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Naegleria Fowleri: How to Protect Against a Rare Brain Infection

​​​​​​​​​You may have heard frightening reports about Naegleria fowleri, commonly called the "brain-eating amoeba." In one recent case, for example, a child was infected with the parasite after swimming in a ​Nebraska river.

​Fortunately, infections from Naegleria fowleri are rare. The Centers for Disease Control and Prevention (CDC) says that only 31 infections​ were reported in the United States between 2012 and 2021.

Still, as a parent, you want to do everything you can to protect your child. Here's what to know about Naegleria fowleri and how you can prevent infection.

What is Naegleria fowleri?

Naegleria fowleri is an amoeba that's commonly found in warm fresh water and moist soil. It loves heat, so it's most often found in water during the summer. But Naegleria fowleri often lives in the sediment at the bottom of freshwater bodies in much cooler temperatures too.

Naegleria fowleri can also grow in hot water heaters, pipes and water systems. This includes systems that are treated for public drinking. It hasn't been found in salt water.

How can Naegleria fowleri infect people?

Naegleria fowleri infections can happen after water containing the amoeba gets into your nose. It can then travel up the nasal cavity to the brain. There, it ​can cause an infection called primary amebic meningoencephalitis (PAM). A PAM infection is almost always deadly because it kills brain tissue quickly. Out of 154 known infections in the United States from 1962 to 2021, only four people have survived.

You can only be infected with Naegleria fowleri through your nose. That means you can't get an infection from drinking water that contains Naegleria fowleri. The infection cannot be spread from person to person either.

When do most Naegleria fowleri infections happen?

PAM infections from Naegleria fowleri typically occur in the summer. They mostly happen to kids and young adults, especially boys 14 years old and younger.

The majority of infections with Naegleria fowleri develop after swimming in lakes, ponds or hot springs.They usually involve diving, swimming or putting your head under water in warm fresh water. It's rare, but you can also be infected at swimming pools, surf parks and splash pads that don't have enough chlorine.

Infections with Naegleria fowleri can happen after using contaminated tap water to rinse your sinuses or nose.

How can I protect against Naegleria fowleri infection?


To prevent Naegleria fowleri infection, you can:

  • Avoid swimming and diving in warm freshwater places, especially in the summer. This includes lakes, ponds, rivers and hot springs.

  • Boil tap water for 1 minute and letting it cool before rinsing your sinuses​ using neti pots, bulb syringes, squeeze bottles and other nasal irrigation devices. Or use distilled, sterile or filtered water.

Reducing the risk

Whenever you're in fresh water, there's a risk of infection. You can lower your family's risk by following these guidelines:

  • Don't dive or jump in. Diving and jumping in makes it more likely for water to go up your nose.

  • When swimming, use nose clips or pinch your nose shut. Even better, don't put your head underwater at all.

  • Keep your head out of hot springs and other bodies of untreated geothermal water.

  • Don't dig into or stir up the sediment at the bottom of shallow bodies of warm fresh water. Naegleria fowleri is most likely to live here.

What are the symptoms of primary amebic meningoencephalitis?

The early symptoms of PAM usually start around 5 days after infection. But they can start anywhere from 1 to 12 days afterward.

Early symptoms of PAM may include:

  • Fever

  • Headache

  • Nausea

  • Vomiting

  • Changes in smell and taste

Later symptoms of PAM can include:

  • Stiff neck

  • Fatigue

  • Confusion

  • Changes in personality

  • Hallucinations

  • Seizures

  • Coma

Death usually happens around 5 days after symptoms start. However, it can occur within 1 to 18 days afterward.

Are there treatments for Naegleria fowleri infections?

Experts are still trying to find the best medicines to treat PAM. It's hard to know what works well because PAM is so rare, and it develops so fast. This is why it's important to start treatment right away if PAM is even suspected.

Right now, PAM is treated with a combination of medications including:

  • Amphotericin B

  • Azithromycin

  • Fluconazole

  • Rifampin

  • Miltefosine

  • Dexamethasone

What should I do if I think my child has a Naegleria fowleri infection?

Keep in mind that Naegleria fowleri infections are extremely rare. What may seem like PAM symptoms are more likely from an illness that's more common, such as bacterial meningitis. That said, if your child has recently been in fresh water and suddenly has symptoms such as fever, headache, stiff neck or vomiting, get medical help right away.

Has climate change affected Naegleria fowleri?

Naegleria fowleri can exist in any body of freshwater, anywhere in the United States. This is especially true during the months of July, August and September. Most infections from Naegleria fowleri have been in southern states. But since 2010, cases have been found in more northern states such as Nebraska, Minnesota and Indiana. This may be partly due to climate change.

More information

Last Updated
American Academy of Pediatrics Section on Infectious Diseases (Copyright © 2023)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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