Alternative Treatment For Naegleria Infection

Naegleriasis is well-known as “brain-eating amoeba”. The disease is rare and highly fatal in children, young adult, and immune-compromised patients. The literature says Naegleriasis has only a few survivors. More than 40 species of the genus Naegleria have been identified using molecular techniques, in which N. fowleri is the only species associated with human disease. The pathogens are free-living amoebae (FLA) survives by feeding on bacteria, fungi, and algae. It exists in lakes, rivers, swimming pools, hot spring, geothermal water, and discharge from industrial plants.

Pathogenesis

Naegleria fowleri proliferates mostly during the month of summer in warm and polluted stagnant water bodies or even in fresh aquatic environments. It will not survive in seawater as it has high salinity. It enters the central nervous system after insufflation of infected water by attaching itself to the olfactory nerve. It then migrates through the cribriform plate and into the olfactory bulbs of the forebrain, where it multiplies itself greatly by feeding on nerve tissue.

At present, the use of antimicrobials in infected individuals is the best treatment for Naegleriasis. As early diagnosis and therapy are critical, laboratory technicians must be able to quickly identify amebae on CSF specimens. Prompt initiation of a regimen including conventional amphotericin, fluconazole, azithromycin, and rifampin is recommended.

Treatment like hypothermia advantageous as it decreases the fever to some extent, but only a few cases have seen success.

So far, no strong evidence or report on herbs or any other alternative treatment regimen stated for Naegleriasis.⁽¹⁾

Herbs For Naegleriasis

Bashyal et al., 2017 reported Larrea tridentata, a well-known as creosote bush, as a novel source for secondary metabolites that display antiparasitic activity against Naegleria fowleri pathogens.⁽²⁾ Similarly, Mafalda Jesus et al., 2016 reported diosgenin, a steroidal sapogenin, occurs abundantly in plants such as Dioscorea alata, Smilax China, and Trigonella foenum graecum. He specified the antiamebic activity of diosgenin against Naegleria fowleri trophozoites at the cellular and molecular levels. Some herbs can interact with prescription or over-the-counter medicines. Hence, research on herbal medicinal products for Naegleriasis must be encouraged.⁽³⁾

Current Treatment Options

Anti-microbial therapy is required for many days to treat the brain edema. To be effective, treatment should be started early, but until a drug with specific activity against the organism suitable for use by a parenteral route and with the ability to reach therapeutic levels in brain tissue is found, successful treatment is unlikely.

Anti-Microbial Therapy

Amphotericin B has a minimal amoebicidal concentration of 0.01 μg/ml against N. fowleri. In vitro studies have shown that an amphotericin B (intrathecal and intravenous amphotericin B) concentration of at least 0.1 μg/ml was needed to suppress greater than 90% of growth, while 0.39 μg/ml was needed to completely suppress amoeba proliferation. Other anti-infective which have been used in case reports include fluconazole, miconazole, miltefosine, azithromycin, and rifampin. Various other agents have been studied in vitro and in vivo, including hygromycin, rokitamycin, clarithromycin, erythromycin, roxithromycin, and zeocin. The CDC has made miltefosine available on a need basis through an investigational new drug (IND) protocol for the treatment of infections caused by free-living amoebas, which include N. fowleri, Balamuthia mandrillaris, and Acanthamoeba species.

Conclusion

Rapid identification of amebae on CSF specimens followed by prompt initiation of a regimen including conventional amphotericin, fluconazole, azithromycin, and rifampin can save the infected patients. Hypothermia is advantageous, but only a few cases have seen success. Larrea tridentate and diosgenin has antiparasitic activity against Naegleria fowleri. However, much research studies are required on herbal medicinal products for Naegleriasis treatment.

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Alternative Treatment For Naegleria Infection

Pathogenesis