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Published Date: 2012-07-22 17:57:01
Subject: PRO/EDR> Amebic meningoencephalitis, primary - USA: (SC) fatal
Archive Number: 20120722.1210641

AMEBIC MENINGOENCEPHALITIS, PRIMARY - USA: (SOUTH CAROLINA) FATAL
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International Society for Infectious Diseases
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Date: 19 Jul 2012
Source: Carolinalive.com [edited]
http://www.carolinalive.com/news/story.aspx?id=778107#.UAmMEWGdCSo

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 swimming with him, are receiving treatment.

"We are saddened to learn that this child was exposed to the deadly organism
_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 2010."

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
- Soil
- Swimming pools that are poorly maintained, with either low levels of
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]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[CDC diagram of life cycle of _N. fowleri_:
http://www.lifeionizers.com/blog/wp-content/uploads/Free-living_amebic_infections.png
Warning poster
http://naturalunseenhazards.files.wordpress.com/2011/08/2285088742_56271f04a2.jpg
Interactive HealthMap map showing South Carolina:
http://healthmap.org/r/2E*P
- Mod.JW]

[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]

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