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Child's death linked to N. fowleri in treated tap water
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A case of primary amebic meningoencephalitis that led to the death of a child in Louisiana was associated with culturable Naegleria fowleri in tap water from a treated drinking water system, CDC investigators reported in Clinical Infectious Diseases.
On July 27, 2013, the boy, aged 4 years, was visiting relatives in St. Bernard Parish, Louisiana, when he developed diarrhea, followed by multiple episodes of vomiting and coupled with poor oral intake, and a severe headache. He was brought to a hospital after a third staring spell, in which he was unresponsive with his eyes fixed and open. He was admitted to the pediatric ICU early July 28 with intermittent headaches and a waxing and waning mental status.
Over the next few days, cerebrospinal fluid from lumbar puncture had elevated protein levels and white blood cell count with neutrophil predominance, but no organisms were identified. He began levetiracetam for staring spells suggestive of seizures. Repeat CT scans progressed from slight symmetric prominence of ventricular system on July 28, to suggestive of cerebral edema and interval compression of lateral and third ventricles on July 30. Brain MRI showed edema in the right frontal lobe and gray-white matter junction, and he continued to have focal seizures.
He underwent an emergency decompressive craniectomy and hyperosmolar therapy, CSF drainage and barbiturate coma to improve intracranial pressure. His condition worsened, and he was declared brain dead. He died on Aug. 1. CSF and blood bacterial and fungal cultures showed no growth. An autopsy of brain specimens at the CDC identified amebic trophozoites in the brain tissue. The diagnosis of primary amebic meningoencephalitis (PAM) was supported also by PCR tests that identified N. fowleri in the brain tissue and CSF.
The Louisiana Department of Health and Hospitals conducted an investigation, focusing on the water contact the child had. He had no contact with surface water in the previous 2 weeks, but played in the yard regularly on a water slide that was filled with water from the outdoor faucet. An evaluation of 28 samples from the parish’s water distribution system detected N. fowleri throughout the drinking water system and the home.
“In addition to newly emerging routes of transmission, the geographic range of N. fowleri infection has increased,” the investigators wrote. “Once limited primarily to 15 southern-tier states, PAM cases have recently been reported from Minnesota (2010 and 2012), Kansas (2011) and Indiana (2012). As a climate-sensitive, thermophilic ameba, predictions of a warming climate have implications for the ecology of N. fowleri and for infections, which warrants further research, monitoring and awareness of this pathogen.”
Disclosure: The researchers report no relevant financial disclosures.
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