Florida Teen Hospitalized For Infections Due To Brain-Eating Ameba, Naegleria Fowleri
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Free -living amebic infections, Source: https://en.wikipedia.org/wiki/File:Free-living_amebic_infections.png (Attribution: CDC, with identification #3412-Photo Credit: -CDC/Alexander J. da Silva, PhD/Melanie Moser, Public Domain license: https://en.wikipedia.org/wiki/Public_domain, Presented at: WindermereSun.com)
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A 13-year old Florida teen, Caleb Ziegelbauer, is fighting to stay alive in the hospital after the brain-eating ameba, Naegleria fowleri, got into his nose when he was swimming in a beach in Port Charlotte, Florida, on July 1, 2022. Caleb was taken to an emergency room by his parents after exhibiting headaches, fever, and hallucinations, in the video published on July 26, 2022, “Florida Teen Infected With Brain-Eating Amoeba“, below:
In the video published on June 14, 2013, “Florida reminds of dangers of ‘brain-eating amoeba,’ Naegleria Fowleri“, below:
According to CDC web site: Naegleria fowleri is an ameba (single-celled living organism) that lives in soil and warm fresh water, such as lakes, rivers, and hot springs. It is commonly called the “brain-eating ameba” because it can cause a brain infection when water containing the ameba goes up the nose. Only about three people in the United States get infected each year, but these infections are usually fatal. Stage 1 symptoms may include: headache, fever, nausea, or vomiting. Stage 2 symptoms may include: stiff neck, seizures, altered mental status, hallucinations, and coma. To see case reports by state of exposure between 1962-2021, please click HERE.
Naegleria fowleri is found naturally in freshwater lakes, rivers, and hot springs in the United States 1-3,, particularly in southern-tier states 4-8, but has recently caused infections as far north as Minnesota 9. No data exist to accurately estimate the true risk of PAM (Primary amebic meningoencephalitis). Hundreds of millions of visits to swimming venues occur each year in the U.S. 10 that result in 0-8 infections per year 11. It is unknown why certain persons become infected with the amebae while millions of others exposed to warm recreational fresh waters do not, including those who were swimming with people who became infected.
Attempts have been made to determine what concentration of Naegleria fowleri in the environment poses an unacceptable risk 12. However, no method currently exists that accurately and reproducibly measures the numbers of amebae in the water. This makes it unclear how a standard might be set to protect human health and how public health officials would measure and enforce such a standard. However, the risk of Naegleria fowleri infection is very low. There have been 31 reported infections in the U.S. in the ten years from 2012 to 2021
For more information about previous survivors of Naegleria fowleri , please refer the excerpt from CDC web site, in italics, below: The disease is generally fatal 3; among well-documented cases, there are only five known survivors in North America: one from the U.S. in 1978 5, one from Mexico in 2003 6, two from the U.S. in 2013 4, 7, 8, and one from the U.S. in 2016. The original U.S. survivor’s condition gradually improved during a one-month hospitalization. The only reported side effect to treatment was a reduction in leg sensation for two months after discharge, which gradually improved. There was also no detection of Naegleria fowleri 3 days post-treatment 5. It has been suggested that the original survivor’s strain of Naegleria fowleri may have been less virulent, which contributed to the patient’s recovery. In laboratory experiments, the California survivor’s strain did not cause damage to cells as quickly as other strains, suggesting that it is less virulent than strains recovered from other fatal cases 9.
In the video published on Aug 24, 2016, “Florida teen survives brain-eating amoeba“, below:
In the video published on Aug 23, 2016, “South Florida teen survives brain-eating amoeba“, below:
The Mexico survivor’s condition did not begin to improve until 40 hours after hospital admission. On day 22 of admission, there was no abnormality shown in the brain scan and the patient was discharged the next day. The patient was followed up for the next 12 months without any recurrence of disease 6.
After 35 years without a Naegleria survivor in the United States, during the summer of 2013, two children with Naegleria fowleri infection survived. The first, a 12-year-old girl, was diagnosed with PAM approximately 30 hours after becoming ill and was started on the recommended treatment within 36 hours. She also received the investigational drug miltefosine, and her brain swelling was aggressively managed with treatments that included therapeutic hypothermia (cooling the body below normal body temperature). This patient made a full neurologic recovery and returned to school. Her recovery has been attributed to early diagnosis and treatment and novel therapeutics including miltefosine and hypothermia 7.
The second, 8-year-old, child is also considered a PAM survivor, although he has suffered what is likely permanent brain damage. He was also treated with miltefosine but was diagnosed and treated several days after his symptoms began. Therapeutic hypothermia was not used in this case 8.
In the summer of 2016, a 16-year-old boy was reported as the 4th U.S. PAM survivor. This patient was diagnosed within hours of presentation to the hospital and was treated with the same protocol used for the 12-year-old 2013 survivor (miltefosine and hypothermia). This patient also made a full neurologic recovery and returned to school.
Overall, the outlook for people who get this disease is poor, although early diagnosis and new treatments might increase the chances for survival.
