Fatal Primary Amebic Meningoencephalitis in Nebraska: Case Report and Environmental Investigation, August 2022

Patrick Maloney, Clayton Mowrer, Lauren Jansen, Tess Karre, Jiri Bedrnicek, Stephen K. Obaro, Peter C. Iwen, Emily McCutchen, Chad Wetzel, Justin Frederick, Muhammad Salman Ashraf, Matthew Donahue

Research output: Contribution to journalArticlepeer-review


Primary amebic meningoencephalitis (PAM) is a rare and lethal infection caused by Naegleria fowleri. We report an epidemiological and environmental investigation relating to a case of PAM in a previously healthy boy age 8 years. An interview of the patient's family was conducted to determine the likely exposure site and to assess risk factors. Data from the United States Geological Survey site at Waterloo, NE, on the Elkhorn River were used to estimate water temperature and streamflow at the time and site of exposure. Data from the National Weather Service were used to estimate precipitation and ambient air temperature at the time and site of exposure. Despite conventional treatment, the patient died 2 days after hospital admission. The patient participated in recreational water activities in the Elkhorn River in northeastern Nebraska 5 days before symptom onset. In the week before exposure, water and ambient air high temperatures reached annual highs, averaging 32.4̊C and 35.8̊C, respectively. The day before infection, 2.2 cm of precipitation was reported. Streamflow was low (407 ft3/s). Infections in several northern states, including Nebraska, suggest an expanding geographic range of N. fowleri transmission, which may lead to increased incidence of PAM in the United States. Similar environmental investigations at suspected exposure sites of future cases will allow data aggregation, enabling investigators to correlate environmental factors with infection risk accurately.

Original languageEnglish (US)
Pages (from-to)322-326
Number of pages5
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number2
StatePublished - Aug 2023

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology


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