Lauren Dempsey, MS in Biomedicine and Law, RN, FISM News 

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Last month, the Florida Department of Health in Charlotte County confirmed the death of a Florida man recently infected with Naegleria fowleri (N. fowleri), possibly as a result of rinsing his sinuses with tap water.

The unnamed man died on February 20, just a few days before the health department issued a warning to residents. This is the first reported case of N. fowleri infection this year and the first case that has been linked to tap water in Florida, although health officials are reassuring the public that tap water is still safe to drink. It is also the first case in the United States that has been reported in the winter, which is a time when the amoeba is considered dormant.

Health officials in Charlotte County are providing nasal clips and educational materials for residents and are encouraging numerous safety measures to avoid nasal exposure.

These safety tips include using distilled, sterile, or boiled tap water when making sinus rinse solutions, keeping all swimming pools adequately disinfected, do not let children play in sprinklers or garden hoses, and avoiding submerging your head underwater or getting water in your nose when bathing, showering, washing your face, or swimming.

WHAT IS N. FOWLERI?

Naegleria fowleri is a microscopic, shapeshifting amoeba that generally lives in soil and warm freshwater environments or improperly maintained swimming pools where it feeds on bacteria. Infection is very rare and only occurs when contaminated water enters the body through the nose and sinuses where it then migrates to the brain. Once the amoeba is in the brain, it causes primary amebic meningoencephalitis (PAM) which destroys brain tissue and is fatal 97% of the time.

Symptoms usually include headache, fever, nausea, disorientation, vomiting, stiff neck, seizures, hallucinations, and loss of balance. Once symptoms start, death typically occurs within 12-14 days. The Charlotte County Health department urges anyone experiencing these symptoms to seek medical attention immediately.

According to the Centers for Disease Control and Prevention (CDC), of the 154 people known to be infected between 1962 and 2021, only four have survived and there is one documented survivor from Mexico. In the U.S. most infections have been linked to swimming in southern states, like Texas and Florida. However, the risk of infection is very low.

While infections are rare, the CDC warns that the amoeba is common in freshwater and people should always assume that water is contaminated. There have only been 31 reported infections in the U.S. in the last ten years with an average of zero to five cases per year. Treatment is difficult and usually involves a combination of drugs, although experts are unsure of how well these drugs actually work.

Cases have been reported for the last four years, in 2022 there were three confirmed annual cases of N. fowleri, which occurred after exposure to freshwater in Iowa, Nebraska, and Arizona, and one suspected case in a Florida teenager.

The Department of Health in Charlotte County said it is “continuing to investigate how this infection occurred and is working with the local public utilities to identify any potential links and make any necessary corrective actions.”