Zachary Reyna, 12, was knee-boarding in a fresh-water ditch near his Florida home August 3 when he contracted a rare infection—a brain-attacking amoeba, which usually kills in a matter of days. The primary amebic meningoencephalitis (PAM) lives in water and attacks through the sinuses, so infections occur during water sports or other activities that may cause large amounts of water to enter the nose.
Only three people in North America have survived PAM out of 128 who have contracted it since 1962, reports the Center for Disease Control (CDC). Reyna is on his way to being the fourth, as he is still holding on after more than 10 days. The amoeba is common in fresh water, though people are rarely infected. Two women died using tap water in a nasal flush, but generally tap water will not cause infection.
Symptoms usually show one to seven days after infection and include severe frontal headache, fever, nausea, and vomiting. In stage two, the symptoms include stiff neck, seizures, altered mental status, hallucinations, and coma.
The cases of survival are so rare it is hard for doctors to determine what contributed to the patients’ recoveries.
A 12-year-old girl in Arkansas, Kali Hardig, survived a PAM infection just last month. The girl was swimming in Willow Springs Water Park in Little Rock. In an Arkansas Times article published August 9, Arkansas Children’s Hospital’s Dr. Mark Heulitt said Hardig was responsive, but not yet talking.
Hardig was treated with a German drug, miltefosine, not yet approved by the U.S. Federal Drug Administration. Doctors got approval to use the drug from the CDC when the girl’s condition became critical. Reyna is also being treated with miltefosine.
But, Heulitt said, the drug may not have been the deciding factor in Hardig’s survival. A 7-year-old who had also been swimming at Willow Springs and contracted PAM in 2010 was treated with the drug and died. He said Hardig’s mother took her daughter to the hospital in the early stages of infection, improving her chances. Willow Springs has been closed, reports the Arkansas Times.
One of the other PAM survivors contracted the infection in California in 1979. CDC reports that this survivor contracted a less virulent strain of the amoeba. Treatment was not necessarily the deciding factor in the case, as others who received the same treatments (of amphotericin B, miconazole/fluconazole/ketoconazole, and/or rifampin) did not survive.
The third case of a PAM survivor was in Mexico, and Reyna’s family and community are holding onto hopes Reyna will be the fourth.