A Comprehensive Narrative Review of Naegleria fowleri Infections: Emerging Epidemiology, Molecular Pathogenesis and Therapeutic Advances (2020-2025)

Abstract

Aim: The heat-loving amoeba “Naegleria fowleri” is responsible for Primary Amoebic Meningoencephalitis (PAM), an infection in the central nervous system that almost always leads to death within a few days. This comprehensive narrative review painstakingly integrates the main findings of the above-mentioned PAM research areas from January 2020 to September 2025. Methods: The literature search that we organized was systematic on PubMed/MEDLINE, Scopus, and Web of Science and was predominantly directed to peer-reviewed articles, case reports, and clinical trials published between January 2020 to September 2025. It was a narrative review and not a formal systematic review. Results: Our synthesis indicates that there has been a huge change in the epidemiology of the disease and that the South Asian region is the new hot spot for PAM cases. With the application of multi-omics approaches, molecular studies have not only discovered new virulence factors but also determined the interactions between the host and the pathogen. Metagenomic next-generation sequencing (mNGS) has drastically reduced the time taken for diagnosis and accuracy. On the therapeutic side, combination treatments consisting of amphotericin B and miltefosine have increased the survival rates to about 50-70% if the intervention is done early. Nanoparticle-based drug delivery and AI-assisted drug discovery are two of the future research directions. Conclusion: PAM continues to be a major challenge in the field of public health. The proper control of the disease would involve the introduction of new monitoring techniques, conducting public awareness campaigns, and research on rapid diagnostics and new treatments being done constantly.