A deadly “brain-eating” amoeba infection usually strikes people in the southern states of the United States, but thanks to climate change, the brain-invading organism is expanding its reach northward. In light of this trend, the Ohio Public Health Association recently released a case report to raise awareness of the disease among health care workers in the state.
The amoebas typically live in soil, warm freshwater, and occasionally water tanks, heaters, and pipes, but in rare cases, they can invade the human brain, causing an infection called primary amebic meningoencephalitis (PAM). PAM is rare, with approximately 0 to 8 cases reported each year nationwide since 1962. Most of these infections have been associated with swimming in the South, particularly Florida and Texas, but since 2010, more northern states such as Minnesota, Kansas, and Indiana in the Midwest have been associated with swimming, and infections are starting to appear in states.
Indiana State, Iowa, Minnesota, and other northern states, as well as Virginia, North Carolina, South Carolina, Georgia, and Florida, are common among Ohioans who have reported Fowleri infections. It has also occurred while on vacation. The report describes a case in which a woman in her mid-30s was rushed to a Midwestern hospital unconscious after experiencing severe headaches, photosensitivity, nausea, and confusion. She was initially reported as having suspected bacterial meningitis, or brain inflammation caused by bacteria. However, the public health nurse, in interviewing the woman’s spouse, learned that her patient and her family had gone to the shore of a freshwater lake four days earlier and had her head submerged.
A sample of the patient’s cerebrospinal fluid was negative for the bacteria, so the researchers found suspected a virus was behind it. Infection. However, as the patient’s condition continued to deteriorate rapidly, the nurse contacted the State Department of Health’s Infectious Diseases Service for other possible causes. The State Department then contacted the CDC. Given the patient’s recent trip to the lake, the CDC suggested that the culprit may be Faurelli.
After communicating this to the patient’s medical team, the CDC provided information about miltefosine. Miltefosine is a drug that has killed fowleri in the lab and killed other types of fowleri. “The patient responded favorably to the medication. Two weeks after her symptom onset, she recovered with minimal neurological damage and was able to resume a quality life with her family,” the case report said.
In addition to miltefosine, PAM is being treated with several drugs, all of which are thought to kill the fowleri bacteria and were previously used in survivors of the infection, according to the CDC. Rapid diagnosis is key to initiating and potentially benefiting patients from these treatments. Health care providers in northern states should investigate whether patients with symptoms of meningitis have recently swam in warm fresh water and contact the CDC at (800) 232. -4636 for suspected PAM, the report notes.
“Coupled with increased incidence in northern climates, untrained and uninformed public health professionals and health care providers exacerbate prolonged diagnosis and delay time-sensitive treatment,” the report said, which could ultimately lead to a rapid decline in PAM.