasite Nigeria fowleri and it’s in the person’s body traveling around looking for you know brain tissue or Central Nervous tissue interestingly though there’s actually different stages and this is very common for parasites again this is from the CDC website or the these are their images and parasites often have different stages and aglariophalori is no exception it actually has a cyst stage the cyst tends to be the toughest stage.
Where it’s the hardest to killatrophizoite stage and then aflagellated stage and flagellated refers to these right here flagella which actually help the parasite swim and humans are a dead end host meaning let’s erase some of our writing here so you can see this a little better meaning that there isn’t human to human transmission when it infects a human obviously will replicate in that human’s brain but then the parasite dies out so it doesn’t necessarily benefit from infecting Human.
It’s more of an incidental dead end host and same thing with animals animals if it travels up and animals nose actually can get this primary amoebic meningoencephalitis as well so we thought that was just kind of interesting show you some pictures of it preventing it this is Preventing something to think about although we really wanted to stress that this is an incredibly incredibly rare infection.
It’s possible to get it from swimming in warm bodies of water fresh water that is true but it is incredibly rare and millions and millions of people swim in warm fresh water many times and get it up their nose and they’re totally fine but if you were for some reason particularly concerned about this some preventative tactics especially the CDC and other organizations.
naegleria fowleri treatment
Proposes don’t sub merge your head in the water of Hot Springs because Hot Springs can be particularly wrought with naglerifolori again still incredibly rare limit the water entering their your nose some people propose plugging your nose nose Clips those types of things this third one though is probably something that people should just out of an abundance of caution really think about.
If you’re going to use one of these Neti Pots right these nutty pots are are the pots where you put water up the nose to try to clear the sinuses again we don’t recommend them necessarily but use sterile water clean water Neti Pots don’t just increase your risk for things like nuclear folarai it can increase your risk for central nervous system infections.
Just in general so probably reasonable to make sure to try to use sterile water and remember that Florida man who’s all over the news because unfortunately he just died used they think that he used a Neti Pot with tap water and that’s how he got it so Conclusion brain eating parasite niggleria fowleri let us know what thoughts comments questions.
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