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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Two serious summer-time related infections are often linked to recreational swimming; Cryptosporidium and PAM (Primary Amoebic Meningoencephalitis) associated with Naegleria fowleri infection. Of the two, Cryptosporidium is by far the most common, but PAM (until recently) has been considered almost invariably fatal.
Nearly every summer we follow sporadic cases of both (see Naegleria Fowleri: Rare, Deadly & Avoidable & Tales From The Crypto), but this year, there is important news regarding the treatment of PAM.
Last year, for the first time in 3 decades, we saw survivors of PAM in the United States – two children – who had received an investigational drug called miltefosine. Last year 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.
But to be effective, this infection must be recognized early, and treatment initiated as soon a possible. Hence the need to get the world out to clinicians on this important development.
Next week the CDC will hold a COCA (Clinician Outreach Communication Activity) call for clinicians on both Cryptosporidium and Naegleria. While primarily of interest to clinicians, others in health-related fields may find these web events of interest as well. Details follow:
Healthy Swimming: Prevent and Treat Infections Caused by Brain-Eating Amebas and Chlorine-Tolerant Parasites
Date:Thursday, June 19, 2014
Time:2:00 – 3:00 PM (Eastern Time)
Dial:888-233-9077 (U.S. Callers)
773-799-3915 (International Callers)Passcode:4972213
Webinar:https://www.mymeetings.com/nc/join.php?i=PW2017964&p=4972213&t=c
Presenter(s)
Jennifer Cope, MD, MPH
Medical Epidemiologist
Waterborne Disease Prevention Branch
National Center for Emerging and Zoonotic Infectious Diseases ─ CDCMichele Hlavsa, RN, MPH
Epidemiologist
Waterborne Disease Prevention Branch
National Center for Emerging and Zoonotic Infectious Diseases ─ CDCOverview
Swimming and other water-related activities are popular during the summer. However, Naegleria fowleri, known as the brain-eating ameba, may be present in warm freshwater and can result in primary amebic meningoencephalitis (PAM) – a rare disease that is almost always fatal. Additionally, the chlorine-tolerant parasite Cryptosporidium, is one of the most frequent causes of waterborne disease among humans in the United States. During this COCA call, clinicians will learn about PAM and diarrhea resulting from Cryptosporidium, how to prevent these diseases, and what to do if you suspect your patient has one of them.
Objectives
At the conclusion of the session, the participant will be able to accomplish the following:
- Describe the epidemiology, clinical features, diagnostic testing, and treatments available
- Discuss the steps that can be taken to prevent PAM and cryptosporidiosis
- State the protocol for contacting CDC to obtain clinical consultation, diagnostic testing, and the investigative drug miltefosine for treatment of PAM caused by Naegleria fowleri
Additional Resources
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And for more on Cryptosporidium, you may wish to revisit these blogs:
Eurosurveillance: More Tales From The Crypto
More Tales From The Crypto
UK: Return To The Crypto
