Naegleria fowleri is an amoeba that lives predominately in warm freshwater. Naegleria fowleri is acquired by people when infected water is forcibly aspirated into the nose. This can occur through recreational swimming, diving, or during sports like water skiing. Once acquired, the amoeba travels into the brain, causing primary amoebic meningoencephalitis (PAM).
The most distressing aspect is that the fatality rate has remained more than 95%. there have been 133 PAM infections from 1962 through 2014 with only three survivors. PAM cases were reported in the developed countries in people who swim in fresh water during the hot summer months. However, prolonged hot and dry periods due to global warming are causing higher freshwater temperatures.
The macrolide antibiotic azithromycin is effective against Naegleria species in vitro and in murine models, but it has been reported to have poor CSF penetrance. Other antimicrobials include clotrim azole, itraconazole, fluconazole, and ketoconazole, with their efficacy. An investigational drug called miltefosine (Impavido) is now available for emergency treatment of naegleria infection.