Saturday, July 27, 2013

Parasitic meningitis: Swimming illness confirmed in 12-year-old girl, symptoms, causes, treatment (Video)

Parasitic meningitis, a usually fatal brain infection that can occur after swimming or irrigating, flushing, or rinsing one's sinuses, has been detected in a 12-year-old girl from Arkansas. 

The brain infection formally known as primary amebic meningoencephalitis (PAM) can occur when people dive in warm freshwater places such as lakes and rivers. The Naegleria fowleri ameba is a single-celled living organism and a parasite that travels up the nose to the brain where it destroys the brain tissue.

On July 26, 2013, parasitic meningitis was confirmed in 12-year-old Kali by the Arkansas Department of Health which is considering the Willow Springs Water Park as the most likely source of infection of parasitic meningitis. 
“There was another case of PAM possibly connected with Willow Springs in 2010. Based on the occurrence of two cases of this rare infection in association with the same body of water and the unique features of the park, the ADH has asked the owner of Willow Springs to voluntarily close the water park to ensure the health and safety of the public."
While infection with Naegleria can occur anywhere, it usually occurs in the warm southern U.S. From 2003-2012, there have only been 31 reported infections in the U.S. This case is only the sixth case in Arkansas in 40 years.

Just one day after 12-year-old Kali Hardig from Benton in Arkansas had gone swimming at Willow Springs Water Park, Kali Hardig showed the typical signs of parasitic meningitis.
 "I couldn't get her fever down. She started vomiting. She'd say her head hurt really bad. She cried, and she would just look at me and her eyes would just kind of roll," said her mother Traci Hardig.
Traci brought her daughter Kali to Children’s Hospital last Friday where doctors told her that 12-year-old Kali suffered parasitic meningitis. She has been put in a medically induced coma.
"They call her stable for the moment, just got to ride out all the inflammation, all the side effects that the meningitis caused," said Kali’s mother.

Causes of parasitic meningitis: 

According to the Centers for Disease Control and Prevention (CDC), parasitic meningitis can be caused by swimming or diving in warm freshwater places like lakes and rivers but it can also “occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated tap water <47°C) enters the nose, for example when people submerge their heads or cleanse during religious practices (1), and, possibly, when people irrigate their sinuses (nose).”

Factors that can increase the risk of parasitic meningitis include:
  • Bodies of warm freshwater, such as lakes and rivers
  • Geothermal (naturally hot) water, such as hot springs
  • Warm water discharge from industrial plants
  • Geothermal (naturally hot) drinking water sources
  • Soil
  • Swimming pools that are poorly maintained, minimally-chlorinated, and/or un-chlorinated
  • Water heaters with temperatures less than 47°C (3, 4)
  • Naegleria fowleri is not found in salt water, like the ocean
  • Parasitic meningitis cannot be spread from one person to another.

Signs & Symptoms of parasitic meningitis: 

Naegleria fowleri causes the disease primary amebic meningoencephalitis (PAM), a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to symptoms of bacterial meningitis.

“Initial symptoms of PAM start 1 to 7 days after infection. The initial symptoms include headache, fever, nausea, vomiting, and stiff neck. Later symptoms include confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly and usually causes death within 1 to 12 days.”

The Arkansas Department of Health describes the symptoms of parasitic meningitis as the following.

“Persons with infection will develop symptoms such as fever, vomiting, stiff neck, headache, light sensitivity, irritability, sleepiness, confusion, or mental status changes within 7 days. If you develop two or more of these symptoms, please contact your doctor.”


Parasitic meningitis is rare and the early symptoms might be more likely caused by bacterial meningitis or viral meningitis. Bacterial meningitis and viral meningitis are much more common than parasitic meningitis.  

“People should seek medical care immediately whenever they develop a sudden onset of fever, headache, stiff neck, and vomiting, particularly if they have been in warm freshwater recently.”


Naegleria fowleri  which causes parasitic meningitis is found in many warm freshwater lakes and rivers in the United States, particularly in southern tier states. It is likely that a low risk of Naegleria fowleri infection will always exist with recreational use of warm freshwater lakes, rivers, and hot springs.

The only certain way to prevent a Naegleria fowleri infection is to refrain from water-related activities in or with warm, untreated, or poorly-treated water. The CDC provides the following advice for preventing parasitic meningitis:
  • Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
  • Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater.
  • Avoid digging in, or stirring up, the sediment while taking part in water-related activities in shallow, warm freshwater areas.
  • If you are irrigating, flushing, or rinsing your sinuses (for example, by using a neti pot), use water that has been distilled, sterilized, previously boiled for 1 minute (at elevations above 6,500 feet, boil for 3 minutes) and left to cool, or filtered, using a filter with an absolute pore size of 1 micron or smaller. Rinse the irrigation device after each use with water that has been distilled, sterilized, filtered, or previously boiled and leave the device open to air dry completely.

Treatment of parasitic meningitis: 

Several drugs are effective against Naegleria fowleri in the laboratory. However, their effectiveness is unclear since almost all infections have been fatal, even when people were treated.

As 12-year-old Kali continues her fight against parasitic meningitis, her mother remains hopeful that her daughter will continue to improve.

Update on August 15, 2013, on Kali's condition: 

The family of Kali Hardig has released the following statement:

“We continue to be amazed by Kali’s progress," her family said. "Today she’s able to sit up on her own, write some words on a white board and stand with assistance for very brief stretches. She’s even able to throw and catch a ball with her therapists. We are grateful for the continued prayers from Kali’s supporters, which no doubt drive her recovery.”

Dr. Vikki Stefans, Kali's attending physician at Arkansas Children's Hospital, also released a statement:

“Kali’s progress is definitely a credit to her wonderful family and support system. There is no longer a question of whether she’ll survive and do well, but just how well.”

Kali is believed to be one of only three people to survive the infection.