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Ziplines at the U.S. National Whitewater Center, a 1,100-acre outdoor adventure complex outside Charlotte, North Carolina.
Ziplines at the U.S. National Whitewater Center, a 1,100-acre outdoor adventure complex outside Charlotte, North Carolina. (Photo: US National Whitewater Center鈥)

Brain-Eating Amoeba Is Killing Paddlers in the South

How did a North Carolina waterpark become ground zero for a mysterious water-borne amoeba that kills nearly every person it infects?

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Ziplines at the U.S. National Whitewater Center, a 1,100-acre outdoor adventure complex outside Charlotte, North Carolina.
(Photo: US National Whitewater Center鈥)

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The , a 1,100-acre outdoor adventure complex situated on the Catawba River outside Charlotte, North Carolina, features all the things you鈥檇 want from an adventure park: ziplines, rock climbing walls, and mountain bike trails. Its most popular attraction, however, is a closed-loop whitewater course with Class IV rapids that draws some 12 million gallons of municipal drinking water from the nearby river. It also has the dubious distinction of being one of only about 140 sites in the country where, over the past 54 years, a common but relatively obscure amoeba has caused a human death.听

Eighteen-year-old Lauren Seitz visited the center on June 8 with fellow members of a Westerville, Ohio, church choir. Seitz, who had recently graduated high school and was heading to college in the fall, was in Charlotte as part of a youth mission music tour. During a guided trip, a raft that听Seitz and her friends were rowing overturned, and Seitz went underwater. Three days later, after she returned to Ohio, Seitz began displaying symptoms, including fever, headaches and vomiting. She died June 19. 听

Health officials say that while at the Whitewater Center, Seitz contracted , often referred to as a 鈥渂rain-eating鈥 amoeba. The single-cell organism causes an infection called primary amebic meningoencephalitis (PAM), which is rare but nearly always fatal. The amoeba is found around the world, primarily in warm freshwater environments, such as lakes and rivers.听

The majority of PAM infections nationwide have occurred during the summer in states in the southern half of the U.S., from California to Virginia, according to the Centers for Disease Control and Prevention (CDC). Historically, nearly three-quarters of the cases have occurred in Texas and Florida, although a few cases have popped up in northern states, including a 2010 case in Minnesota.听

Health officials believe that people only get infected when water containing the amoeba enters the body through the nose. While you can鈥檛 get PAM from drinking contaminated water, there have been a few rare instances when people have been infected after irrigating their sinuses using contaminated tap water. The amoeba travels up the olfactory nerves and attacks the brain鈥檚 frontal lobe and connective tissue, causing swelling. Once a person is infected, death usually occurs within five to 18 days.

Seitz鈥檚 death is the second this summer to be attributed to PAM. Earlier this month听in Texas, the CDC confirmed that 19-year-old Hudson Adams contracted the amoeba while working as a lifeguard at Lake Maverick and Houston County Lake. Similar to Seitz, Adams began to experience flu-like symptoms. After his condition worsened, he was flown to the Texas Medical Center, where he died July 13. These recent tragedies have put the deadly PAM infection in the spotlight, even as lawmakers and health officials struggle to determine how to best address the potential dangers of the amoeba moving forward.听

鈥淭his is certainly a priority for us,鈥 says Jennifer Cope, a medical epidemiologist and infectious disease physician in CDC鈥檚 Waterborne Disease Prevention Branch. 鈥淓ach summer we continue to see new and different ways and venues in which the amoeba is transmitted. It鈥檚 important that we keep track and study PAM so we can put out the best messages to protect the public.鈥澨

The Naegleria fowleri amoeba, which has likely been around for thousands of years, is essentially a parasite that lives underwater and feeds on bacteria and other microorganisms, says Stephen R. Keener, medical director of the Mecklenburg County Health Department, which is leading the investigation in the Charlotte PAM case. For much of its lifecycle the amoeba is inactive, in a hibernation-like stage. But when the conditions are favorable for growth鈥攕uch as stagnant water with high temperatures鈥攖he amoeba 鈥渨akes up.鈥 鈥淚t鈥檚 only in this more active form that the amoeba infects humans,鈥 Keener says.听

鈥淚t鈥檚 very common,鈥 Keener says. 鈥淚t鈥檚 not something that escaped from a lab.鈥

According to the CDC, 138 cases of PAM have been reported in the U.S. since 1962, and all but three patients died. About 75 percent of PAM victims are male, with a median age of 12. 鈥淥ur theory is simply that younger males are boisterous and more likely to have water go up the nose,鈥 says Cope. 鈥淲e don鈥檛 know if there鈥檚 some other biological tendency.鈥澨

