title: The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a US treated public drinking water system.
abstract: BACKGROUND
  Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old boy died of meningoencephalitis of unknown etiology in a Louisiana hospital.
  
  
  METHODS
  Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures.
  
  
  RESULTS
  Based on testing of cerebrospinal fluid and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri was identified in water samples from both the home and the water distribution system.
  
  
  CONCLUSIONS
  This case is the first reported PAM death associated with culturable N. fowleri in tap water from a US treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern states, with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Cope
authors.affiliation: Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge.
authors.forename: Raoult C
authors.initials: RC
authors.lastname: Ratard
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Vincent R
authors.initials: VR
authors.lastname: Hill
authors.affiliation: Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge.
authors.forename: Theresa
authors.initials: T
authors.lastname: Sokol
authors.affiliation: Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge.
authors.forename: Jonathan Jake
authors.initials: JJ
authors.lastname: Causey
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Yoder
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Gayatri
authors.initials: G
authors.lastname: Mirani
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Mull
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Mukerjee
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jothikumar
authors.initials: J
authors.lastname: Narayanan
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Meggie
authors.initials: M
authors.lastname: Doucet
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Qvarnstrom
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Charla N
authors.initials: CN
authors.lastname: Poole
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Olugbenga A
authors.initials: OA
authors.lastname: Akingbola
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jana M
authors.initials: JM
authors.lastname: Ritter
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Zhenggang
authors.initials: Z
authors.lastname: Xiong
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Alexandre J
authors.initials: AJ
authors.lastname: da Silva
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dawn
authors.initials: D
authors.lastname: Roellig
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Van Dyke
authors.affiliation: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors.forename: Harlan
authors.initials: H
authors.lastname: Stern
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lihua
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beach
mesh_terms: D000562:Amebiasis / Q000175:diagnosis* / Q000469:parasitology*; D001921:Brain / Q000469:parasitology; D020808:Central Nervous System Protozoal Infections / Q000175:diagnosis* / Q000469:parasitology*; D002555:Cerebrospinal Fluid / Q000469:parasitology; D002675:Child, Preschool; D060766:Drinking Water / Q000469:parasitology*; D017809:Fatal Outcome; D006801:Humans; D008145:Louisiana; D008297:Male; D016848:Naegleria fowleri / Q000302:isolation & purification*; D009842:Oligopeptides
chemical_list: D060766:Drinking Water; D009842:Oligopeptides; C053418:tyrosyl-arginyl-phenylalanyl-sarcosine
keywords: Naegleria fowleri; free-living ameba; primary amebic meningoencephalitis