The First Association of a Primary Amebic Meningoencephalitis Death with Culturable Naegleria fowleri in Tap Water from a U.S. Treated Public Drinking Water System

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Cope, Jennifer R. ; Ratard, Raoult C. ; Hill, Vincent R. ; Sokol, Theresa ; Causey, Jonathan Jake ; Yoder, Jonathan S. ; Mirani, Gayatri ; Mull, Bonnie ; Mukerjee, Kimberly A. ; Narayanan, Jothikumar ; Doucet, Meggie ; Qvarnstrom, Yvonne ; Poole, Charla N. ; Akingbola, Olugbenga A. ; Ritter, Jana ; Xiong, Zhenggang ; da Silva, Alexandre ; Roellig, Dawn ; Van Dyke, Russell ; Stern, Harlan ; Xiao, Lihua ; Beach, Michael J.
• Description:
  Background
  
  Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri–containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old child died of meningoencephalitis of unknown etiology in a Louisiana hospital.
  
  Methods
  
  Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures.
  
  Results
  
  Based on testing of CSF and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri were identified in water samples from both the home and the water distribution system.
  
  Conclusions
  
  This case is the first reported PAM death associated with culturable N. fowleri in tap water from a U.S. treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures.
  
  
• Subjects:
  Amebiasis Article Brain Central Nervous System Protozoal Infections Cerebrospinal Fluid Child, Preschool Drinking Water Fatal Outcome Free-living Ameba Humans Louisiana Male Naegleria Fowleri Oligopeptides Primary Amebic Meningoencephalitis

  More +
• Source:
  Clin Infect Dis. 60(8):e36-e42
• Pubmed ID:
  25595746
• Pubmed Central ID:
  PMC4627687
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Place as Subject:
  United States
• Volume:
  60
• Issue:
  8
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6b492f04d9f4a93e2bb030c76e799176f294b9874cfc7c73737713fd89a19c94
• Download URL:
  https://stacks.cdc.gov/view/cdc/36349/cdc_36349_DS1.pdf
• File Type:
  [PDF - 366.17 KB ]