Avian Flu Diary: NCDHHS: A Fatal Case of Naegleria fowleri In North Carolina

http://www.cdc.gov/parasites/naegleria/pdf/naegleria-state-map-2015.pdf

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Early each summer we take a look at a rare, mostly fatal brain infection caused by free living amebas (Naegleria fowleri) that inhabit warm, fresh water (see A Reminder About Naegleria Season - 2019).

Since 1962 more than 140 cases have been reported in the United States, primarily (but not exclusively) in the southern tier of states (see map above).

Dubbed the `brain eating amoeba' by the press - this infection is called PAM (Primary amebic meningoencephalitis) - and occurs when the amoeba enters the brain through the nasal passages, usually due to the forceful aspiration of contaminated water into the nose.

We generally only hear about 3 or 4 cases in the United States each summer, but in 2017 a research letter written by epidemiologists at the CDC (see EID Journal: Estimation of Undiagnosed Naegleria fowleri (PAM), United States) estimated the yearly number PAM cases in the United States probably averages closer to 16 (8 males, 8 females).

Meaning that right now, 70%-80% likely go unrecognized.

Yesterday the North Carolina Department of Health & Human Services announced a fatal case linked to swimming at a water park two weeks ago.

Rare Brain Infection, Death Linked to Swim in a Cumberland County Lake

Raleigh
Jul 25, 2019

Public health officials with the North Carolina Department of Health and Human Services and the Cumberland County Department of Public Health are reporting that an individual died after developing an illness caused by an amoeba that is naturally present in warm freshwater during the summer. The individual became ill after swimming in Fantasy Lake Water Park in Cumberland County on July 12, 2019.

Laboratory testing at the federal Centers for Disease Control and Prevention confirmed the individual’s illness was caused by Naegleria fowleri, an amoeba (one-celled living organism) commonly found in warm freshwater. Naegleria fowleri, referred to as the brain-eating amoeba, does not cause illness if swallowed but can be fatal if forced up the nose, as can occur during diving, water-skiing or other water activities.

These rare infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels. Symptoms of Naegleria fowleri infection start with severe headache, fever, nausea and vomiting and progress to stiff neck, seizures and coma.

Local health officials are working with the water park to provide guidance and education about the presence of Naegleria fowleri and how to take precautions when in natural bodies of freshwater.

"Our sympathies are with the family and loved ones," said State Epidemiologist Zack Moore, M.D. "People should be aware that this organism is present in warm freshwater lakes, rivers and hot springs across North Carolina, so be mindful as you swim or enjoy water sports."

Naegleria fowleri infections are rare, with only 145 known infected individuals in the U.S. (between zero and eight cases annually) from 1962 through 2018. North Carolina had five cases during that time period. This amoeba can cause severe illness up to nine days after exposure. A person cannot be infected with Naegleria fowleri by drinking water and the amoeba is not found in salt water.

As there is no means to eliminate this amoeba from fresh water lakes, in warmer areas where this infection has been more common, recommended precautions include:

Limit the amount of water going up your nose. Hold your nose shut, use nose clips or keep your head above water when taking part in warm freshwater-related activities.

Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.

Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.

For more information on Primary Amebic Meningoencephalitis visit www.cdc.gov/parasites/naegleria.

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).

Photo Credit – Wikipedia Commons

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 http://amoeba-season.com/, 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.

As a thermophilic (heat-loving), free-living amoeba, it is hardly surprising that Florida and Texas lead the nation in cases over the past three decades, but infections have occurred as far north as Minnesota.