The first day of summer is only a few short days away, bringing with it higher temperatures and warmer water. To keep cool, people will spend time on a lake, in a river, or at a water park, but before heading out, everyone should be aware of primary amebic meningoencephalitis (PAM).
It’s a microscopic organism living in warm, freshwater called Naegleria fowleri, commonly known as the “brain-eating amoeba,” and can potentially cause a severe, deadly brain infection.
This little organism is commonly found in warm freshwater environments such as rivers and lakes and even poorly maintained swimming pools and splash pads.
It thrives in temperatures above 77 degrees Fahrenheit. The amoeba enters the body through the nose when a person swims, dives, and plays in contaminated water. It’s safe to assume that the amoeba is always present in any freshwater, but it’s only a danger if that water goes up the nose.
According to the Centers for Disease Control (CDC) records, there were 157 cases of PAM reported from 1962 to 2022. Texas and Florida have the highest counts with 39 cases and 37 cases, respectively. As of 2022 data, 97% of cases end in a fatality, with only four people having ever survived Naegleria fowleri.
One of those who fell to that statistic was 10-year-old Lily Mae Avant, who contracted the amoeba while playing in the river just behind her home.
“It happened Labor Day weekend in 2019,” Lily’s mother, Laci Avant, explained. “We were having a family gathering and playing in the river like we usually did. The following Sunday (5 days later) is when she started to complain of a headache that even with medication would not go away, and then the fever started that same evening.”
Initial PAM symptoms include headache, fever, nausea, and vomiting. Since PAM is known to progress rapidly, later symptoms may include a stiff neck, confusion, loss of balance, seizures, and hallucinations. According to the CDC, it can take anywhere from two to 15 days for symptoms to appear, and the infection usually kills within an average of five days after the first symptoms show up.
“I took her to the doctor Monday where he tested her for strep and flu, which came back negative. Her doctor did an exam thinking it might be meningitis, PAM mimics meningitis, which is the reason it is often misdiagnosed,” explained Avant. “Her doctor really couldn’t figure out what was wrong, so he sent us home and told me if she wasn’t better by the morning, to bring her back in and we’ll go from there. The next morning, Tuesday, I woke up and she was unresponsive. I put her in the car and rushed her to the emergency room where they immediately careflighted her to Cooks in Fort Worth. They immediately did a spinal tap, revealing that she had contracted Naegleria fowleri.”
Avant explains, “The infectious disease doctor came in and explained to us that it is 99% fatal, they started administering the medication, but told us she probably won’t make it. She passed away five days later. Initial symptoms show 1 to 14 days after contact, but life is typically lost within 3 to 5 days after symptoms begin to show.”
While Naegleria fowleri infections are exceptionally rare, it is crucial to be aware of the risks and take appropriate preventive measures, especially when participating in water activities in warm freshwater environments.
To avoid being exposed to PAM, you don’t have to avoid all freshwater. Here are some preventative steps you can take:
- Avoid jumping or diving into bodies of warm freshwater, especially during the summer.
- Hold your nose shut, use nose clips, or keep your head above water when in warm, fresh water bodies.
- Avoid putting your head underwater in hot springs and other untreated geothermal waters.
- Avoid digging in or stirring up the sediment in shallow, warm fresh water. The amoeba are more likely to live in sediment at the bottom of lakes, ponds, and rivers.
- Avoid placing your face directly in the path of water shooting up from a splash pad. Again, holding your nose or using nose clips is vital.
It’s imperative to seek immediate medical attention if you or someone you know develops a headache, fever, or vomiting after swimming or playing in freshwater. The Texas Department of State Health Services has a list of Naegleria fowleri FAQs here.
Prevention is key when it comes to such rare, but potentially severe, infections. Avant says, “I want others to be safe and never want anyone to have to live this nightmare. So, nose plugs! You have your child wear a seat belt while in the car, why not a nose plug when they’re in the water?”