Naegleria fowleri: emerging therapies and translational challenges

Introduction
Naegleria fowleri is a rare but fatal free-living ameba with > 97% mortality rate. Despite advances in clinical and scientific understanding, therapeutic options remain limited, and diagnosis is often delayed, presenting significant public health challenges.

Areas covered
We reviewed recent literature from the last decade, using Google Scholar and PubMed on N. fowleri treatment, emerging drug candidates, repurposed therapeutics, and innovative delivery strategies. Advancements in drug screening are highlighted, unveiling novel therapeutic targets and mechanisms of action. Additionally, the role of climate change and environmental factors in geographic expansion and increased incidence of infections is explored, posing a growing public health risk.

Expert opinion
Effective management of N. fowleri infections hinges on early detection and addressing research gaps, particularly in understanding transmission/disease mechanisms. Recent advances in therapeutics, diagnostics, and water treatment to reduce environmental contamination by N. fowleri show promise for lowering infection risk and improving outcomes for primary amebic meningoencephalitis. Collaboration among academic institutions, pharmaceutical companies, and water industries is essential, with research advancing treatments and vaccines, and water industries contributing by reducing environmental contamination/human exposure to N. fowleri. A combination of treatment strategies and stringent surveillance will be crucial to limit future outbreaks and improve patient prognosis.