AMEBIC MENINGOENCEPHALITIS, PRIMARY - USA: (SOUTH CAROLINA) FATAL
A ProMED-mail post
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International Society for Infectious Diseases <http://www.isid.org>
Date: 19 Jul 2012
Source: Carolinalive.com [edited]
The South Carolina Department of Health and Environmental Control says
an 8 year old boy, has died of a rare brain infection caused by a
deadly organism known as _Naegleria fowleri_.
WLTX in Columbia is reporting [his] aunt said he started to complain
about not feeling well after swimming in Lake Marion last Saturday [14
Jul 2012]. He died Tuesday [17 Jul 2012], and lab tests confirmed the
cause of death Wednesday [18 Jul 2012].
A facebook page dedicated to him [where it mentions that his 2
sisters, who were wwimming with him, are receiving treatment.
"We are saddened to learn that this child was exposed to the deadly
_Naegleria fowleri_," said Catherine Templeton, DHEC director. "While
this organism is present in many warm water lakes, rivers and streams
in the South, infection in humans is extremely rare. _Naegleria
fowleri_ [infection] almost always results in death."
In a news release Kathleen Antonetti, M.D. and DHEC medical
epidemiologist,said that people should seek immediate medical
attention after swimming in fresh water if they experience headache,
nausea, vomiting, high fever and neck stiffness. Its severity
increases very quickly, resulting in death within 1 to 12 days. It
cannot be spread from person to person.
Although the _Naegleria fowleri_ ameba is widespread in warm waters,
illness occurs only under certain circumstances. "Water must be
forced up the nose, through the nasal passages, so that the ameba is
able to travel up to the brain and destroy tissue," Dr. Antonetti
said. "People should avoid swimming or jumping into bodies of fresh
water when the water is warm and the water levels are low. You cannot
be infected by merely drinking water containing the ameba. These
infections are so rare, the U.S. Centers for Disease Control and
Prevention documented only 32 cases in this country from 2001 to
According to the CDC, _Naegleria fowleri_ is found around the world.
In the United States, the majority of infections have been caused by
exposure to freshwater located in southern states. Typically, the
ameba can be found in:
- Bodies of warm freshwater, such as lakes and rivers
- Geothermal (naturally hot) water, such as hot springs
- Warm water discharge from industrial plants
- Geothermal (naturally hot) drinking water sources
- Swimming pools that are poorly maintained, with either low levels
chlorine or unchlorinated
- Water heaters with temperatures less than 116 F.
_Naegleria fowleri_ is not found in salt water, like the ocean.
[Byline: Tonya Brown]
ProMED-mail Rapporteur Kunihiko Iizuka
[CDC diagram of life cycle of _N. fowleri_:
Interactive HealthMap map showing South Carolina:
[Borrowing from Mod.EP's comment in Amebic meningoencephalitis,
primary - USA: (MN) 20100829.3077:
"Encephalitis from free living amoeba occurs worldwide except in the
arctic regions. The route of infection is through the nasal mucosa
directly into the brain. The diagnosis is difficult and requires a
brain biopsy with histology, supplemented by PCR.
"Several species of free living amoeba may cause encephalitis:
_Naegleria fowleri_, _Acanthamoeba_, _Balamuthia mandrillaris_, and
recently _Paravahlkampfia francinae_ have been described.
"A recent review of amebic encephalitis in the United Sates was
published in 2009: Hannafin B et al. Update on emerging infections:
News from the Centers for Disease Control and Prevention. Primary
amebic meningoencephalitis-Arizona, Florida, and Texas, 2007. Ann
Emerg Med. 2009;54:469-72.
"Treatment is difficult, and several combinations of amphotericin B
plus azithromycin, rifampicin and fluconazole have reportedly had
effect in animal models or single human cases.
"The broad spectrum anti-protozoan drug nitazoxanide is theoretically
an option, but no studies or cases have been reported." - Mod.MPP]
Amebic meningoencephalitis - USA (04): (LA) 20111216.3613
Amebic meningoencephalitis - USA (03): (KS) 20110913.2784
Amebic meningoencephalitis - USA (02): (VA, LA) 20110820.2534
Amebic meningoencephalitis - USA: (VA, FL) 20110817.2494
Amebic meningoencephalitis, primary - USA: (MN) 20100829.3077]
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