Primary Amebic Meningoencephalitis Associated with Hot Spring Exposure During International Travel - Seminole County, Florida, July 2014

Primary amebic meningoencephalitis (PAM) is a rare, devastating infection of the brain caused by Naegleria fowleri, a free-living ameba found in warm, fresh water bodies throughout the world. Amoebae are aspirated into the nasal cavity through swimming, splashing, or nasal irrigation, and after attaching to the nasal mucosa, migrate across the cribriform plate to the brain via the olfactory nerves, causing extensive damage to the frontal lobes of the brain. In Aug 2013, miltefosine, an antiparasitic drug with activity against N. fowleri, became available from the Centers for Disease Control and Prevention as an investigational drug used for the treatment of free-living ameba infections in combination with other antimicrobial drugs. Here, Booth et al examine the case of a patient with PAM.