1 / 21

Naegleria Fowleri: The Danger in Your Swimming Hole

Learn about the thermophilic, free-living ameba Naegleria fowleri, its infection known as primary amebic meningoencephalitis (PAM), and how to prevent it.

underhill
Download Presentation

Naegleria Fowleri: The Danger in Your Swimming Hole

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Naegleria Fowleri: The Danger in Your Swimming Hole Nancy Wilson, MPH student Walden University PUBH 6165-4, Environmental Health Dr. Raymond Thron Summer 2014

  2. What is Naegleria fowleri? What is primary amebic meningoencephalitis? How is a person infected? How can infection be prevented? Learning Objectives

  3. What is Naegleria fowleri? • Thermophilic, free-living ameba • Found in warm fresh water • Lakes, ponds, rivers, hot springs • Feeds on bacteria • Image credit: Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Kemble, S. K., Lynfield, R., DeVries, A. S., Drehner, D. M., Pomputius III, W. F., Beach, M. J.,...Danila, R. (2012). Fatal Naegleria fowleri infection acquired in Minnesota: Possible expanded range of a deadly thermophilic organism. Clinical Infectious Diseases, 54(6), 805-809. doi:10.1093/cid/cir961

  4. How are people infected? • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  5. Where can N. fowleri be found? • Every continent except Antarctica (Painter, Pfau, Brady, & McFarland, 2013) • In the U.S., more frequently in southern states (Yoder et al., 2012) • In ponds, lakes, rivers, and hot springs (Painter et al., 2013) • In drinking water • Not regulated (Yoder et al., 2012). Painter, S. M., Pfau, R. S., Brady, J. A., & McFarland, A. S. (2013). Quantitative assessment of Naegleria fowleri and Escherichia coli concentrations within a Texas reservoir. Journal of Water & Health, 11(2), 346-357. doi:10.2166/wh.2013.162 Yoder, J. S., Straif-Bourgeois, S., Roy, S. L., Moore, T. A., Visvesvara, G. S., Ratard, R. C.,... Xiao, L. (2012). Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clinical Infectious Diseases, 55(9), e79-e85.

  6. Reported U.S. Cases, 1962-2013 • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  7. Why should we pay attention? • Sood, A. A., Chauhan, S. S., Chandel, L. L., & Jaryal, S. C. (2014). Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian Journal of Medical Microbiology, 32(2), 193-196. doi:10.4103/0255-0857.129834

  8. What is PAM? • Primary • Amebic • Meningoencephalitis Meningo + encephal + itis membranes + brain + inflammation • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  9. The Symptoms of PAM • Headache • Fever • Nausea/vomiting • Stiff neck • Altered mental status • Seizures Yousuf, F. A., Siddiqui, R., Subhani, F., & Khan, N. A. (2013). Status of free-living amoebae (Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris) in drinking water supplies in Karachi, Pakistan. Journal of Water & Health, 11(2), 371-375. doi:10.2166/wh.2013.112 Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  10. How quickly does PAM progress? • Symptoms start 1-7 days after infection (median is 5 days) • Death occurs an average of 10 days after infection, or 1-12 days (median 5.3 days) after initial symptoms • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Painter, S. M., Pfau, R. S., Brady, J. A., & McFarland, A. S. (2013). Quantitative assessment of Naegleria fowleri and Escherichia coli concentrations within a Texas reservoir. Journal of Water & Health, 11(2), 346-357. doi:10.2166/wh.2013.162

  11. Who is at risk? • Children and young adults • Males • Freshwater swimmers • Those who play, swim, or bathe in fresh water in July or August • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  12. Are people only at risk when swimming? • Short answer: No. • Nasal exposure to infected drinking water • Shower or bath • Slip-n-slide • Nasal irrigation or rinsing • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  13. How is PAM diagnosed? • Laboratory tests • Direct visualization • Antigen detection • Polymerase chain reaction (PCR) • Ameba culture • Environmental detection • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  14. What treatment is available? • Miltefosine, breast cancer drug • Successful usage in 2013 (CDC, 2013) • Amphotericin B, confirmed clinical efficacy • In combination with fluconazole, rifampicin, sulfadiazine, dexamethasone, or other drugs (Sood, Chauhan, Chandel, & Jaryal, 2014) • Early treatment is best! • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Sood, A. A., Chauhan, S. S., Chandel, L. L., & Jaryal, S. C. (2014). Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian Journal of Medical Microbiology, 32(2), 193-196. doi:10.4103/0255-0857.129834

  15. How can infection be prevented? • Avoid activities in freshwater when there is a high water temperature (Yoder et all., 2012) • Avoid getting water up the nose • Use nose clips (Yoder et al., 2012) • Avoid head submersion (CDC, 2013) • Avoid stirring up sediment during water-related activities (Yoder et al., 2012) • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Yoder, J. S., Straif-Bourgeois, S., Roy, S. L., Moore, T. A., Visvesvara, G. S., Ratard, R. C.,... Xiao, L. (2012). Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clinical Infectious Diseases, 55(9), e79-e85.

  16. How can infection be prevented? • Use sterile, distilled, filtered, or previously boiled water for nasal irrigation (Yoder et al., 2012) • Do not allow bathing water to go up in nose (CDC, 2013) • Avoid the use of slip-n-slides (CDC, 2013) • Do not allow children to play unsupervised with hoses or sprinklers (CDC, 2013) • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Yoder, J. S., Straif-Bourgeois, S., Roy, S. L., Moore, T. A., Visvesvara, G. S., Ratard, R. C.,... Xiao, L. (2012). Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clinical Infectious Diseases, 55(9), e79-e85.

  17. What should I do if I suspect Naegleria fowleri infection? • Go to the hospital immediately and report possible exposure • CDC Emergency Operations Center is available for consult on any suspected infection case • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html

  18. Points to Remember • Be wary of warm freshwater! • Protect your nose! • It is better to be safe than sorry! • Early is best!

  19. References • Centers for Disease Control and Prevention. (2013). Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM). Retrieved from http://www.cdc.gov/parasites/naegleria/index.html • Kemble, S. K., Lynfield, R., DeVries, A. S., Drehner, D. M., Pomputius III, W. F., Beach, M. J.,...Danila, R. (2012). Fatal Naegleria fowleri infection acquired in Minnesota: Possible expanded range of a deadly thermophilic organism. Clinical Infectious Diseases, 54(6), 805-809. doi:10.1093/cid/cir961 • Painter, S. M., Pfau, R. S., Brady, J. A., & McFarland, A. S. (2013). Quantitative assessment of Naegleria fowleri and Escherichia coli concentrations within a Texas reservoir. Journal of Water & Health, 11(2), 346-357. doi:10.2166/wh.2013.162

  20. References • Sood, A. A., Chauhan, S. S., Chandel, L. L., & Jaryal, S. C. (2014). Prompt diagnosis and extraordinary survival from Naegleria fowleri meningitis: A rare case report. Indian Journal of Medical Microbiology, 32(2), 193-196. doi:10.4103/0255-0857.129834 • Yoder, J. S., Straif-Bourgeois, S., Roy, S. L., Moore, T. A., Visvesvara, G. S., Ratard, R. C.,... Xiao, L. (2012). Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clinical Infectious Diseases, 55(9), e79-e85. • Yousuf, F. A., Siddiqui, R., Subhani, F., & Khan, N. A. (2013). Status of free-living amoebae (Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris) in drinking water supplies in Karachi, Pakistan. Journal of Water & Health, 11(2), 371-375. doi:10.2166/wh.2013.112

  21. Thank You! Any Questions?

More Related