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It happens to everyone at some point.  You’re enjoying a fun-filled summer day in the water when suddenly you experience the horror that comes with getting water up your nose.  No harm, really, just a horrible burning sensation that soon subsides, right?  Maybe not.  In fact, getting water up your nose can be deadly.

Naegleria fowleri, an amoeba that is present in all surface water, is responsible for primary amebic meningoencephalitis, or PAM, a disease contracted when water infected by the amoeba is forced up the nasal passages. 

The hot and dry conditions that accompany Texas summers provide an ideal environment for the PAM amoeba to thrive, which means that those who go swimming in lakes, streams, ponds or rivers should take extra precautions

Fortunately, the infection caused by the amoeba is rare. In 2014, there were five cases of PAM reported nationwide. But unfortunately, for those who are infected, the condition is almost always fatal. According to the Center for Disease Control (CDC) the fatality rate is over 97 percent. Only three people out of 138 known infected individuals in the United States from 1962 to 2015 have survived.

The Texas Department of State Health Services says from 1972-2015, there have been a total of 34 cases of PAM reported, occurring most often in children that were recently exposed to freshwater lakes, ponds, and rivers during the warm summer months.

The infection caused by the amoeba is often misdiagnosed since it first appears with flu-like symptoms.  The Mayo Clinic lists symptoms as:

  • A change in the sense of smell or taste
  • Fever
  • Sudden, severe headache
  • Stiff neck
  • Sensitivity to light
  • Nausea and vomiting
  • Confusion
  • Loss of balance
  • Sleepiness
  • Seizures
  • Hallucinations

These signs and symptoms can progress rapidly. The infection causes brain inflammation, destroying brain tissue and typically leading to death within a week.

The CDC notes that there have been four documented cases of a person surviving a PAM infection: one in the United States in 1978, one in Mexico in 2003 and two in the United States in 2013.

Of the known PAM survivors, one owes their recovery to a new drug that will soon be available to a limited number of hospitals nationally.  “An investigational breast cancer and anti-leishmania drug, miltefosine, has shown some promise in combination with some of these other drugs,” according to the CDC.  In Texas, Cook Children’s Health Center in Fort Worth was the first facility to receive the experimental drug from the CDC.    

The only way to absolutely prevent contact with the Naegleria fowleri amoeba is to avoid freshwater activities. However, since infections from the amoeba are rare, there are some ways to greatly reduce the risk while still enjoying water activities.

State health officials recommend that those taking part in warm, fresh water-related activities use nose clips or hold their noses shut while jumping into water. With the amoeba often found in soil, it is best to avoid stirring up underwater sediment. Health officials also recommend that people avoid stagnant or polluted water and take “No Swimming” signs seriously. 

PAM cannot be spread person to person or by drinking water. Swimming pools and hot tubs that are properly cleaned, maintained and chlorinated are generally safe, as is salt water.

For more information about PAM, go here  or contact the Texas Department of State Health Services Public Information Office at (512) 458-7400.