Credit CDC
# 8710
While exceedingly rare in the United States, nearly every summer we hear of one or two (almost always fatal) infections with Naegleria Fowleria, the so-called `brain eating amoeba’. Last year, in mid-August (see Florida Reports Naegleria fowleri Infection) we learned of an 12-year-old boy with the infection, and in July (see Arkansas: Naegleria fowleri Shuts Water Park) the victim was a 12-year-old girl.
Although most infections occur while swimming in warm, freshwater lakes and streams, last year we saw a 4 year-old infected in Louisiana, through contact with the municipal water supply. Subsequently we saw the St. Bernard Parish Water Supply Tests Positive For Naegleria Fowleri, which prompted an increase in chlorination.
Although usually only a danger to swimmers, in 2011 we saw a new wrinkle when 2 people in Louisiana became infected through the introduction of tap water into their sinuses using a neti pot. These incidents caused the Louisiana Health Department to recommend that people `use distilled, sterile or previously boiled water to make up the irrigation solution’ (see Neti Pots & Naegleria Fowleri).
Photo Credit FDA
The bottom line is that after introduction of this Free Living Amoeba (FLA) into the nasal passages, it makes a direct bee line to the brain, where is causes PAM (Primary Amebic Meningoencephalitis). Up until recently, there was little that could be done for someone infected, and the illness was almost always fatal.
Last year, however, the CDC announced:
Clinicians: CDC now has an investigational drug called miltefosine available for treatment of free-living ameba (FLA) infections caused by Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba species. If you have a patient with suspected FLA infection, please contact the CDC Emergency Operations Center at 770-488-7100 to consult with a CDC expert regarding the use of this drug.
Although most cases of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri infection in the United States have been fatal (129/132 in the U.S., 1), there have been four well-documented survivors in North America: one in the U.S. in 1978 2, 3, one in Mexico in 2003 4, and two additional survivors from the U.S. in 2013. It has been suggested that the original U.S. survivor’s strain of Naegleria fowleri was less virulent, which contributed to the patient’s recovery. In laboratory experiments, the original U.S. survivor’s strain did not cause damage to cells as rapidly as other strains, suggesting that it is less virulent than strains recovered from other fatal infections 5.
Remarkably, after 35 years without seeing a survivor in the United States, last year two children survived this infection. The CDC describes their outcomes:
The first, a 12-year-old girl, was diagnosed with PAM approximately 30 hours after becoming ill and was started on the recommended treatment within 36 hours. She also received the investigational drug miltefosine 6-8 and her brain swelling was aggressively managed with treatments that included cooling the body below normal body temperature (therapeutic hypothermia). This patient made a full neurologic recovery and returned to school. Her recovery has been attributed to early diagnosis and treatment and novel therapeutics including miltefosine and hypothermia.
A second child, an 8-year-old male, is also considered a PAM survivor, although he has suffered what is likely to be permanent brain damage. He was also treated with miltefosine but was diagnosed and treated several days after his symptoms began. Cooling of the body below normal body temperature was not used.
Naegleria infection happen almost anywhere, but in the United States is most common in the warmer southern states. Every year the State of Florida issues warnings to people on how to avoid this rare, but deadly, parasite.
This from the Florida DOH.
FOR IMMEDIATE RELEASE Contact: Communications Office
June 4, 2014 (850) 245-4111
THE FLORIDA DEPARTMENT OF HEALTH REMINDS RESIDENTS OF THE DANGERS OF NAEGLERIA FOWLERITALLAHASSEE -The Florida Department of Health cautions those who swim frequently in Florida’s lakes, rivers and ponds during warm temperatures about the possible presence of Naegleria fowleri. Contact with this amoeba is rare, but the organism targets a person’s brain and usually results in death. Adverse health effects on humans can be prevented by avoiding nasal contact with the waters, since the amoeba enters through the nasal passages. Though there are only 34 reported casesin Florida since 1962, Naegleria fowlerican cause Primary Amebic Meningoencephalitis(PAM) disease which usually leads to death once infected. As a precaution, health officials recommend the following:
- Avoid water-related activities in bodies of warm freshwater, hot springs and thermally polluted water such as water around power plants.
- Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
- Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
- Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.
- Please note exposure to the amoeba may also occur when using neti pots to rinse your sinuses of cold/allergy-related congestion or conducting religious rituals with tap water.
- Use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
If you experience any of these symptoms after swimming in any warm body of water, contact your health care provider immediately:headache, fever, nausea, disorientation, vomiting, stiff neck, seizures, loss of balance, or hallucinations. It is essential to seek medical attention right away, as PAM usually becomes fatal within five days of exposure.
Remember, this disease is rare and effective prevention strategies can allow for a safe and relaxing summer swim season.
For more information on the Naegleria parasite, you can also visit the CDC’s Naegleria webpage.
