Florida Reports Death Associated with Brain-Eating Amoeba Infection

On February 20, 2023, a man in Florida died from an infection with Naegleria fowleri, often called a brain-eating amoeba. The CDC reported that the disease was associated with an improper nasal rinse using tap water instead of distilled, previously boiled, or sterile water. This incident follows a 2022 Southern Nevada Health District announcement confirming the infection and death of a pediatric patient who contracted Naegleria fowleri.

“This is the first reported case of Naegleria fowleri infection in the United States this year, and the first ever reported in winter months in the United States,” officials told Fox4 about the most recent Florida infection.  

Primary amebic meningoencephalitis (PAM) is an infection caused by Naegleria fowleri. Often found in warm freshwater, this single-celled organism enters the body through the nose and travels to the brain, destroying brain tissue and causing PAM. It is important to note that the nasal passage is the only way this amoeba infects humans.

The physical symptoms of this highly fatal condition usually manifest five days after infection; however, symptoms can begin 1–12 days after nasal exposure. The early stage of the disease, stage one, is typically associated with symptoms such as frontal headache, fever, nausea, and vomiting. As symptoms progress into stage two, patients may experience stiff necks, seizures, altered mental status, hallucinations, or coma.

It is improbable for individuals to survive PAM. The CDC notes that between 1962 and 2021, only 154 cases of PAM have been reported in the United States, with only four patients surviving.

According to the CDC, treatment for this condition involves the following medications, which are thought to act against the amoeba: amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone. Most patients die within 18 days of symptom onset if treatment does not work.

While this condition is thought to be rare, experts have become increasingly concerned about how changing climates may impact the presence of Naegleria fowleri. Like the impact on other infections, such as tickborne illnesses and zoonotic diseases, rising temperatures have expanded the geographical range of Naegleria fowleri.

An expanded geographical range has led to rising infection rates and risks; however, some methods can prevent or minimize risk. First and foremost, the FDA notes that sinus rinses should only be used with distilled or sterile water, water that has been boiled and cooled, or water passed through a filter intended to filter out infectious organisms. People are also advised to minimize nasal contact in warm fresh water.

Beyond prevention, detecting the infection early may improve patient outcomes. With that in mind, Jose Alexander, MD, a clinical microbiologist and director of microbiology, virology, and immunology for AdventHealth Orlando, and his team have developed a new PCR test for detecting Naegleria fowleri and two other amoebas, Balamuthia mandrilaris and Acanthamoeba spp.

Alexander told LifeSciencesIntelligence that traditional testing could take up to six days, meaning that many patients are diagnosed post-mortem. However, this new molecular test uses PCR technology to detect amoebas in cerebrospinal fluid within three hours.

As temperatures continue to rise amid the climate change crisis, this test may be a critical tool for detecting infections and initiating early treatment. While treatment does not necessarily correlate with survival, early detection may allow healthcare professionals to manage patient care and disseminate information on infections more rapidly.