For more information about Illness & Symptoms associated with Naegleria fowleri , please refer the excerpt from CDC web site, in italics, below:
Primary amebic meningoencephalitis (PAM) is a disease of the central nervous system 1,2. PAM is caused by Naegleria fowleri, a free-living ameba. It is a rare disease* that is almost always fatal 3; only four people in the U.S. out of 154 have survived infection from 1962 to 2021 4. Signs and symptoms of Naegleria fowleri infection are clinically similar to bacterial meningitis, which lowers the chances of initially diagnosing PAM 4. Humans become infected when water containing Naegleria fowleri enters the nose and the ameba migrates to the brain along the olfactory nerve 2,3. People do not become infected from drinking contaminated water. Symptoms start 1-9 days (median 5 days) after swimming or other nasal exposure to Naegleria-containing water. People die 1-18 days (median 5 days) after symptoms begin 4. PAM is difficult to detect because the disease progresses rapidly so that diagnosis is usually made after death 1,2. Stage 1 symptoms may include: headache, fever, nausea, or vomiting. Stage 2 symptoms may include: stiff neck, seizures, altered mental status, hallucinations, and coma.
For more information about Treatment associated with Naegleria fowleri , please refer the excerpt from CDC web site, in italics, (there may be repetition of information about previous survivors of Naegleria fowleri above), below:
Primary Amebic Meningoencephalitis (PAM) is treated with a combination of drugs, often including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone. These drugs are used because they are thought to have activity against Naegleria fowleri and have been used to treat patients who survived. Miltefosine is the newest of these drugs and has shown ameba-killing activity against free-living amebae, including Naegleria fowleri, in the laboratory1, 2, 3. Miltefosine has also been used to successfully treat patients infected with Balamuthia4 and disseminated Acanthamoeba infection5.
Although most cases of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri infection in the United States have been fatal (150/154 in the U.S.)6, 7, there have been five documented survivors in North America: one in the U.S. in 19788, 9, one in Mexico in 200310, two additional survivors from the U.S. in 2013 5, 6, and one from the U.S. in 2016. It has been suggested that the original U.S. survivor’s strain of Naegleria fowleri was less virulent, which contributed to the patient’s recovery. In laboratory experiments, the original U.S. survivor’s strain did not cause damage to cells as rapidly as other strains, suggesting that it is less virulent than strains recovered from other fatal infections13.
After 35 years without a Naegleria survivor in the United States, during the summer of 2013, two children with Naegleria fowleri infection survived. The first, a 12-year-old girl, was diagnosed with PAM approximately 30 hours after becoming ill and was started on the recommended treatment of amphotericin B, fluconazole, rifampin, azithromycin, and dexamethasone within 36 hours. She also received the investigational drug miltefosine 7-9 and her brain swelling was aggressively managed with treatments that included cooling the body below normal body temperature (therapeutic hypothermia). This patient made a full neurologic recovery and returned to school. Her recovery has been attributed to early diagnosis and treatment and novel therapeutics including miltefosine and hypothermia11.
A second child, an 8-year-old male, is also considered a PAM survivor, although he has suffered what is likely to be permanent brain damage. He was also treated with amphotericin B, fluconazole, rifampin, azithromycin, miltefosine, and dexamethasone but was diagnosed and treated several days after his symptoms began. Cooling of the body below normal body temperature was not used12.
In the summer of 2016, a 16-year-old boy was reported as the 4th U.S. PAM survivor. This patient was diagnosed within hours of presentation to the hospital and was treated with the same protocol used for the 12-year-old 2013 survivor (miltefosine and hypothermia). This patient also made a full neurologic recovery and returned to school.
Note for Clinicians: For 24/7 diagnostic assistance, specimen collection guidance, shipping instructions, and treatment recommendations, please contact the CDC Emergency Operations Center at 770-488-7100. More detailed guidance is under Information for Public Health & Medical Professionals.
Note for Clinicians: CDC no longer provides miltefosine for treatment of free-living ameba infections. Miltefosine is now commercially available. Please visit impavido.com for more information on obtaining miltefosine in the United States. If you have a patient with suspected free-living ameba infection, please contact the CDC Emergency Operations Center at 770-488-7100 to consult with a CDC expert.
For more information about Prevention & Control associated with Naegleria fowleri , please refer the excerpt from CDC web site, in italics, below:
Naegleria fowleri infects people when water containing the ameba enters the body through the nose. Infection is rare and typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. Very rarely, infections have been reported when people submerge their heads, cleanse their noses during religious practices, or irrigate their sinuses (nose) using contaminated tap or faucet water. Naegleria fowleri can grow in pipes, hot water heaters, and water systems, including treated public drinking water systems. You cannot get infected from drinking water contaminated with Naegleria. You can only be infected when contaminated water goes up into your nose.
If you have more questions, please refer to the FAQ at CDC web site by clicking HERE.
For more about Naegleria fowleri, please refer to wikipedia page on the subject by clicking HERE.
Gathered, written, and posted by Windermere Sun-Susan Sun Nunamaker More about the community at www.WindermereSun.com
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