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Among various genera of free-living amoebae prevalent in nature, some members are identified as causative agents of human encephalitis, in which  Naegleria fowleri  followed by  Acanthamoeba  spp. and  Balamuthia mandrillaris  have been successively discovered. As the three dominant genera responsible for infections,  Acanthamoeba  and  Balamuthia  work as opportunistic pathogens of granulomatous amoebic encephalitis in immunocompetent and immunocompromised individuals, whereas  Naegleria  induces primary amoebic meningoencephalitis mostly in healthy children and young adults as a more violent and deadly disease. Due to the lack of typical symptoms and laboratory findings, all these amoebic encephalitic diseases are difficult to diagnose. Considering that subsequent therapies are also affected, all these brain infections cause significant mortality worldwide, with more than 90% of the cases being fatal. Along with global warming and population explosion, expanding areas of human and amoebae activity in some regions lead to increased contact, resulting in more serious infections and drawing increased public attention. In this review, we summarize the present information of these pathogenic free-living amoebae, including their phylogeny, classification, biology, and ecology. The mechanisms of pathogenesis, immunology, pathophysiology, clinical manifestations, epidemiology, diagnosis, and therapies are also discussed.

Various brain-eating amoebae: the protozoa, the pathogenesis, and the disease