THE RISING THREAT OF NAEGLERIA FOWLERI: A SYSTEMATIC REVIEW OF RECENT TRENDS, MOLECULAR MECHANISMS, AND TREATMENT STRATEGIES (2020-2025)

Abstract

The thermophilic amoeba Naegleria fowleri, which can live independently, is normally located in hot freshwater and is responsible for a disease named Primary Amoebic Meningoencephalitis (PAM), a quick and nearly always lethal infection of the central nervous system. The present review critically updates the global distribution, molecular mechanisms, and treatment options of PAM during the period of 2020-2025.

A thorough literature search of the databases like PubMed, Scopus, and Web of Science was carried out by giving in-depth focus to peer-reviewed articles, case reports, and clinical trials conducted within this timeframe. The synthesis of our findings indicates a considerable geographical change in the occurrence of PAM cases, with South Asia, especially Pakistan and India, being the new hotspot, a transition that is closely linked to climate change and water management practices. In parallel, molecular studies have been yielding new knowledge of pathogenesis through multi-omics approaches and studying unique virulence factors and host-pathogen relations. The use of metagenomic next-generation sequencing (mNGS) has been excellent in aiding the diagnosis of PAM, while rapid confirmation has been made possible through its use. On the other hand, a shift from amphotericin B monotherapy to a combination of antifungal drugs, including miltefosine, has been one of the factors contributing to the improved survival in several recent cases, while the promise of nanoparticle-based drug delivery and AI-assisted therapies is also on the cards among the experimental strategies that are being looked at. In conclusion, PAM has unveiled many secrets, but it remains a very hard disease to fight against. A persistent struggle will demand a multipronged approach and, as such, the urgent need for raising public awareness, the establishment of a robust environmental monitoring system, and the continuous search for new diagnosis and treatment methods will be among the priorities.