florida health officials are warning residents Charlotte County to be careful when swimming and washing their faces and to avoid using unsterile tap water for nasal irrigation after a local man died of a brain-eating amoeba infection.
They asked residents to avoid getting water in their noses when showering or swimming and to not allow children to play unsupervised with hoses, sprinklers or during any other activity that allows water to enter their noses.
The Florida Department of Health stressed that you cannot be infected with the organism called Naegleria fowleri, drinking tap water. The amoeba causes an infection called primary amebic meningoencephalitis (PAM), which is almost always fatal.
Health officials issued the warning on February 23 and have not released any further details about the patient who died. The media reported that the patient was a man who rinsed his sinuses. daily with unboiled tap water.
While infections and deaths are dramatic, they are thankfully rare. “Anyone can get it in the right setting, but the risk is low,” says Dr. Adarsh Bhimraj, an infectious disease physician at Houston Methodist.
he Centers for Disease Control and Prevention 154 cases of PAM of Naegleria fowleri in the US between 1962 and 2021. All but four were fatal.
It’s not the first time
This is not the first time someone has been infected with the amoeba by rinsing their nostrils with unsterile tap water. he Louisiana Department of Health It recorded two deaths in 2011, both attributed to tap water delivered via a neti pot, a type of sinus irrigation system that uses salt and water.
Naegleria fowleri it can also enter through the nose when swimming or diving. In 2021, a 10 year old girl in Texas became infected and died, likely after swimming in a splash pad near Dallas where the organism was detected.
Naegleria fowleri it is not the only amoeba that can cause disease or even death. TO 69 year old woman in Seattle died after apparently coming into contact with the amoeba Balamuthia mandrillarisagain with tap water in a neti pot, although the water had been run through a Brita purifier. Balamuthia mandrillaris causes a much slower infection than Naegleria fowleri.
A third type of amoeba, Acanthamoeba, can also infect humans, according to a study in id cases. They are all free-living, meaning they don’t need a host to survive, Bhimraj explained. “It’s not uncommon to find them in the environment.”
a perfect storm
Brain-eating infections are fairly rare because “everything has to line up perfectly,” said Juan Dumois, a pediatric infectious disease physician at Johns Hopkins All Children’s Hospital in St. Petersburg, who has seen one case in his career.
You need to start with a water source that contains amoeba first. Even then, not everyone exposed to the same infected water will get sick. The water has to enter through the nose and stick. “If you just wash it down or go down the esophagus, it won’t cause any problems,” Dumois explained.
Even so, infectious organisms still have a long way to go, a path that involves finding their way to one of the olfactory nerves. These nerves give you the ability to detect odors and are the same ones that are damaged in some people with COVID. The germs can travel up the nerve to the brain and cause an infection. “If the amoeba never finds that nerve, that’s it,” Dumois said. “Otherwise, it’s bad luck from a specific series of events.”
Once lodged in your brain, Naegleria fowleri it will burrow into brain tissue and consume brain cells. This then activates the immune system to try to fight it off. “A lot of white blood cells go in there and try to destroy the amoeba, and in the process, the white blood cells cause damage as well,” Dumois said. “There are actually areas in the brain that start to break down and liquefy from the inflammatory reaction of fighting the amoeba.”
the right environment
Typically, Naegleria fowleri they occur in warmer climates, which is where the organisms thrive. Most of the recorded infections occurred in 15 southern states, with Texas and Florida accounting for nearly half. Infections that occur further north, such as in Michigan or Minnesota, tend to occur in the summer. The amoeba lives only in fresh water like lakes and rivers and sometimes in brackish water, but not in salt water.
In general, infections peak in July and August. But experts predict that infections will become more common in northern areas as a result of climate change. “With climate change, temperatures even in Wisconsin and Minnesota have been warm enough,” Bhimraj said.
It can also be found in swimming pools that are not properly chlorinated and in municipal water supplies under certain conditions. With tap water, “the problem is how the water is distributed,” Dumois explained. “The water is treated at the water plant and then pumped into the pipes. He then has to travel different distances before reaching the tap. The more time that has to pass and the longer the water stays in the pipes, the lower the chlorine level.” If the pipes are not used for a while, the chlorine levels drop.
Symptoms and treatment of brain infection
Patients with PAM, the brain infection caused by Naegleria fowleri, It usually starts with symptoms of meningitis, meaning fever, stiff neck and “the worst headache I’ve ever had,” Dumois said. Subsequently, they can develop seizures, hallucinations and even fall into a coma.
According to Dumois, survival largely depends on the infection being diagnosed correctly and treated on time. Doctors can perform a lumbar puncture and test for different bacteria that cause meningitis, but not the amoeba. “You’re only going to suspect Naegleria fowleri if they were told or asked if the patient has been in a situation where fresh water has come up their nose,” Dumois said.
Doctors usually treat MAP with a combination of drugs, including some antibiotics.
avoid infection
First of all, never use water straight from the tap to irrigate your sinuses. Water that has been boiled for one to five minutes and then cooled should be safe, as should store-bought distilled water. “That is the type of water you want to use,” Bhimraj said. “Why take the risk?”
Washing your face can also be a risk. “If you can wash your face without getting water up your nose, it should be fine to wash your face under running tap water,” Dumois said. “If you have a tendency to get water up your nose when you wash your face, you’re probably doing it too hard.”
There is no danger if you are going to swim in salt water. You’re also safe if you swim in fresh water but don’t stick your head below the surface, Dumois said. Swimming underwater, diving, splashing, water skiing or using a water slide could result in an unfortunate chance encounter with Naegleria fowleri. Covering your nose will help, as will wearing a well-fitting diving mask that covers your eyes and nose. “That will keep most of the water out of your nose as long as you have a good fit,” Dumois said.
