In 2007, I noted in the news a small but significant increase in this rare disease. Around the same time, I and others were commenting on how the weather patterns in recent years has been strangely variable and the summers unusually hot, even for Florida. Climate change has been a serious concern for me. In the past decade, I have changed most aspects of my lifestyle dramatically, doing my small part and advocating for sustainability, in the hope of reversing human-driven effects on climate. The “blip” in incidence was therefore an alarm to me, and I became concerned that cases of Naegleria would begin to trend upward. Since then, I lost my son to this parasite, and I have followed the news of others’ deaths, including in geographically unlikely areas, while experts have continued to call it “rare”.
It IS rare. Just not to me. I and other parents of victims can no longer believe that it is as rare as presupposed. We need only the empirical evidence of our devastation. Of emerging weather havoc that we have never seen in our lifetimes. These patterns are now all too clear to us, and we wish they were glaringly obvious to others.
For us, there is some comfort that this parasite and the role of climate change are garnering the attention of experts, and that awareness is spreading to clinicians. Scientific understanding advances only with care and meticulous research. We are ever so grateful for the efforts of public health in the investigation of Naegleria fowleri and the advancement of knowledge that may benefit others.
I should note that this is not likely to be the first Minnesota case, only the first definitive diagnosis. There is reason to suggest another case occurred in 2008, but confirmation was not possible then (unpublished, personal communication from a parent of a girl who died under suggestive circumstances).
Fatal Naegleria fowleri Infection Acquired in Minnesota: Possible Expanded Range of a Deadly Thermophilic Organism
Sarah K. Kemble,1,3 Ruth Lynfield,1 Aaron S. DeVries,1 Dennis M. Drehner,2 William F. Pomputius III,2 Michael J. Beach,4 Govinda S. Visvesvara,4 Alexandre J. da Silva,5 Vincent R. Hill,4 Jonathan S. Yoder,4 Lihua Xiao,4 Kirk E. Smith,1 andRichard Danila1
1Minnesota Department of Health, Saint Paul; 2Children’s Hospitals and Clinics of Minnesota, Minneapolis; 3Epidemic Intelligence Service, 4National
Center for Emerging and Zoonotic Infectious Diseases, and 5Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
Background.
Primary amebic meningoencephalitis (PAM), caused by the free-living ameba Naegleria fowleri, has historically been associated with warm freshwater exposures at lower latitudes of the United States. In August 2010, a Minnesota resident, aged 7 years, died of rapidly progressive meningoencephalitis after local freshwater exposures, with no history of travel outside the state. PAM was suspected on the basis of amebae observed in cerebrospinal fluid.
Methods. Water and sediment samples were collected at locations where the patient swam during the 2 weeks preceding illness onset. Patient and environmental samples were tested for N. fowleri with use of culture and realtime polymerase chain reaction (PCR); isolates were genotyped. Historic local ambient temperature data were obtained.
Results. N. fowleri isolated from a specimen of the patient’s brain and from water and sediment samples was confirmed using PCR as N. fowleri genotype 3. Surface water temperatures at the times of collection of the positive environmental samples ranged from 22.1_C to 24.5_C. August 2010 average air temperature near the exposure site was 25_C, 3.6_C above normal and the third warmest for August in the Minneapolis area since 1891.
Conclusions. This first reported case of PAM acquired in Minnesota occurred 550 miles north of the previously reported northernmost case in the Americas. Clinicians should be aware that N. fowleri–associated PAM can occur in areas at much higher latitude than previously described. Local weather patterns and long-term climate change could impact the frequency of PAM.
