Serious Health Risk: Brain-eating Amoeba!

There’s something vile and dangerous in the water. Naegleria fowleri, a brain-eating amoeba, is commonly found in warm freshwater (like lakes, rivers and hot-springs) and can cause a rare and devastating infection of the brain called primary amoebic meningoencephalitis (PAM). The Department of Health and Hospitals (DHH) in Louisiana and the CDC confirmed the presence of Naegleria fowleri in two treated public drinking water systems in September-October 2013.

Trophozoites of Naegleria fowleri in brain tissue. - Credit: marsmettn tallahassee via Flickr

Trophozoites of Naegleria fowleri in brain tissue.Credit: marsmettn tallahassee via Flickr

This amoeba has been responsible for deaths in disinfected public drinking water supplies in Australia, Pakistan and Arizona. The infections were linked to the practice of piping drinking water overland, sometimes for hundreds of miles, that resulted in the water heating up, which decreased disinfectant levels. These conditions allowed the water and pipes to be colonized by Naegleria fowleri.

Water pipelines. - Credit: brian kong via Flickr

Water pipelines.Credit: brian kong via Flickr

It’s important to note that you CANNOT get infected from DRINKING contaminated water, but there is a risk when washing your face or showering. Infection typically occurs when people go swimming or diving in freshwater and the contaminated water enters the body through the nose. Once the amoeba enters the nose, it travels to the brain where it causes PAM, which is most often fatal.

It is critical to prevent water going up the nose, so follow these precautions from the CDC:

  • DO NOT allow water to go up your nose or sniff water into your nose when bathing, showering, washing your face, or swimming in small hard plastic/blow-up pools.
  • DO NOT jump into or put your head under bathing water (bathtubs, small hard plastic/blow-up pools) – walk or lower yourself in.
  • DO NOT allow children to play unsupervised with hoses or sprinklers, as they may accidentally squirt water up their nose. Avoid slip-n-slides or other activities where it is difficult to prevent water going up the nose.
  • DO run bath and shower taps and hoses for 5 minutes before use to flush out the pipes. This is most important the first time you use the tap after the water utility raises the disinfectant level.
  • DO keep small hard plastic/blow-up pools clean by emptying, scrubbing, and allowing them to dry after each use.
  • DO use only boiled and cooled, distilled, or sterile water for making sinus rinse solutions for neti pots or performing ritual ablutions.
  • DO keep your swimming pool adequately disinfected before and during use. Adequate disinfection means:
    • Pools: free chlorine at 1–3 parts per million (ppm) and pH 7.2–7.8
    • Hot tubs/spas: free chlorine 2–4 parts per million (ppm) or free bromine 4–6 ppm and pH 7.2–7.8
    • If you need to top off the water in your swimming pool with tap water,
      DO place the hose directly into the skimmer box and ensure that the filter is running.
      DO NOT top off by placing the hose in the body of the pool.
Histopathology of amoebic meningoencephalitis. - Credit: Dr. Govinda S. Visvesvara (CDC)

Histopathology of amoebic meningoencephalitis (PAM).Credit: Dr. Govinda S. Visvesvara (CDC)

According to the CDC, “symptoms start 1-7 days (median 5 days) after swimming or other nasal exposure to Naegleria-containing water. People die 1-12 days (median 5.3 days) after symptoms begin. PAM is difficult to detect because the disease progresses rapidly so that diagnosis is usually made after death.

Symptoms of PAM include the following and you should seek immediate medical attention if symptoms are experienced:

  • Stage 1
    • Severe frontal headache
    • Fever
    • Nausea
    • Vomiting
  • Stage 2
    • Stiff neck
    • Seizures
    • Altered mental status
    • Hallucinations
    • Coma


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This entry was posted in Awareness, Safety.