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.”
Diagnosis
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.”
Prevention
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.
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.
