Primary Amebic Meningoencephalitis (PAM)

Primary Amebic Meningoencephalitis (PAM) is a rare and often deadly disease caused by the protozoan parasite Naegleria fowleri. This amoeba is commonly found in warm freshwater environments, such as lakes, rivers, and hot springs, as well as in soil and contaminated water.

Symptoms

The symptoms of PAM typically begin within 1-9 days after exposure to the parasite and may include:

• Fever
• Headache
• Nausea and vomiting
• Stiff neck
• Confusion
• Seizures
• Loss of balance and coordination
• Personality changes, such as irritability or restlessness

Cause and Transmission

PAM is caused by the Naegleria fowleri parasite, which enters the body through the nasal passages when contaminated water is inhaled. The amoeba then migrates to the brain via the olfactory nerve, where it begins to multiply and cause damage.

The most common ways to become infected with PAM include:

• Swimming or diving in warm freshwater lakes, rivers, or hot springs
• Using contaminated water for nasal irrigation or other medical procedures
• Exposure to contaminated soil or water during activities such as gardening or construction work

Treatments

Treatment for PAM typically involves a combination of medications and supportive care. The most commonly used treatments include:

• Amphotericin B: an antifungal medication that is also effective against Naegleria fowleri
• Miltefosine: an antiprotozoal medication that has been shown to be effective in treating PAM
• Rifampicin: an antibiotic that may be used in combination with other medications to treat PAM
• Supportive care, such as hospitalization, respiratory support, and management of seizures and other symptoms

Prevention

To reduce the risk of contracting PAM, it is recommended to:

• Avoid swimming or diving in warm freshwater lakes, rivers, or hot springs, especially during periods of high water temperature
• Use sterile or distilled water for nasal irrigation and other medical procedures
• Avoid stirring up sediment while swimming or engaging in water activities
• Wear a nose clip when swimming or diving to reduce the risk of inhaling contaminated water

Prognosis

The prognosis for PAM is generally poor, with a mortality rate of approximately 95%. However, prompt treatment and supportive care can improve outcomes, and some patients have been known to survive the disease.