A 29-year-old man from New Jersey has died from an infection of the “brain-eating amoeba” Naegleria fowleri, prompting a Centers for Disease Control and Prevention (CDC) investigation into the Waco, Texas, water park he visited shortly before he fell ill.
According to his obituary, Fabrizio “Fab” Stabile was declared brain dead by physicians at the Atlantic City Medical Center on September 21, just one day after he was diagnosed with primary amebic meningoencephalitis (PAM). A GoFundMe page – set up by Stabile’s friends and family to raise awareness about PAM – writes that Stabile’s symptoms first appeared on the afternoon of September 16, when he experienced an intense headache that forced him to take pain medication and lie down. Multiple reports confirm that he had returned home from a visit to the BSR Cable Park Surf Resort several days prior.
The young man was rushed to the hospital the next day after he could not get out of bed or speak coherently. Stabile’s headache, fever, confusion, and brain swelling all pointed to some type of bacterial meningitis – a severe and often life-threatening inflammation of the membrane surrounding the brain. Meningitis can be caused by a number of bacteria, viruses, and parasites, therefore determining the best treatment requires identifying the responsible organism. This is done by analyzing a sample of cerebrospinal fluid (CSF). However, patients who present with acute meningitis symptoms are immediately treated with an array of antibiotics and anti-inflammatories while the lab tests are pending.
“Unfortunately, Fabrizio was not responding to these measures and his condition was rapidly deteriorating. He had been tested for a multitude of illnesses caused by various bacteria and viruses, but the results were coming back negative or inconclusive,” the GoFundMe page said.
Finally, on September 20, "Fabrizio’s cerebrospinal fluid (CSF) tested positive for the amoeba, Naegleria fowleri, which caused a rare infection that has only been diagnosed 143 times in the United States in the last 55 years. "The worst-case scenario was unfolding in front of our eyes as we learned that this infection results in a 98% fatality rate,” the page continued, sharing mortality figures listed by the CDC.
Naegleria fowleri occurs naturally in warm, freshwater bodies across the world and may be found in pools and hot tubs that are not sufficiently chemically treated. But despite its ubiquity in the waters we humans love to swim in, cases of PAM are incredibly few and far between because the amoeba is harmless if it enters the body through the digestive tract (i.e. from accidentally ingesting water while paddling and splashing). Instead, PAM arises when N. fowleri comes in contact with the tissue lining the inside of the nose and sinuses. From there, the microbe follows the olfactory nerves into the brain, where it begins consuming neural tissue and rapidly multiplying.
Past PAM victims contracted the amoeba after getting water up their nose while swimming or from using contaminated water to irrigate their sinuses. To prevent infection, the CDC recommends using only purified water for Neti pots and their ilk and using nose clips or holding your nose while swimming.
Due to its rarity and extremely lethal nature, historically, the medical community has had little chance to develop and compare PAM treatments. Yet some progress has been made in recent years. Since 2013, three PAM patients have survived after their antimicrobial and steroid regimen was supplemented with the anti-parasitic drug miltefosine. Stabile’s brain damage had passed the point of no return by the time miltefosine could have been administered.
According to the Waco Tribune-Herald, the CDC has collected water samples from the BSR Surf Resort, which has voluntarily closed pending the test results.