Aquatics: A Boon or Bane under the Shadow of Naegleria fowleri:A Meta-analysis and Systemic review

Abstract

Water sports activities during hot summer seasons attract all age groups specially children and young adult. Same season acts favorably for multiplication of Naegleria fowleri in stagnant or slow moving water and exposure will lead to highly fatal Primary Amoebic Meningoencephalitis. Naegleria fowleri travels from nasopharyngeal mucosa to brain to cause highly fatal disease. In-spite of more than 300 cases reported worldwide the figure is still underreported or erroneously reported due to Clinical & Biochemical similarity with Acute Bacterial Meningitis. Radiological finding CT or MRI scan are also initially normal for initial 2 days and unable to differentiate between bacterial or parasitic meningoencephalitis. Diagnosis of low surviving disease depend mainly on Microscopy/Giemsa staining, which can be confirmed by amoebic culture, PCR and gene sequencing with the help of reference center (CDC). Treatment can be intravenous and/or intrathecal Amphotericin-B, Rifampicin and Fluconazole. Miltefosine shows some promising results but not found satisfactory. So, prevention is the only hope to fight with Naegleria fowleri infection, which needs to be looked at seriously by concerned authorities, especially in developing countries. A total of 29 articles selected for meta-analysis study from Pubmed & Google Scholar. Surprising water exposure history found in many article that included enjoyment in Water-Splashing Festival, bathing in pond & unchlorinated water, religious nasal cleaning practice with contaminated water, accidental fall in river with remain submerged for long time and many more, were results in fatal Primary Amoebic Meningoencephalitis. This review cover clinical management of the cases of Primary Amoebic Meningoencephalitis as well as more important it’s preventive aspect which include identification of source of Naegleria fowleri, restricted activity with public awareness about unknown dangers of fatal disease acquired during enjoyment, which was missed by some authors.