With the amoeba being so prevalent in warm freshwater environments, health officials don鈥檛 yet understand why relatively few people get the deadly infection. 鈥淭hat鈥檚 the big question and mystery around this,鈥 Cope says. 鈥淢illions of people in the U.S. participate in freshwater recreational activities, but we usually only document a few cases each year, which is fortunate given how devastating the infection is.鈥澨

When the Whitewater Center in Charlotte opened in 2006, it was the first facility of its kind, and it鈥檚 not regulated under state standards that are used with public swimming pools or water parks. 鈥淭here weren鈥檛 any existing guidelines or regulations that could be used as a reference when the center opened,鈥 says Keener.

Following Seitz鈥檚 death, the CDC conducted water tests at the center, which indicated the presence of the deadly amoeba鈥檚 DNA in all 11 water samples. Cope said the CDC had not seen the presence of Naegleria fowleri at such significant levels during other tests conducted at freshwater venues where a PAM case had occurred. The CDC also indicated that the park鈥檚 filtration systems were inadequate to neutralize the amoeba, and that there needs to be engineering and operating modifications before the Whitewater Center鈥檚 channels reopen.听Keener says the county is now considering a plan in which authorities would treat the water that contains the potentially deadly amoeba with chlorine. Then they would remove the chlorine once the parasite is inactivated and dump the water into the Catawba River, where it would eventually flow into a creek.

Meanwhile, the rest of the Whitewater Center remains open, and the company has posted on its website that it is working with water quality experts and engineering firms to implement additional water quality measures. 鈥淥ur goal is to be rafting again in a matter of weeks,鈥 the center鈥檚 website reads. (Representatives for the center did not reply to requests for comment.)

As one of Charlotte鈥檚 most popular attractions, attracting some 800,000 visitors annually, the Whitewater Center is also noted for being a USA Canoe/Kayak official Olympic Training Center for whitewater slalom racing since it first opened in 2006. Wade Blackwood, CEO of USA Canoe/Kayak, says that despite this recent incident, the team will continue training at the Whitewater Center if and when it reopens. Two of the USA Canoe/Kayak Olympic athletes who live and train in Charlotte have been in Europe for the past several months preparing for the 2016 Olympic Games in Rio, so they haven鈥檛 been directly impacted. 鈥淚t鈥檚 a tragic story, but from a paddling perspective, we know there are a lot of dangers anywhere you go,鈥 says Blackwood. 鈥淲e need recreational venues like this to introduce people to the sport in a controlled, outdoor environment. I don鈥檛 think shutting it down is the answer.鈥 听

In early July, the North Carolina Senate opted to delay a vote on legislation passed by the House that would have regulated the U.S. National Whitewater Center under the same state regulations as swimming pools. Dr. Randall Williams, the state鈥檚 deputy secretary of health services, stressed that any legislation would be 鈥済etting ahead鈥 of the efforts being put forth by the CDC and the Whitewater Center.

Cope added that because the Whitewater Center falls into this regulatory gray area, it鈥檚 been difficult determining what the center should look like moving forward in terms of minimizing the chances of this happening again. 鈥淭hese are the challenges and discussions that are ongoing,鈥 she says. 鈥淭his is a very scary case, but you also have to put it into perspective. People do many things every day that put them in greater risk of being hurt and dying. Still, it鈥檚 important that people are aware of the potential dangers.鈥

The U.S. Health and Human Services Department offers some common sense measures that swimmers can use to protect themselves, and there is also a new medication that fights the infection:

  • Limit the amount of water going up your nose by holding your nose shut or using nose clips.
  • Avoid freshwater activities during periods of high water temperature and low water levels.
  • Don鈥檛 stir up the sediment while in shallow, warm freshwater areas.
  • There is a new drug on the market called miltefosine that that has been used to successfully treat a few isolated cases of PAM, including a 12-year-old girl and an eight-year-old boy in 2013. Both patients survived, although the young boy has suffered what is likely permanent brain damage. The drug, known by the brand name Impavido and approved by health officials in 2014, is commercially available through a company in Florida. 听The Amoeba Awareness Foundation is working to make the drug available across the country.
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Lead Photo: US National Whitewater Center鈥

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