Get the facts about Naegleria fowleri and Primary Amoebic Meningoencephalitis.
Enters body through the nose
The amoeba Naegleria fowleri can only enter the body through the nose. The water must be forced well up into the nasal cavity. You cannot be infected with Naegleria fowleri from drinking contaminated water.
TThere have now been 150 confirmed cases of PAM in the United States. Since 2014, there have been over 50 confirmed deaths in Karachi, Pakistan and 4 confirmed deaths in Costa Rica from Naegleria fowleri. These numbers only reflect confirmed cases, not suspected cases. The fatality rate of someone infected with Naegleria fowleri is 98%.
Since there is no early detection test, infection from Naegleria fowleri is very difficult to diagnose, early symptoms often appear to be flu like symptoms, or Viral Meningitis. Therefore, it is essential that doctors rule out PAM first – rather than last, when patients present to a hospital ER if the patient recently had freshwater exposure up the nose. There is no early detection test for PAM and very few autopsies are performed looking for Naegleria fowleri.
The Center for Disease Control (CDC) has conceded that Naegleria fowleri can be found in all warm fresh water globally, including lakes, rivers, hot springs, retention ponds, streams, ditches, soil and un-chlorinated swimming pools. There have even been cases with the amoeba present in public drinking water and water heaters when the water supply is under chlorinated.
Naegleria fowleri is a thermophile, heat-loving, single cell organism that is highly active at temperatures from 106 to 115 degrees F. The brain-eating-amoeba Naegleria fowleri can survive in water temperatures that range from 40 to 120.5 degrees F, in water up to 9,000 ppm (3 times saltier that a saltwater pool) and in water with pH ranges of 3.0 to 12.0
The Center for Disease Control (CDC) states that no data exists to accurately estimate the true risk from Primary Amebic Meningoencephalitis (PAM) and it is unknown why certain people are infected and others swimming with them are not. There are no known means of controlling naturally occurring Naegleria fowleri levels in lakes and rivers.
Studies have been conducted in Texas lakes with water samples (80 per lake) taken along the edge of the lake, 10 feet from shore, 300 feet from shore and in the middle of the lake in 300 feet of water and Naegleria fowleri was positive in 87% of the samples, including in the middle of the lake.
Naegleria fowleri cannot survive in sea water and has not been found in sea water.
Because Naegleria fowleri is found in 3 different stages: trophozoite, cyst and flagellated stages. They are resistant to adverse environments such as high temperatures from 122-149 degrees for short periods of time, in brackish water up to 9,000 ppm of salt content, for short periods of time, or in very cold temperatures for longer periods of time.
Physicians M. Fowler and R. F. Carter first identified and described a disease caused by amoeba-flagellates in Australia in 1965 that affected 4 patients. The amoebas could effectively live both freely in the environment and in a human host. The earliest known confirmed case of Naegleria fowleri was a patient from Virginia in 1937, but the case wasn’t filed until 1968, when Dr. Santos identified the PAM patient after reviewing autopsy samples.
Children and Young Adults
Naegleria fowleri causes Primary Amoebic Meningoencephalitis (PAM), which is primarily a disease afflicting children and young adults (83% of cases under the age of 18) with a median age of 12 years, infecting males over females at a ratio of 3:1. The majority of infections are in the 5-14 age groups. The youngest person infected was an 8-month old baby and the oldest was a 64-year old.
Contaminated Public Water Systems
There have been seven (7) confirmed Primary Amoebic Meningoencephalitis (PAM) cases in the U.S. from contaminated public water systems infected with Naegleria fowleri. The cases included immersion of the head in a bathtub, using a slip-n-slide in the yard from a hose, from a splash pad and mixing solutions for nasal irrigation using tap water. PAM infections also occurred in Australian public water systems, during the 1980s, from showering and swimming in pools that had contaminated when water was added.
Primary Amoebis Meningoencephalitis (PAM) symptoms
Primary Amoebic Meningoencephalitis (PAM) symptoms begin 1-9days after swimming or through other nasal exposure to water containing Naegleria fowleri. People die 1-12 days after symptoms begin; the median is just 5 days. Signs of symptoms of the infection are severe frontal headache, fever, nausea, vomiting, stiff neck, eventually followed by altered mental status, hallucinations, seizures and finally coma.
Primary Amoebic Meningoencephalitis
Primary Amoebic Meningoencephalitis Reported Cases
Through 2020, the state-by-state case reports show, Florida and Texas with the most cases of Primary Amoebic Meningoencephalitis (PAM).
The breakdown is as follows:
Florida – 37
Texas – 36
Arizona, California, South Carolina & Virginia – 7 to 10
Arkansas, Oklahoma – 6
Georgia – 5
Louisiana, North Carolina – 3
Minnesota – 2
6 states – 1
Primary Amoebic Meningoencephalitis Survivors
There have been 4 survivors of Primary Amoebic Meningoencephalitis (PAM) in the United States. The patients were correctly diagnosed with PAM within 18 hours of presenting to the ER. It is critical that patients be taken to the emergency room as soon as symptoms appear (headache, stiff neck and vomiting) after swimming in warm fresh water.
Primary Amoebic Meningoencephalitis Diagnosis and Treatment
The Center for Disease Control (CDC) has representatives available 24/7 for diagnostic assistance and treatment recommendations.
Contact the Center for Disease Control (CDC) at 770-488-7100.
The Center for Disease Control (CDC) now has an investigational drug called Miltefosine (Impavido) available for treatment of Primary Amoebic Meningoencephalitis (PAM). It is critical that the emergency room personnel are made aware that the patient recently swam in warm fresh water.
The CDC has provided a link to the LAB Detection of Naegleria fowleri training video found here: https://www.cdc.gov/parasites/naegleria/diagnosis-hcp.html showing the only two known methods of detecting Naegleria fowleri in a patient without a PCR test. You will find the link to the video in the center of the page.
Primary Amoebic Meningoencephalitis International Cases
Primary Amoebic Meningoencephalitis (PAM) is a global issue, not just a problem in the United States.
Cases have been reported in the following countries:
- Czech Republic – between 1962-65 – 16 young people died from PAM as a result of swimming in an indoor pool.
- India – there have been two reported cases in infants.
- Iran – the first reported case was in 2012 in an infant.
- New Zealand – 1968-78 eight reported cases from swimming in hot springs.
- Pakistan –there have been over 50 reported cases in Karachi since 2014.
- Taiwan – one case in 2011 from bathing in hot springs.
- United Kingdom – in 1979 one child died after swimming in Roman baths.
- Costa Rica – 4 total cases with 1 survivor!
- Venezuela – first case reported in 1998 and two more in 2006.
- Spain – one reported case and the child survived!