Published Date: 2011-09-13 11:14:53
Subject: PRO/EDR> Amebic meningoencephalitis - USA (03): (KS)
Archive Number: 20110913.2784
AMEBIC MENINGOENCEPHALITIS - USA (03): (KANSAS)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 9 Sep 2011
Source: Kansas Department of Health and Environment news release
Local and state health officials investigating probable primary
amoebic meningoencephalitis (PAM) death
State and local health officials have been notified of a probable case
of primary amoebic meningoencephalitis (PAM) caused by _Naegleria
fowleri_, a free-living amoeba found in freshwater, which resulted in
the death of a Sedgwick County resident. The investigation by Sedgwick
County Health Department staff indicates the infection likely occurred
while swimming in Winfield City Lake in Cowley County.
The Centers for Disease Control and Prevention [CDC] has confirmed the
presence of _N. fowleri_ in a specimen from the patient. Pending
additional studies from the CDC and the Sedgwick County Regional
Forensic Science Center, this is the 1st known case of PAM caused by
_N. fowleri_ in Kansas.
_N. fowleri_ can be found in freshwater environments around the world,
but infection causing PAM is extremely rare. From 2001 to 2010, 32
infections were reported in the US. The risk of infection increases
during the summer months, and may be related to prolonged periods of
hot weather associated with higher water temperatures and lower water
The infection, which is nearly always fatal, typically occurs when the
amoeba enters the body through the nose while the person is swimming
underwater or diving, and travels to the brain.
"Cases like this are very rare in the United States, and we express
our heartfelt condolences to the family and friends of the person who
suffered this infection," said Robert Moser, MD, KDHE [Kansas
Department of Health and Environment] secretary and state health
Symptoms include headache, fever, nausea and vomiting, stiff neck,
confusion, lack of attention to people and surroundings, loss of
balance and bodily control, seizures, and hallucinations. This
infection cannot be spread from person to person or contracted from a
properly maintained swimming pool.
Though the risk of infection is extremely low, the following
precautions might decrease the possibility of infection:
- Avoiding water-related activities in bodies of warm freshwater, hot
springs, and thermally-polluted water such as water around power
- Avoiding water-related activities in warm freshwater during periods
of high water temperature and low water levels.
- Keeping your head out of the water, holding your nose shut or using
nose clips when taking part in water-related activities in bodies of
warm freshwater such as lakes, rivers, or hot springs.
- Avoiding digging in or stirring up the sediment while taking part in
water-related activities in shallow, warm freshwater areas.
The safest way to prevent infection from an amoeba is to not swim in
warm standing water, poorly maintained swimming pools, storm water
holding areas or in places where "no swimming" signs are posted.
For more information on healthy swimming visit the CDC website at
[Amanda Matthews, Sedgwick County Heath Department
Warren Porter, City of Winfield
David Brazil, City-Cowley County Health Department
Miranda Myrick, Kansas Department of Health and Environment]
[The state of Kansas can be located on the HealthMap/ProMED-mail
interactive map at http://healthmap.org/r/1emV. Cowley County in
south central Kansas can be seen on the map at
[Amebic encephalitis from free-living amoebae like _Naegleria fowleri_
is rare in the USA. Free-living amoeba are probably ubiquitous, but
very little is known about distribution. Diagnosis is difficult and
the infection probably underdiagnosed.
A study of domestic water from homes in Arizona, United States, using
nested PCR found that out of 19 samples collected from bathroom and
kitchen pipes and sink traps, 17 samples were positive for _N.
fowleri_ by PCR (Marciano-Cabral F et al: Identification of _Naegleria
fowleri_ in domestic water sources by nested PCR. Appl Environ
Microbiol. 2003; 69(10): 5864-9;
A more recent study from Taiwan found _Naegleria_ in 28.6 percent of
raw domestic water 14.7 percent in stream water and in 6.5 percent in
spring water (Huang SW, Hsu BM: Survey of _Naegleria_ from Taiwan
recreational waters using culture enrichment combined with PCR. Acta
Trop. 2011; 119(2-1): 114-8;