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Pathogenicity of Naegleria
A few Naegleria species have been shown to be pathogenic in humans
and animals most notably N. fowleri. This amoeba is a facultative
pathogen capable of living many generations without infecting a
host. Trophozoites are thought to enter the nose during swimming in
warm water and thereafter the brain by locomotion and destruction of
neurons. N. fowleri causes Primary Amoebic Meningoencephalitis (PAM)
in man Naegleria fowleri posesses secreted proteases (Ferrante &
Bates, 1988), phospholipases (Fulford et al, 1985; Barbour &
Marciano-Cabral, 2001), and pore-forming peptides (Herbst et al,
2002), all of which have been implicated in the pathogenic process.
Although man can act as a host, this occurs so infrequently that we
are very unlikely to be the primary host. This host (if indeed
there is one) has not yet been clearly identified, but many any
other mammals have been reported to be infected or infectable.
These include; mice, cotton rats, squirrels, muskrats (John & Hope,
1990), guinea pigs (Culbertson et al, 1972), and sheep (Young et al,
1980). Many wild animals (but not all) have significant titres of
Naegleria reactive antibodies suggesting that they come into contact
with this group (Kollars & Wilhelm, 1996). It is possible that the
main host are fish as these are frequently found to be parasitized
by Naegleria and other amoebae (especially the gills).
Invertebrates too cannot be ruled out as snails, amphibians and
reptiles are also associated with Naegleria (Franke & Mackiewicz,
1982).
As in other amoebae there is a strong correlation between temperature tolerance and pathogenicity of Naegleria species (Griffin, 1972). Naturally, any amoeba that lives within a human host must be able to survive the normal 37oC and elevation above this that occurs in disease associated fevers. The majority of human PAM cases are caused by Naegleria fowleri which can grow at temperatures as high as 45oC. N. fowleri and other temperature tolerant Naegleria sp. multiply in bodies of water both natural and man-made that are warm. Most PAM cases where Naegleria is involved have been caused by swimming or other intimate contact with these waters and the introduction of the amoebae is assumed to be via the nose. However there have been at least three cases have been documented where no such association has been made (Lawande et al, 1979; Sugita et al, 1999; Shenoy et al, 2002).
Treatment of Primary Amoebic Meningoencephalitis (PAM)
Of the 300 or so cases of this disease world-wide, only seven or so
have been survived (Jain et al, 2002). The drug of choice has been
amphotericin B (Anderson & Jamieson, 1972;Seidel et al, 1982;Jain et
al, 2002 ) it is usually given intravenously at 1mg/kg/day (see
Shenoy et al, 2002). In the cases where patients have survived
early diagnosis has been crucial. Symptoms are generally like
bacterial meningitis but with no bacteria in the cerebrospinal
fluid, the presence of amoebae can however be detected by
observation of the CSF under a microscope. The incubation period is
usually between 3 and 8 days and the patient usually dies 7-10 days
after infection (Butt, 1966; Anderson & Jamieson, 1972; Barnett et
al, 1996).
Molecular Biology of Naegleria
The nucleus of Naegleria is similar in overall structure to a number
of protists in that the nucleolus is very prominent (Figure 1).
Although the ploidy (how many copies of the genome exist in the
nucleus) of Naegleria is not known it is suspected that it is
polyploid (Clarke et al, 1990). There are about 23 chromosomes with
total genome of about 104 Mb (Clarke et al, 1990). The most
remarkable thing about the molecular biology of Naegleria is that
the rRNA genes are carried on a 14 Kb plasmid present as a
multi-copy (4,000) episome! (Clark & Cross, 1987). These circular
plasmids are a feature of the Vahlkampfiid amoeba (Clark & Cross,
1988) and are easily isolated from the amoeba (click here for
method).
Classification of Naegleria species
Many different strains of Naegleria have been isolated and most
described as belonging to the N. gruberi groups, however molecular
analysis indicates that these are not monophylectic and the genus
has now been reclassified into some 24 species (this number will
soon expand). In order to simplify the classification, only the
current situation will be discussed based on molecular data (usually
5.8S rDNA or SSUrDNA gene data). See (De Jonckheere 2002) for
details.
Amoeba to Flagellate transformation.
The flagellate stage is presumed to be a mechanism whereby
Naegleria can colonies new regions rapidly by swimming rather
than by crawling. One of the stimuli for this to occur is by
dilution of the culture media which may imitate rainfall?
Certainly, Naegleria flagellates are to be found in puddles
after heavy rain.