In­fec­tions of ‘brain-eat­ing’ amoeba rare but deadly

Woman died af­ter swim in Ce­cil County; 138 deaths known from 1962 to 2015

Baltimore Sun - - FRONT PAGE - By Mered­ith Cohn

News that a col­lege stu­dent from New York died from an in­fec­tion she likely got swim­ming in Ce­cil County was frightening for many who spend time in lo­cal wa­ter.

The Nae­g­le­ria fow­leri amoeba is so com­mon in warm fresh­wa­ter that pub­lic health au­thor­i­ties don’t bother test­ing for it. They don’t plan to put up signs, or take any other pre­cau­tions to pre­vent more in­fec­tions.

In­fec­tions are al­most al­ways fa­tal — but they are also ex­ceed­ingly rare. The case of 19-year Kerry Stouten­burgh was the first linked to Mary­land wa­ters. Na­tion­wide, only 138 peo­ple were in­fected be­tween1962 and 2015, ac­cord­ing to the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion.

Lo­cal pub­lic health of­fi­cials don’t know why Stouten­burgh, a CUNY Brook­lyn Col­lege stu­dent from Kingston, N.Y., was sick­ened. She died Aug. 31, weeks af­ter Stouten­burgh

swim­ming dur­ing a visit to Mary­land.

“This in­ci­dent is in­cred­i­bly tragic, ob­vi­ously, but it’s very rare that the in­fec­tion hap­pens,” said Gregg Bortz, a spokesman for the Ce­cil County Health Depart­ment. “Con­sid­er­ing how many peo­ple go swim­ming in a year, 138 cases give you an in­di­ca­tion of how rare and how low the risk is. But it is an ever-present risk.”

Nae­g­le­ria fow­leri is known as the braineat­ing amoeba. It doesn’t ac­tu­ally con­sume brain tis­sue, but it does cause rapid and cat­a­strophic brain dam­age.

New York State health of­fi­cials no­ti­fied the Ce­cil health depart­ment of the Nae­g­le­ria fow­leri in­fec­tion and the likely source, Bortz said.

He said the CDC does not ad­vise health or en­vi­ron­men­tal de­part­ments to test for the amoeba, but to as­sume that the or­gan­ism was present wher­ever there is warm wa­ter.

The agency also ad­vises against post­ing warn­ing signs, be­cause they could lead the pub­lic to as­sume that bod­ies of wa­ter that don’t have signs are free of the amoeba.

Sci­en­tists don’t know why some peo­ple be­come in­fected. The most fre­quent vic­tims have been chil­dren and young adults, mostly males.

This could be be­cause of their be­hav­ior. The in­fec­tion oc­curs when wa­ter shoots up the vic­tim’s nose and into the brain, which can oc­cur when some­one jumps or dives into the wa­ter.

“It’s an un­usual cir­cum­stance where just the right part of the wa­ter gets into just the right part of the nose at just the right time,” said Dr. Amesh Adalja, a spokesman for the In­fec­tious Dis­ease So­ci­ety of Amer­ica.

“Maybe there is some vari­a­tion in the peo­ple who get it,” said Adalja, a se­nior as­so­ciate at the Cen­ter for Health Se­cu­rity at the Univer­sity of Pitts­burgh Med­i­cal Cen­ter. “There are so few cases that it’s hard to un­der­stand. A lot of peo­ple get wa­ter up their nose and don’t get in­fected. We do know of many in­fec­tious dis­eases where peo­ple have a pre­dis­po­si­tion to it.”

Some peo­ple have be­come in­fected when cleans­ing their nose with a neti pot of im­prop­erly treated tap wa­ter that is warm enough to har­bor the amoeba, Adalja said.

He said peo­ple can’t be­come sick by drink­ing wa­ter with the amoeba be­cause stom­ach acid would kill the or­gan­ism. The nose of­fers a di­rect con­duit to the brain, where the amoeba quickly destroys tis­sue.

To avoid in­fec­tion by the Nae­g­le­ria fow­leri amoeba or other agents com­monly found in wa­ter, pro­fes­sion­als say, peo­ple should keep the wa­ter out of the noses and mouths. Those with open wounds or a weak­ened im­mune sys­tem should avoid the wa­ter al­to­gether.

Other or­gan­isms are much more likely to sicken, and even kill swim­mers, Adalja said.

There were 42 cases of in­fec­tion from the bac­te­ria Vib­rio in Mary­land in 2014, state data shows. A Tal­bot County man was in­fected re­cently with a species called Vib­rio vul­nifi­cus, also known as flesheat­ing bac­te­ria, af­ter nick­ing his fore­arm while re­triev­ing a crab pot. The open wounds that de­vel­oped re­quired sev­eral surg­eries, ac­cord­ing to a warn­ing from the en­vi­ron­men­tal group Mid­shore River­keeper Con­ser­vancy.

Adalja ac­knowl­edged that some­thing known as a brain-eat­ing amoeba is ter­ri­fy­ing, even if it’s rare. There are just a few doc­u­mented cases in which a vic­tim has sur­vived. They in­clude a 16-year-old boy who was treated suc­cess­fully this sum­mer at the Florida Hos­pi­tal for Chil­dren.

Most cases are not di­ag­nosed in time. The ag­gres­sive amoeba causes a type of menin­gi­tis, and has sim­i­lar symp­toms: fever, headache, vom­it­ing and stiff­ness.

The CDC re­ports there is an in­ves­ti­ga­tional drug avail­able for treat­ment. Adalja said doc­tors need to rule out other, more com­mon in­fec­tions first.

“If they treated ev­ery­one as­sum­ing they were in­fected with an amoeba,” he said. “They’d be wrong al­most all the time.”

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