Sunday, May 29, 2016

Avoiding Naegleria


Each summer we see a handful of tragic deaths – mostly of children – due to a nearly always fatal condition called PAM (Primary amebic meningoencephalitis), caused by a brain infection from an amoebic parasite called Naegleria fowleri.

Dubbed the `brain eating amoeba' by the press, this parasite enters the brain through the nasal passages, usually due to the forceful aspiration of water (containing the amoeba) into the nose. 

Until a few years ago, nearly all of the Naegleria infections reported in the United States were linked to swimming in warm, stagnant freshwater ponds and lakes (see Naegleria: Rare, 99% Fatal & Preventable), making this pretty much a summer time threat.

In 2011, however,  we saw two cases reported in Neti pot users from Louisiana, prompting 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).

While extraordinarily rare in the United States, every year Pakistan reports a dozen or more infections from this `killer amoeba’, as chlorination of their water supplies is often inadequate, and for many, nasal ablutions are part of their daily ritual. 

Unusually, in 2013 we saw a 4 year-old  infected through contact with a municipal water supply while visiting St. Bernard Parish, Louisiana.  Since then testing has revealed Naegleria in a number of municipal water supplies across the state of Louisiana (see Louisiana: 2nd Public Water System Reports Naegleria).

And just last month we looked at an MMWR: Epidemiological Investigation Into A Case Of Primary Amebic Meningoencephalitis  in California which suggested a poorly chlorinated spring-fed swimming pool was the likely source of infection and death of a 21 year old woman.  

This was also an unusual finding, and furthers the recent pattern of seeing PAM cases arise from atypical settings (Northern states, via neti pots and municipal water supplies, etc.) in the United States.

Up until a recently, infection with Naegleria fowleri was universally fatal, but in 2013 an investigational drug called miltefosine was used successfully for the first time to treat the infection.  Early diagnosis, and administration of this drug, are crucial however.

Even with this new drug, prevention is the key to saving lives, and leading the charge in educating the public is, a USF Philip T. Gompf Memorial Fund project, which was set up by a pair of Florida doctors who tragically lost their 10 year-old son to this parasite in 2009.  

Their twitter account -  @AmoebaSeason - is promoting Healthy and Safe Swimming Week 2016  all this week, which will culminate with with a twitter `Thunderclap' on May 31 at 4:00PM EDT urging the CDC to make brain amoeba infection reportable.

I'm hoping some of my readers will join in. 

In the meantime, their website offers a wealth of information on the amoeba, and some important safety advice to avoid this waterborne threat.

For some of my earlier blogs on Naegleria you may wish to revisit:

A Reminder About Naegleria
Reminder: COCA Call Today On Naegleria Fowleri & Cryptosporidium
MMWR: CDC Imports Investigational Drug For Amoebic Infections

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