reference : Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water

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reftype Journal Article
Abstract BACKGROUND: Naegleria fowleri is a climate-sensitive, thermophilic ameba found in the environment, including warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In 2011, 2 adults died in Louisiana hospitals of infectious meningoencephalitis after brief illnesses. METHODS: Clinical and environmental testing and case investigations were initiated to determine the cause of death and to identify the exposures. RESULTS: Both patients had diagnoses of PAM. Their only reported water exposures were tap water used for household activities, including regular sinus irrigation with neti pots. Water samples, tap swab samples, and neti pots were collected from both households and tested; N. fowleri were identified in water samples from both homes. CONCLUSIONS: These are the first reported PAM cases in the United States associated with the presence of N. fowleri in household plumbing served by treated municipal water supplies and the first reports of PAM potentially associated with the use of a nasal irrigation device. These cases occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Virginia. These infections introduce an additional consideration for physicians recommending nasal irrigation and demonstrate the importance of using appropriate water (distilled, boiled, filtered) for nasal irrigation. Furthermore, the changing epidemiology of PAM highlights the importance of raising awareness about this disease among physicians treating persons showing meningitislike symptoms.
Author Yoder, J. S.; Straif-Bourgeois, S.; Roy, S. L.; Moore, T. A.; Visvesvara, G. S.; Ratard, R. C.; Hill, V. R.; Wilson, J. D.; Linscott, A. J.; Crager, R.; Kozak, N. A.; Sriram, R.; Narayanan, J.; Mull, B.; Kahler, A. M.; Schneeberger, C.; da Silva, A. J.; Poudel, M.; Baumgarten, K. L.; Xiao, L.; Beach, M. J.
DOI 10.1093/cid/cis626
Date Nov
ISSN 1537-6591
Issue 9
Journal Clinical Infectious Diseases
Keywords Adult; Amebiasis/*chemically induced/*mortality; Central Nervous System Protozoal Infections/*chemically induced/*mortality; Female; Humans; Louisiana; Male; Middle Aged; Naegleria fowleri/*isolation & purification/pathogenicity; Paranasal Sinus Diseases/*complications/*therapy; Therapeutic Irrigation/*adverse effects
Language eng
Notes 1537-6591 Yoder, Jonathan S Straif-Bourgeois, Susanne Roy, Sharon L Moore, Thomas A Visvesvara, Govinda S Ratard, Raoult C Hill, Vincent R Wilson, Jon D Linscott, Andrea J Crager, Ron Kozak, Natalia A Sriram, Rama Narayanan, Jothikumar Mull, Bonnie Kahler, Amy M Schneeberger, Chandra da Silva, Alexandre J Poudel, Mahendra Baumgarten, Katherine L Xiao, Lihua Beach, Michael J Case Reports Journal Article United States Clin Infect Dis. 2012 Nov;55(9):e79-85. doi: 10.1093/cid/cis626. Epub 2012 Aug 22.
Pages e79-e85
Title Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water
Volume 55
Year 2012
Bibliographic identifiers
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_record_number 19024
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