Infectious Disease Compendium



A free living fresh water amoeba. N. fowleri. (PLoS Review)

Epidemiologic Risks

Swimming in warm fresh water lakes. It runs up the 1st nerve through the cribriform plate and thence into the brain.

Most cases have come from the warm, wet Southern US as it grows best at 115 degrees and can be found in a variety of hot waters.

It can be found in tap water, including in the US (PubMed).

Thanks to global warming, it is now as far north as Minnesota, oh yeah sure doncha know (PubMed).

Washing out your sinus with a Netti pot with tap water is another way to get the bug into your brain (PubMed)(PubMed).

There was a case from a waterwater rafting park (PubMed).


Acute meningoencephalitis. Diagnose by seeing it wriggling in the CSF with a microscope.


It is mostly case reports of people throwing the amoebic kitchen sink at the bug.

Miltefosine plus hypothermia plus amphotericin b plus rifampin plus fluconazole?

If you have a patient with suspected free-living ameba infection, contact the CDC Emergency Operations Center at 770-488-7100 to consult with a CDC expert.


Most die. 143 cases, 4 survivors, those who live usually have extensive brain damage. It isn't pretty. But based on a few case reports perhaps early treatment with miltefosine and hypothermia (a thermophile, the cooler the body, the harder it will be for it to grow) will lead to a good outcome. Early is less than 36 hours.

Last update: 05/05/18