L & R: Trophozoites of N. fowleri in brain tissue, stained with H&E. Center: Ameboflagellate trophozoite of N. fowleri. Credit: DPDx
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Each summer we generally hear of one or two cases of Naegleria Fowleri infection – often called the `killer amoeba’ by the press – usually connected to swimming in warm, stagnant pools of fresh water. In mid-August, in 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.
Last week, a third case was reported in Louisiana, that of a 4-year-old Mississippi child visiting a St. Bernard Parish home, who (according to this NOLA.COM report) appears to have contracted the amoeba while playing on a slip-and-slide. The announcement from the Louisiana Department of Health & Hospitals follows:
DHH Confirms Death of a Child Associated with Rare Amoeba Found in St. Bernard Parish Home
Initial tests of parish water system negative for Naegleria fowleri, State and Parish taking precautions to protect the public
Thursday, September 5, 2013 | Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov
BATON ROUGE, La.—The federal Centers for Disease Control and Prevention (CDC) has confirmed that a child who died from encephalitis, caused by the Naegleria fowleri amoeba, contracted the illness while visiting a home in St. Bernard Parish, the Department of Health and Hospitals announced Thursday.
While water samples taken from the home tested positive for Naegleria fowleri, initial tests of the parish water system are negative for Naegleria fowleri. Because some DHH tests showed low levels of chlorine in some areas of the system, the parish is taking preventative measures to flush its water system and DHH will perform additional testing. These actions are being done out of an abundance of caution to ensure public safety.
Additional testing has been completed, and yesterday the Louisiana Dept of Health announced that Naegleria had been detected at four locations in the St. Bernard Parish’s water system.
CDC Confirms Rare Ameba in St. Bernard Water System
State health department says water is safe to drink, but urges residents to take precautions
Thursday, September 12, 2013 | Contact: Media & Communications: Phone: 225.342.1532, E-mail: dhhinfo@la.gov
BATON ROUGE, La.—Additional test results from the federal Centers for Disease Control and Prevention (CDC) confirm the presence of the rare ameba Naegleria fowleri in four locations of the St. Bernard Parish water system, the Louisiana Department of Health and Hospitals (DHH) announced Thursday.
DHH announced last week that the encephalitis death of a child that had visited St. Bernard Parish was connected to the rare ameba, which testing confirmed was present at the home. Because some water samples showed low residual levels of chlorine, DHH sent additional water samples to the CDC for testing last week and St. Bernard parish began flushing its water lines with additional chlorine last week, as a precautionary measure.
Assistant Secretary for Public Health J.T. Lane said, "We know that chlorine kills Naegleria fowleri, which is why it was critical that the parish proactively began flushing its water system with additional chlorine last week. The parish will continue this action until it raises chlorine residuals to recommended levels, and this process will continue for several weeks. DHH is working with parish officials to provide assistance and support to the parish's staff to ensure that chlorine levels are being monitored daily."
State Health Officer Jimmy Guidry said, "The water is safe to drink and there are basic precautions that families can take -- such as chlorinating their pools and avoiding getting water in their noses -- to protect themselves, though infection from this ameba is very rare."
While the water is safe to drink, there is a risk if the ameba enters their nose. There are basic precautions that families can take -- such as chlorinating their pools and avoiding getting water in their noses -- to protect themselves, though infection from this ameba is very rare."
Today's confirmation is from four sites located in Violet and Arabi. DHH scientists pulled samples from hydrants and faucets that connected directly to the water lines. Hundreds of liters of water were filtered in order to capture any amebas that might be present in the water.
Naegleria fowleri is a rare infection that has been associated with three deaths traced to water in Louisiana since 2011. Two people died in 2011, in addition to the death being announced last week. The CDC confirmed that Naegleria fowleri was the cause of the death after specialized testing was conducted.
PRECAUTIONARY MEASURES FOR FAMILIES
According to the CDC, personal actions to reduce the risk of Naegleria fowleri infection should focus on limiting the amount of water going up a person's nose and lowering the chances that Naegleria fowleri may be in the water. For information on preventative measures, please visit the CDC Website here: http://www.cdc.gov/parasites/naegleria/prevention.html
To prevent any risk when using drinking water, make sure water does not go up your nose. Some common sense suggestions from the CDC include:
- DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools.
- DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools) - walk or lower yourself in.
- DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
- DO run bath and shower taps and hoses for 5 minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level.
- DO keep small hard plastic/blow-up pools clean by emptying, scrubbing, and allowing them to dry after each use.
- DO use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
- DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means:
- Pools: free chlorine at 1-3 parts per million (ppm) and pH 7.2-7.8
- Hot tubs/spas: free chlorine 2-4 parts per million (ppm) or free bromine 4-6 ppm and pH 7.2-7.8
- If you need to top off the water in your swimming pool with tap water,
- DO place the hose directly into the skimmer box and ensure that the filter is running.
- DO NOT top off by placing the hose in the body of the pool.
Although the primary route of infection is from swimming in shallow, warm, (usually stagnant) fresh-water lakes and streams, in 2011 we saw a couple of cases in Louisiana related to the use of Neti Pots for nasal irrigation (see FDA Advice On Safe Use Of Neti Pots).
Photo Credit FDA
Daily nasal irrigation is also practiced by many in the Muslim community, and that has led to dozens of deaths in recent years in Karachi, Pakistan where tap water standards are suspect. This recent report from last June:
Another man dies due to naegleria fowleri
KARACHI: The deadly waterborne infection, which is caused by an amoeba Naegleria fowleri claimed another life in the city on Saturday. With this case, the death toll, caused by this fatal infection, is now three since January 2013.
Last year, we saw Pakistan: Naegleria Fowleri Blamed For 10 Deaths, while in 2011, the CDC’s EID journal carried the following dispatch on a much bigger outbreak:
Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan
Sadia Shakoor, Mohammad Asim Beg, Syed Faisal Mahmood
, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali, Govinda S. Visvesvara, and Afia Zafar
Abstract
We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.
While the risks of developing PAM (primary amebic meningoencephalitis) from the use of a Neti pot is very low, given this infection is almost always fatal, it makes sense to follow the FDA’s advice to boil the water first.
Last month, in MMWR: CDC Imports Investigational Drug For Amoebic Infections, we learned that the CDC was making available an experimental drug for the treatment of PAM. While there’s not a lot of history of using this drug to treat these infections, the CDC believes there is enough evidence that it provides a `survival advantage’ to have imported the drug for this use.
The State of Florida has a 1-minute PSA on this amoebic threat, which you can view below.
The Florida Department of Health offers some additional common sense safety advice on how to avoid this parasite.
Photo Credit – Florida DOH
For more information on the Naegleria parasite, you can also visit the CDC’s Naegleria webpage.
