Extremely rare but almost always fatal — Midlands child dies from freshwater amoeba infection

COLUMBIA, SC (WOLO) — A Midlands child has died after being exposed to a freshwater amoeba known as “naegleria fowleri,” according to Prisma Health and SC Department of Public Health officials.

Commonly referred to as a “brain eating” amoeba and found in freshwater bodies of water across South Carolina — like lakes, ponds, rivers, and hot springs — doctors say naegleria fowleri is only dangerous when the organism is forcefully introduced up someone’s nasal passages.

“It typically likes to live in the silt in the bottom of lakes rivers, those kinds of things, but as it gets hot outside, it increases the number of the amoeba but in addition when it gets really hot, a lot of times water levels drop so it condenses the amount of amoeba per how much water there is,” says Pediatric Infectious Diseases Dr. Anna Kathryn Burch with Prisma Health Children’s Hospital.

Most people who come in contact with the organism, she says,  will not be harmed. Drinking one of the amoebas or getting them on your skin is not harmful.

“Where it can cause an issue is if forceful water gets up the nose and is able to cross from the nose into the brain. That’s where people can get infected with this type of amoeba,” says Dr. Burch.

The amoeba then infects the brain, causing it to swell. Symptoms typically show up within one to 12 days and may include a severe headache, fever, diarrhea, nausea and vomiting, and a stiff neck.

And while cases are extremely rare with only around 10 people infected annually across the entire U.S.,  Dr. Burch says almost all cases are fatal.

“Greater than 97% of cases that have occurred since the 1960’s have been fatal. There have only been four cases in the U.S. who have lived — and those who live have variable outcomes,” says Dr. Burch.

When it comes to prevention, Dr. Burch says diving, or forcefully falling into the water from a tube or raft increases your exposure.

“That being said, teaching children how to either blow out of their nose or holding their nose, or you could do something easy like wearing nose clips that keeps your nose clipped while playing in the water. Other things to note is we don’t like individuals to be digging into the sand or the dirt especially in shallow water because that is where the amoeba likes to live,” says Dr. Burch.

There have also been rare cases of exposure through tap water by using nasal irrigation systems on your nose from nasal irrigation systems such as Neti pots. While chlorine kills this amoeba, tap water not treated with chlorine may be at risk.

“It needs to be boiled at least one minute and let it cool to room temperature before you use the water — or you can always use distilled water or sterile water in those devices,” says Dr. Burch.

Prisma Health or the SC Department of Public Health have not released any further information on the patient or the body of water where the infection occurred.

Because of how rare it is, cases are not required to be reported to the SC DPH and the agency does not track infections.

According to the Associated Press, health officials say the amoeba is known to have infected just 145 people in the U.S. from 1962 through 2018. Five of those cases occurred in North Carolina.

SC DPH issued the following statement on Monday to press:

As previously noted, infection with Naegleria fowleri is not required to be reported to South Carolina Department of Public Health (DPH) and DPH does not provide information about or comment on individual cases. This includes details about physical condition, hospitalization, age, sex and residence.

Recreational water users should assume that Naegleria fowleri is present in warm freshwater; however, the risk of infection is very low. Given that millions of Americans swim in warm freshwater every year but there are less than ten cases annually, people do not need to take any action except in the very unlikely case that they have symptoms. There is no need to be checked just because someone has been in warm freshwater where Naegleria fowleri is very likely present. 

Symptoms typically begin one-to-seven days after the infection occurs; however, it can be as many as 15 days before symptoms develop. Common symptoms include headache, fever, nausea, vomiting and a stiff neck. Later symptoms can include confusion, lack of attention, loss of balance, seizures and hallucinations. Per the CDC, you should seek medical care right away if you suddenly develop fever, headache, vomiting, or stiff neck. This is especially critical if you’ve been in warm fresh water where Naegleria fowleri thrives.