Primary amoebic meningoencephalitis: discovery and understanding of a novel disease.

Abstract

Primary amoebic meningoencephalitis (PAM) or "brain-eating amoeba disease" is a relatively rare but typically fatal infectious disease of increasing global concern. Discovery of PAM and that Naegleria fowleri is the causative agent responsible are frequently credited to a paper published by the Australian pathologists Malcolm Fowler and Rodney F. Carter in 1965. It was significant as confirmation of an earlier suspicion that free-living, non-parasitic amoebae may be opportunistic pathogens of the human central nervous system. Like many discoveries, however, the historical details are rather more complicated and involved a number of researchers and clinicians working over a decade from 1958 to 1971. Philosophical accounts of scientific discovery since Kuhn (Science, 136, 760-764, 1962) agree that discovery requires both recognition that something exists and understanding what it is. But there is little agreement about how much or what kind of understanding is required. This paper (i) excavates the complex array of observations, inferences, experiments, re-evaluations, and public statements by a number of scientific researchers and physicians that collectively resulted in the recognition of PAM as a novel form of central nervous system infection caused by a novel species of free-living amoeba; and (ii) considers how well several recent accounts of discovery apply to these achievements.