In a nutshell… This short article discusses Naegleria fowleri risk and prevention in water. These free-living amoebas can grow in heat freshwaters such together lakes and also sometimes inadequately treated, warm household (e.g., drinking, bathing) water. Entrance of contaminated water with the nose—not through swallowing—can result in a fatal brain infection. Just a grasp of situations are reported every year, therefore while the after-effects are grave, the actual risk of epidemic is minuscule for the vast variety of people that recreate in warmth water.

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Top: Computer-generated images of Naegleria fowleri amoeba in the feeding, traveling, and survival life stages: trophozoite (left), flagellated (middle), and cyst (right). Photo credit: CDC.

By now, plenty of of us have actually experienced this sentiment “can 2020 get any kind of worse?” but recent reports the a child’s fatality from Naegleria fowleri (Nf), generally called the “brain-eating amoeba,” from contaminated water in a southeast Texas ar proves the it can and just did. The Water top quality & health and wellness Council has actually written around this amoeba before, including to to mark the role the chlorine-based water disinfection to aid prevent infections, which while very rare, are practically always fatal.

Naegleria fowleri Basics

Naegleria is a genus the free-living, single-celled amoeba found about the world. They feed on bacteria and other microbes in the environment. Although over there are nearly 50 separate species of Naegleria, just Nf infects humans.

The amoebas are commonly found in heat freshwaters (e.g., lakes, rivers, ponds, canals) and also wet soil. Detection requires devoted testing. Because they room ubiquitous, it should be suspect that any type of warm body of freshwater could be colonized/contaminated. Most infections indigenous the amoeba happen in warmer states, however cases have been reported as much north together Minnesota. Lock can additionally be discovered in warm springs, heat water discharges from commercial plants, poorly kept swimming pools, and also even water heaters and also pipes delivering household water. Naegleria cannot make it through in freshwater the is clean, cool, and also adequately chlorinated. That is not uncovered in maritime waters.

Did You say “Brain-Eating” Amoeba?

Yes. Naegleria fowleri typically infects individuals when contaminated, warm water enters the nose forcibly via recreational activity or intentionally through the usage of contaminated water for nasal watering (e.g., “neti pots”). When the amoeba has gone into the sleep cavity, it should cross multiple defense obstacles before it can reach and infect a who brain. This in part explains the, thankfully, excessive rareness the the disease. Yet once Nf will the brain, that can reason a damaging infection dubbed primary amebic meningoencephalitis (PAM), which outcomes in the destruction of mind tissue. According to the U.S. Centers for an illness Control and Prevention (CDC), between 2010 and 2019 only 34 Nf PAM infections were reported in the U.S. Population of around 325 million, or around 1 in 10 million. Yet of this 34 infections, 31 were fatal. 

Most situations of PAM room in children and young adults as a an outcome of vigorous recreational water contact such as diving, splashing, and also kayaking. Also if water include the amoeba does walk up the nose, the possibility of a person contracting PAM is still extremely small. You cannot acquire infected native swallowing water include Nf amoeba and also PAM can not be spread out from person to person.

Tragedy Strikes in southeast Texas 

Following the epidemic of a 6-year-old in late September 2020, Nf amoeba to be detected in the storage tank of the Lake Jackson Civic center Splash Pad wherein he had actually played, an outdoor hose at the child’s home, and a dead-end fire hydrant located near the splash pad. Succeeding testing also found amoebas in the water supply of the neighborhood drinking water utility. The children infection and subsequent death, as well as water test results, obtained national news coverage. Although the Lake Jackson, Texas, water is again considered safe to drink, the utility continues to urge citizens to minimize their risk of infection by avoiding getting water into their noses. Top top October 11, 2020, following considerable water testing and also CDC genetic evaluation of the amoeba, local health and wellness officials announced that the splash pad warehouse tank was the resource of the amoeba.

Naegleria fowleri and Drinking Water

The amoeba was very first isolated from drink water offers in Australia in the 1980s, years prior to it was considered a danger in the united States. And also Australia proceeds to be a global leader in the usage of disinfection and risk monitoring strategies for Nf in to chat waters and drinking water. Naegleria fowleri proceeds to be uncovered periodically—when looked for—in U.S. Drinking water systems. Number of deaths from and also detections the Nf in Louisiana drinking water systems starting in 2012 elevated water professional and public awareness of the deadly amoeba. They also led come statewide changes in disinfection practices.

Drinking water treatment plants and also distribution equipment can control Nf threats using developed disinfection processes. However, low distribution system disinfectant residuals will proceed to pose obstacles for part systems—particularly in warmer climates/seasons and in areas with high water temperatures and “water age” (i.e., the moment it takes because that centrally cure water to take trip to a consumer’s tap) the lowers or gets rid of residual disinfectant levels. Undoubtedly, the greatest difficulty for Nf regulate is because that in-building (premise) plumbing systems where disinfection and water quality problems are mostly beyond the regulate of drinking water utilities.

Naegleria fowleri Prevention

Several personal actions can be bring away to reduce the danger of Nf amoeba infection, focusing on (1) limiting the lot of water going up the nose, and (2) lowering the opportunities that the amoeba may be in the water. The adhering to list of general tips, adapted from the Queensland federal government in Australia, space helpful:

Caution kids (of all ages) around risks jumping or diving into bodies of heat fresh water, particularly shallow and also muddy pools. Keep your head over water in spas and warm new water bodies or hold your nose shut or use nose clips when recreating in body of warm freshwater or spas.Empty, clean, and air-dry small collapsible wading pools after every use.Ensure swim pools and spas are adequately chlorinated and well maintained. Always flush stagnant water from hoses before permitting children come play v hoses or sprinklers.Supervise kids playing with hoses or sprinklers and teach them to no squirt water up their nose.If you are using unchlorinated water, don’t enable water to walk up your nose once bathing, showering, or washing her face. 

Most importantly, if you take place to endure unusual symptoms, including unusual frontal headache, fever, nausea, and also stiff neck in ~ a week or 2 of feasible exposure come Nf (e.g., diving in a fresh water lake)—let your physician know. Early detection and treatment provide the best and ONLY chance of survival.

Final Thoughts

According come CDC, there is no way to accurately estimate the true risk of PAM led to by Nf. Numerous millions of visits to freshwater venues occur annually in the joined States an outcome in just a grasp (0 come 8) the PAM infections. The is unknown why details persons become infected with the amoebas while countless others exposed come recreational waters containing the amoebas execute not. This instance is akin come walking across a country road and not searching for cars. If the chance of getting hit might be tiny, the repercussion of gaining hit is catastrophic. So, look once you overcome streets, teach children when swim (or showering) to shot to store water the end of their nose, and constantly use sterile, boiled, or distilled water through neti pots.

Awareness of Nf threats should be what guides our precautions. The people is filled with risks, this one should not induce panic as that is very low and also easily avoided.

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Bruce K. Bernard, PhD, is president of SRA Consulting, Inc., associate Editor that the worldwide Journal of Toxicology, and lives in Cambridge, MD. Steve Hubbs, PE, retirement from water therapy operations at the Louisville Water agency in 2004. That was energetic in training water therapy operators in the wake of Nf comes to in Louisiana in 2013 and 2014.