title: Fatal Naegleria fowleri infection acquired in Minnesota: possible expanded range of a deadly thermophilic organism.
abstract: 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 real-time 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.
authors.affiliation: Minnesota Department of Health, Saint Paul, MN 55164, USA. sarah.kemble@state.mn.us
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Kemble
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.forename: Aaron S
authors.initials: AS
authors.lastname: DeVries
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Drehner
authors.forename: William F
authors.initials: WF
authors.lastname: Pomputius
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
authors.forename: Govinda S
authors.initials: GS
authors.lastname: Visvesvara
authors.forename: Alexandre J
authors.initials: AJ
authors.lastname: da Silva
authors.forename: Vincent R
authors.initials: VR
authors.lastname: Hill
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Yoder
authors.forename: Lihua
authors.initials: L
authors.lastname: Xiao
authors.forename: Kirk E
authors.initials: KE
authors.lastname: Smith
authors.forename: Richard
authors.initials: R
authors.lastname: Danila
mesh_terms: D000562:Amebiasis / Q000134:cerebrospinal fluid / Q000469:parasitology*; D000818:Animals; D001921:Brain / Q000469:parasitology; D020808:Central Nervous System Protozoal Infections / Q000134:cerebrospinal fluid / Q000469:parasitology*; D002648:Child; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D060106:Lakes / Q000469:parasitology*; D008910:Minnesota; D016848:Naegleria fowleri / Q000302:isolation & purification*; D013550:Swimming; D014871:Water Microbiology