Three Percent Survival Rate for Disease You Get While Swimming

Liza Hollingsworth, of Charleston, South Carolina died after a swimming trip. It is unclear if she had been swimming in Lake Moultrie or a pond, but wherever she was swimming, she apparently took in a nose full of water. Her parents say that a few days after her swimming trip, she developed a headache. She died just three days after her symptoms started. It was too late to save Liza by the time doctors realized that she had primary amoebic meningoencephalitis.

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Primary amoebic meningoencephalitis (PAM) is caused when Naegleria fowleri, an amoebae,  infiltrates the body through the nasal passage and enters the central nervous system. Naegleria fowleri is found in abundance in warm stagnant bodies of freshwater- ponds, lakes, streams, rivers, and creeks. It is extremely sensitive to chlorine, but only if in the correct levels. So, improperly maintained pools can also be a source of exposure. 

After the amoebae infected water is sucked into the nose, it begins to migrate, all while feeding on nerve tissue to multiply. Encephalitic symptoms appear when the amoebae reach the cerebrum. The person usually dies within 14 days of exposure.

Symptoms of the disease usually appear within three to seven days after exposure.  Symptoms include: severe headache, vomiting, neck stiffness seizures, and coma.

PAM is extremely rare. According to the CDC, there have only been 111 cases of PAM since 1962.   However, PAM is also extremely fatal. There is only a 3% survival rate from the confirmed cases of PAM.

The current treatment is with very large doses of intravenous Amphotericin B. The dose is so high that it causes permanent nephrotoxicity. 

Luckily, the only route of infection is through the nasal passage, and the infected water must be “sucked in” far enough to reach the olfactory nerve.

The only 100% effective way to avoid Naegleria fowleri is to avoid potential sources (stagnant and warm freshwater or un-maintained pools.) The CDC has been looking in recent years at science-based recommendations for reducing the risk of infection, but have not issued any at this time. My personal recommendation would be to use nose plugs when swimming in any water that you are unsure of.