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Freshwater amoeba killed 6 lake, river swimmers in '07
A rare brain illness spread in freshwater
lakes, rivers and hot springs killed six in Florida, Texas and Arizona in 2007,
the most in more than five years, according to a U.S. report.
The infection, almost always fatal, typically affects boys swimming during July,
August and September, said the report, released Thursday by the U.S. Centers for
Disease Control and Prevention in Atlanta.
Known as primary amebic meningoencephalitis, or PAM, 121 in 15 southern states
have been affected over the past 71 years, the CDC said. It is caused when
Naegleria fowleri, an amoeba found in fresh warm water, goes up the nose to the
brain, leading to fatal damage.
"An updated and consistent approach to N. fowleri risk-reduction messages,
diagnosis and treatment is needed," the CDC said in its report.
In Florida, three boys from the Orlando area died from the infections between
June and August last year after swimming in shallow, hot, freshwater bodies. The
tiny organisms live in mud on the bottom. Health officials said the boys
ingested the amoeba at a water sports park and a lake.
In Arizona, a 14-year-old was hospitalized with a severe headache, stiff neck
and fever. He died from the infection eight days after diving and splashing in
shallow water in a lake.
A 12-year-old Texas boy was infected during water activities in a lake at summer
camp. He was hospitalized and died five days after admission. Also in Texas, a
man, 22, died after wakeboarding in a lake.
is an ameba commonly found in warm freshwater and soil. Only one species of
Naegleria infects people, Naegleria fowleri. It causes a very
rare but severe brain infection. Most infections are fatal.
infects people by entering the body through the nose. Generally, this occurs
when people use warm freshwater for activities like swimming or diving. The
ameba travels up the nose to the brain and spinal cord where it destroys the
brain tissue. Infections do not occur as a result of drinking contaminated
Where is Naegleria found?
Naegleria fowleri is found around the world. In the United States,
it has caused infections in 15 southern tier states (AR, AZ, CA, FL, GA, LA, MO,
MS, NC, NM, NV, OK, SC, TX, and VA). The ameba grows best in warm or hot water.
Most commonly, the ameba may be found in:
- Bodies of warm
freshwater, such as lakes, rivers
(naturally hot) water such as hot springs
(naturally hot) drinking water sources
- Warm water
discharge from industrial plants
maintained and minimally-chlorinated or unchlorinated swimming pools
is not found in salt water locations like the ocean.
Can I get Naegleria infection from a
disinfected swimming pool?
No. You cannot get a Naegleria infection from a properly cleaned,
maintained, and disinfected swimming pool.
How common are Naegleria
infections in the United States?
very rare even though Naegleria is commonly found in freshwater. In the
10 years from 1998 to 2007, 33 infections were reported in the U.S. Thirty-one
people had contact with recreational water and two people had contact with water
from a geothermal (naturally hot) water supply.
When do Naegleria infections most
with Naegleria are very rare, they occur mainly during the summer
months of July, August, and September. These infections are more likely to occur
in southern tier states. They usually occur when it is hot for prolonged periods
causing higher water temperatures and lower water levels. Infections can
increase during heat wave years.
Can infection be spread from one person to another?
infection cannot be spread from one person to another.
What are the symptoms of Naegleria infection?
Naegleria causes the disease primary amebic meningoencephalitis (PAM),
a brain infection that leads to the destruction of brain tissue. In its early
stages, Naegleria infection may be similar to bacterial meningitis.
of PAM start 1 to 14 days after infection. The initial symptoms include
headache, fever, nausea, vomiting, and stiff neck. Later symptoms include
confusion, lack of attention to people and surroundings, loss of balance,
seizures, and hallucinations. After the start of symptoms, the disease
progresses rapidly and usually causes death within 3 to 7 days.
Is there effective treatment for infection with
It is not clear.
Several drugs are effective against Naegleria in the laboratory.
However, their effectiveness is unclear since almost all infections have been
fatal even when people were treated.
What should I do if I have been swimming or playing in
freshwater and now think I have symptoms associated with Naegleria?
Naegleria is very rare. The early symptoms of Naegleria
infection are more likely to be caused by other more common illnesses, such as
meningitis. People should seek medical care immediately whenever they develop a
sudden onset of fever, headache, stiff neck, and vomiting particularly if they
have been in warm fresh water within the previous 2 weeks.
How common is
Naegleria in the environment?
is commonly found in most lakes in southern tier states during the summer. This
means that recreational water users should be aware that there will always be a
low level risk of infection when entering these waters.
Is there a
routine and rapid test for Naegleria in the water?
No. It can take
weeks to grow and identify the ameba. Newer genetic detection tests for ameba
are still under development. Water testing suggests that the amebae are so
common that recreational water users should assume that there is a low level of
risk when entering all warm fresh water in southern tier states.
How does the
risk of Naegleria fowleri infection compare with other water-related
infections are severe, the risk of Naegleria fowleri infection is very
low. There have been 33 reported infections in the U.S. during the 10 years from
1998 to 2007, despite millions of recreational water exposures each year. By
comparison, during the ten years from 1996 to 2005, there were over 36,000
drowning deaths in the U.S.
How will the
public know if a lake or other water body has Naegleria?
water users should assume that there is always a low level of risk whenever they
enter warm freshwater (for example swimming, waterskiing) in southern tier
states. Posting signs is unlikely to be an effective way to prevent infections.
This is because the location and number of amebae in the water can vary a lot
over time. In addition, posted signs might create a misconception that bodies of
water without signs are Naegleria-free. Information about the risks of
Naegleria infection should be put into public health messages
discussing general issues of water safety and risk.
How can I reduce the risk of infection with Naegleria?
is found in many warm freshwater lakes and rivers in the United States,
particularly in southern tier states. It is likely that a low risk of
Naegleria infection will always exist with recreational use of warm
freshwater lakes, rivers, and hot springs. The low number of infections makes it
difficult to know why some people have been infected compared to the millions of
other people using the same or similar waters across the U.S. The only known way
to prevent Naegleria infections is to refrain from water-related activities.
However, some measures that might reduce risk by limiting the chance of
contaminated water going up the nose include:
water-related activities in bodies of warm freshwater, hot springs, and
thermally-polluted water such as water around power plants.
water-related activities in warm freshwater during periods of high water
temperature and low water levels.
- Hold the nose
shut or use nose clips when taking part in water-related activities in bodies
of warm freshwater such as lakes, rivers, or hot springs.
- Avoid digging
in or stirring up the sediment while taking part in water-related activities
in shallow, warm freshwater areas.
For further information on protecting yourself from recreational water
illnesses, go to