Health officials say a New York college student has died of a rare brain infection she probably contracted while swimming in a body of fresh water in Maryland.
News that a college student from New York died from an infection she likely got swimming in Cecil County was frightening for many who spend time in local water.
The Naegleria fowleri amoeba is so common in warm freshwater that public health authorities don't bother testing for it. They don't plan to put up signs, or take any other precautions to prevent more infections.
Infections are almost always fatal — but they are also exceedingly rare. The case of 19-year Kerry Stoutenburgh was the first linked to Maryland waters. Nationwide, only 138 people were infected between 1962 and 2015, according to the U.S. Centers for Disease Control and Prevention.
Local public health officials don't know why Stoutenburgh, a CUNY Brooklyn College student from Kingston, N.Y., was sickened. She died Aug. 31, weeks after swimming during a visit to Maryland.
"This incident is incredibly tragic, obviously, but it's very rare that the infection happens," said Gregg Bortz, a spokesman for the Cecil County Health Department. "Considering how many people go swimming in a year, 138 cases give you an indication of how rare and how low the risk is. But it is an ever-present risk."
This could be because of their behavior. The infection occurs when water shoots up the victim's nose and into the brain, which can occur when someone jumps or dives into the water.
"It's an unusual circumstance where just the right part of the water gets into just the right part of the nose at just the right time," said Dr. Amesh Adalja, a spokesman for the Infectious Disease Society of America.
"Maybe there is some variation in the people who get it," said Adalja, a senior associate at the Center for Health Security at the University of Pittsburgh Medical Center. "There are so few cases that it's hard to understand. A lot of people get water up their nose and don't get infected. We do know of many infectious diseases where people have a predisposition to it."
Some people have become infected when cleansing their nose with a neti pot of improperly treated tap water that is warm enough to harbor the amoeba, Adalja said.
He said people can't become sick by drinking water with the amoeba because stomach acid would kill the organism. The nose offers a direct conduit to the brain, where the amoeba quickly destroys tissue.
To avoid infection by the Naegleria fowleri amoeba or other agents commonly found in water, professionals say, people should keep the water out of the noses and mouths. Those with open wounds or a weakened immune system should avoid the water altogether.
Other organisms are much more likely to sicken, and even kill swimmers, Adalja said.
There were 42 cases of infection from the bacteria Vibrio in Maryland in 2014, state data shows. A Talbot County man was infected recently with a species called Vibrio vulnificus, also known as flesh-eating bacteria, after nicking his forearm while retrieving a crab pot. The open wounds that developed required several surgeries, according to a warning from the environmental group Midshore Riverkeeper Conservancy.
Adalja acknowledged that something known as a brain-eating amoeba is terrifying, even if it's rare. There are just a few documented cases in which a victim has survived. They include a 16-year-old boy who was treated successfully this summer at the Florida Hospital for Children.
Most cases are not diagnosed in time. The aggressive amoeba causes a type of meningitis, and has similar symptoms: fever, headache, vomiting and stiffness.
Bacterial and viral types of meningitis are far more common. Typically in cases of Naegleria fowleri, by the time medical providers determine that an amoeba is to blame, the infection is too far along.
The CDC reports there is an investigational drug available for treatment. Researchers at the University of South Florida and Georgia State University say they are working on other therapies.
Adalja said doctors need to rule out other, more common infections first.
"If they treated everyone assuming they were infected with an amoeba," he said. "They'd be wrong almost all the time."