Certain maladies stoke our most primal fears. Naegleria fowleri, also known as the “brain-eating” amoeba, ranks among them. This single-celled organism’s latest victim is a well-loved 14-year-old who tragically contracted the amoeba during preseason training when his cross-country track and field team decided to take a swim in a Texas state park.
The story is terrifying to many because the amoeba’s victims have done absolutely nothing out of the ordinary and have still become infected. While it’s important that we place our risk in context, there’s nothing wrong with putting a little fear to good use.
The amoeba itself seems like an insurmountable foe. It is abundant in freshwater and soil and its levels rise as the summer heat drags on. And while we encounter it routinely, only some of us become infected.
Many of the people in the headlines are children and teenagers. That’s because the amoeba climbs into the brain via branches of the olfactory nerve, which we use to smell. It’s a cranial nerve, which means it connects directly to the brain through holes in the skull, and its pathway at the roof of the nose is more developmentally exposed in children.
Once in the brain, the amoeba can start up a severe meningitis marked by uncontrolled inflammation that initiates a catastrophic rise in intracerebral pressure. Unconsciousness follows.
The organism earns its sci-fi “brain eating” moniker thanks to structures called “food-cups” that actively ingest brain tissue, or most anything else in their way.
That’s the horrible news. The better news is that the infection is extremely rare. Only 40 people have been infected in the United States over the past decade. We see about that number of shark attacks every year, by contrast.
But while shark attacks often maim but rarely kill, only three of the 133 people known to have been infected by Naegleria fowleri in the United States have survived. Worldwide, there are only seven known survivors, according to a recent medical journal report. That’s a death rate that outstrips Ebola.
Unlike Ebola, which is far more contagious, Naegleria fowleri is a very common organism in our environment. It circulates in freshwater bodies like lakes and streams and the soil itself, especially in Southern states.
How to keep safe? While you can zero out your risk by avoiding natural bodies of fresh water altogether, that’s not necessary given the extreme rarity of this infection. If your quality of life and mental well-being were to take a dive because you’re suddenly afraid to dip into your favorite lake, that change in your behavior will probably have more important impacts on your health than this miniscule risk.
That said, encouraging children to limit their amount of underwater swimming and diving, and using nose clips or nose plugs with activities that might drive water up their noses, seems like a reasonable measure to take. If the water is quite murky or stagnant, it’s best to avoid it altogether.
Local health departments in Southern states should consider identifying key recreational swimming locations and implementing a testing regime, much as we already do for bacteria counts on beaches near metropolitan areas. There’s no simple or rapid test for the amoeba, but a few key lakes could be used as a proxy for amoeba counts in a given region and health departments can publicize the numbers via local media and their websites.
I agree with a petition that’s being put forward by Dr. Sandra Gompf, an infectious diseases specialist who lost her own son in just three days to amoebic meningoencephalitis caused by Naegleria fowleri.
She’s asking the CDC to use its power to designate infections with the organism as worthy of mandatory reporting.
Such reporting, which necessitates more testing, should spur more commercial interest in facilitating rapid diagnostic tests that will drive down costs and speed up processing. We’d know more about the disease’s true incidence and behavior under a mandatory reporting regime, and such information can only help developing smarter prevention and treatment strategies.
Naegleria fowleri deserves more such calm and collected attention from our neocortex. Our deeper, primal brains needn’t paralyze themselves with visions of approaching amoebic food-cups. Easier said than done, I know.