As I listened to a story of a young 18 year old dying relatively suddenly within 3 days of “viral meningitis” in a neighboring town in Florida this past week, I couldn’t help but think about the possibility of a missed diagnosis. Summertime in Florida and all over the country, young (and old) people flock to lakes and streams for some good, wet fun. Could this young person have been at a local watering hole and this part of her history not been relayed to the doctors for some reason? Could she have actually succumbed to Naegleria fowleri, the amoeba that invades through the nose to the brain and can kill quickly? Doctors and the public alike need more education on this entity.
First, doctors… this entity may be more than 90% survivable with an easily obtainable anti-parasitic that is available in most hospitals in Florida. And if it is not available in your hospital, it is available within a few hours from the company that makes it. The diagnosis is difficult but can be made with direct visualization in the cerebrospinal fluid or with PCR. The treatment must be given within hours for a successful outcome. Please make it a point to ask about water exposures, if the patient has fever and delirium and a stiff neck. This includes the use of “neti-pots”, water slides, bouncy houses, water-skiing, swimming, inner-tubing, etc – almost any activity in warm, fresh water where water could go up the nose.
The medication is called miltefosine and prescribing information as well as how to obtain it, can be found at THIS SITE.
Next, the public… if you are spending time in the water this summer, avoid water going up your nose. The best way is to wear one of these noseclips you can see in the picture accompanying the article…
Avoiding water going up your nose is important in ALL water activities in fresh water, including water slides and swimming. It is not limited to Florida and, we have noted cases in Kansas, Indiana, Tennessee – even as far north as Minnesota (3 recent cases). And parents, make sure to invest, at the beginning of the summer, in several nose clips, because they do get lost. And do not use non-sterile water with nasal rinses. Boil the water first for at least 3 minutes, allow it to cool, then use the water in the nasal rinse. Naegleria fowleri is an amoeba that likely kills more than a dozen young persons every year, and some of these are likely not diagnosed until after death, if at all. The life you save with a simple nose clip could be your child’s.
Check out these sites for more information – Amoeba Awareness, Kyle Cares, Jordan Smelski, Swim Above Water…. these parents are trying to educate you about the dangers that their children faced.