What is Naegleria?
Naegleria is an ameba (single-celled living organism) commonly found in warm freshwater (for example, lakes, rivers, and hot springs) and soil. Only one species (type) of Naegleria infects people: Naegleria fowleri.
How does infection with Naegleria fowleri occur?
Naegleria fowleri infects people when water containing the ameba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri ameba then travels up the nose to the brain where it destroys the brain tissue.
You cannot be infected with Naegleria fowleri by drinking contaminated water. In very rare instances, Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated and contaminated tap water) enters the nose, for example when people submerge their heads or cleanse during religious practices, and when people irrigate their sinuses (nose) using contaminated tap water.
Where is Naegleria fowleri found?
Naegleria fowleri is found around the world. In the United States, the majority of infections have been caused by Naegleria fowleri from freshwater located in southern-tier states. The ameba can be found in:
- 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
- Swimming pools that are poorly maintained, minimally-chlorinated, and/or un-chlorinated
- Water heaters. Naegleria fowleri grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.
Naegleria fowleri is not found in salt water, like the ocean.
In what water temperature does Naegleria fowleri cause infection?
Naegleria fowleri is a heat-loving (thermophilic) microbe. It grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures. It is less likely to be found in the water as temperatures decline. The ameba can be found in lake or river sediment at temperatures well below where one would find the ameba in the water.
What is the source of food for Naegleria fowleri?
Naegleria fowleri eats other microbes like bacteria found in the sediment in lakes and rivers.
Can I get a Naegleria fowleri infection from a disinfected swimming pool?
No. You cannot get a Naegleria fowleri infection from a properly cleaned, maintained, and disinfected swimming pool.
How common are Naegleria fowleri infections in the United States?
Naegleria fowleri infections are rare *. In the 10 years from 2003 to 2012, 31 infections were reported in the U.S. Of those cases, 28 people were infected by contaminated recreational water, and 3 people were infected after performing nasal irrigation using contaminated tap water.
When do Naegleria fowleri infections most commonly occur?
While infections with Naegleria fowleri are rare, they occur mainly during the summer months of July, August, and September. Infections are more likely to occur in southern-tier states, but can also occur in other locations. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.
Can infection be spread from one person to another?
No. Naegleria fowleri infection cannot be spread from one person to another.
What are the symptoms of Naegleria fowleri infection?
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 about 5 days (range 1 to 7 days) after infection. The initial symptoms may include headache, fever, nausea, or vomiting. Later symptoms can include stiff neck, 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 about 5 days (range 1 to 12 days).
What is the actual mechanism of death from Naegleria fowleri infection?
The infection destroys brain tissue causing brain swelling and death.
What is the fatality rate for an infected person who begins to show signs and symptoms?
The fatality rate is over 99%. Only 1 person out of 128 known infected individuals in the United States from 1962 to 2012 has survived.
Is there effective treatment for infection with Naegleria fowleri?
It is not clear. 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 with similar drug combinations.
What should I do if I have been swimming or playing in freshwater and now think I have symptoms associated with Naegleria fowleri?
Infection with Naegleria fowleri is rare. The early symptoms of Naegleria fowleri infection are similar to those caused by other more common illnesses, such as bacterial 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.
How common is Naegleria fowleri in the environment?
Naegleria fowleri is commonly found in lakes in southern-tier states during the summer. This means that recreational water users should be aware that there will always be a low level risk of infection when entering these waters. In very rare instances, Naegleria has been identified in water from other sources such as inadequately chlorinated swimming pool water or heated and contaminated tap water. Naegleria fowleri grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.
Is there a routine and rapid test for Naegleria fowleri in the water?
No. It can take weeks to identify the ameba, but new detection tests are under development. Previous water testing has shown that Naegleria fowleri is commonly found in freshwater venues. Therefore, recreational water users should assume that there is a low level of risk when entering all warm freshwater, particularly in southern-tier states.
How does the risk of Naegleria fowleri infection compare with other water-related risks?
The risk of Naegleria fowleri infection is very low. There have been 31 reported infections in the U.S. in the 10 years from 2003 to 2012, despite millions of recreational water exposures each year. By comparison, in the ten years from 1996 to 2005, there were more than 39,000 drowning deaths in the U.S.
What swimming behaviors have been associated with Naegleria fowleri infection?
Behaviors associated with the infection include diving or jumping into the water, submerging the head under water or engaging in other water-related activities that cause water to go up the nose.
How will the public know if a lake or other water body has Naegleria fowleri?
Recreational water users should assume that Naegleria fowleri is present in warm freshwater in southern-tier states. Posting signs based on finding Naegleria fowleri in the water is unlikely to be an effective way to prevent infections. This is because:
- Naegleria fowleri occurrence is common, infections are rare.
- The relationship between finding Naegleria fowleri in the water and the occurrence of infections is unclear
- The location and number of amebae in the water can vary over time within the same lake or river.
- There are no rapid, standardized testing methods to detect and quantitate Naegleria fowleri in water.
- Posting signs might create a misconception that bodies of water without signs are Naegleria fowleri-free.
How can I reduce the risk of infection with Naegleria fowleri?
Naegleria fowleri 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 low number of infections makes it difficult to know why a few people have been infected compared to the millions of other people using the same or similar waters across the U.S. 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.
Personal actions to reduce the risk of Naegleria fowleri infection should focus on limiting the amount of water going up the nose and lowering the chances that Naegleria fowleri may be in the water. These actions could include:
- Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater.
- Avoid putting your head under the water in hot springs and other untreated thermal waters.
- Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
- Avoid digging in, or stirring up, the sediment while taking part in water-related activities in shallow, warm freshwater areas.
These recommendations make common sense but are not based on any scientific testing since the low numbers of infections make it difficult to ever show that they are effective.
Even more rarely, infections have been reported when people submerge their heads, cleanse during religious practices, or irrigate their sinuses (nose) using heated and contaminated tap water. If you are making a solution for irrigating, flushing, or rinsing your sinuses (for example, by using a neti-pot, sinus rinse bottle or other irrigation device), use water that has been:
- previously boiled for 1 minute (at elevations above 6,500 feet, boil for 3 minutes) and left to cool
- filtered, using a filter with an absolute pore size of 1 micron or smaller
- purchased with a label specifying that it contains distilled or sterile water
Rinse the irrigation device after each use with water that has been previously boiled, filtered, distilled, or sterilized and leave the device open to air dry completely.
For more information on neti pots and other nasal rinsing devices, see FDA’s Consumer Update: Is Rinsing Your Sinuses Safe?
This information is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the parasites described above or think that you may have a parasitic infection, consult a health care provider.
There is no universal definition of a “rare disease” but the U.S. Rare Disease Act of 2002 defined a rare disease as affecting less than 200,000 people in the U.S. and this definition has been adopted by the National Institutes of Health, Office of Rare Diseases.