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Shaukat A, Khaliq N, Riaz R, Munsab R, Ashraf T, Raufi N, Shah H. Noninvasive diagnostic biomarkers, genomic profiling, and advanced microscopic imaging in the early detection and characterization of Naegleria fowleri infections leading to primary amebic meningoencephalitis (PAM). Ann Med Surg (Lond) 2024; 86:2032-2048. [PMID: 38576920 PMCID: PMC10990330 DOI: 10.1097/ms9.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
This review delves into the strategies for early detection and characterization of Naegleria fowleri infections leading to primary amoebic meningoencephalitis (PAM). The study provides an in-depth analysis of current diagnostic approaches, including cerebrospinal fluid analysis, brain tissue examination, immunostaining techniques, and culture methods, elucidating their strengths and limitations. It explores the geographical distribution of N. fowleri, with a focus on regions near the equator, and environmental factors contributing to its prevalence. The review emphasizes the crucial role of early detection in PAM management, discussing the benefits of timely identification in treatment, personalized care, and prevention strategies. Genomic profiling techniques, such as conventional PCR, nested PCR, multiplex PCR, and real-time PCR, are thoroughly examined as essential tools for accurate and prompt diagnosis. Additionally, the study explores advanced microscopic imaging techniques to characterize N. fowleri's morphology and behavior at different infection stages, enhancing our understanding of its life cycle and pathogenic mechanisms. In conclusion, this review underscores the potential of these strategies to improve our ability to detect, understand, and combat N. fowleri infections, ultimately leading to better patient outcomes and enhanced public health protection.
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Affiliation(s)
| | - Nawal Khaliq
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rumaisa Riaz
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rabbia Munsab
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nahid Raufi
- Department of Medicine, Kabul Medical University, Kabul, Afghanistan
| | - Hafsa Shah
- Dow University of Health Sciences, Karachi, Pakistan
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2
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Barnhart E, Kinsey SM, Wright PR, Caldwell SL, Hill V, Kahler A, Mattioli M, Cornman RS, Iwanowicz D, Eddy Z, Halonen S, Mueller R, Peyton BM, Puzon GJ. Naegleria fowleri Detected in Grand Teton National Park Hot Springs. ACS ES&T WATER 2024; 4:628-637. [PMID: 38356928 PMCID: PMC10862551 DOI: 10.1021/acsestwater.3c00650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
The free-living thermophilic amoeba Naegleria fowleri (N. fowleri) causes the highly fatal disease primary amoebic meningoencephalitis. The environmental conditions that are favorable to the growth and proliferation of N. fowleri are not well-defined, especially in northern regions of the United States. In this study, we used culture-based methods and multiple molecular approaches to detect and analyzeN. fowleri and other Naegleria spp. in water, sediment, and biofilm samples from five hot spring sites in Grand Teton National Park, Wyoming, U.S.A. These results provide the first detections of N. fowleri in Grand Teton National Park and provide new insights into the distribution of pathogenic N. fowleri and other nonpathogenic Naegleria spp. in natural thermal water systems in northern latitudes.
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Affiliation(s)
- Elliott
P. Barnhart
- U.S.
Geological Survey, Wyoming/Montana Water Science Center, 3162 Bozeman Ave., Helena, Montana 59601, United States
| | - Stacy M. Kinsey
- U.S.
Geological Survey, Wyoming/Montana Water Science Center, 3162 Bozeman Ave., Helena, Montana 59601, United States
| | - Peter R. Wright
- U.S.
Geological Survey, Wyoming/Montana Water Science Center, 3162 Bozeman Ave., Helena, Montana 59601, United States
| | - Sara L. Caldwell
- U.S.
Geological Survey, Wyoming/Montana Water Science Center, 3162 Bozeman Ave., Helena, Montana 59601, United States
| | - Vince Hill
- U.S.
Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia 30333, United States
| | - Amy Kahler
- U.S.
Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia 30333, United States
| | - Mia Mattioli
- U.S.
Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, Georgia 30333, United States
| | - Robert S. Cornman
- U.S.
Geological Survey, Fort Collins Science Center, 2150 Centre Ave., Bldg. C, Fort Collins, Colorado 80526, United States
| | - Deborah Iwanowicz
- U.S.
Geological Survey, Eastern Ecological Science Center, 11649 Leetown Road, Kearneysville, West Virginia 25430, United States
| | - Zachary Eddy
- U.S.
Geological Survey, Wyoming/Montana Water Science Center, 3162 Bozeman Ave., Helena, Montana 59601, United States
| | - Sandra Halonen
- Department
of Microbiology & Cell Biology, Montana
State University, P.O. Box 173520, Bozeman, Montana 59717, United States
| | - Rebecca Mueller
- Western Regional
Research Center, U.S. Department of Agriculture
Agricultural Research Service, 800 Buchanan St., Albany, California 94710, United States
| | - Brent M. Peyton
- Center
for Biofilm Engineering, Chemical and Biochemical Engineering Department, Montana State University, 366 Barnard Hall, Bozeman Montana 59717, United States
| | - Geoffrey J Puzon
- CSIRO
Environment, Private
Bag No. 5, Wembley, Western
Australia 6913, Australia
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3
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Ward L, Sherchan SP. Surveillance of Naegleria fowleri in Louisiana's public water systems. JOURNAL OF WATER AND HEALTH 2023; 21:1627-1631. [PMID: 38017594 PMCID: wh_2023_040 DOI: 10.2166/wh.2023.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The free-living amoeba Naegleria fowleri (Nf) inhabits soil and natural waters worldwide: it is thermophilic and thrives at temperatures up to 45 °C and in a multitude of environments. Three deaths in Louisiana were attributed to primary amoebic meningoencephalitis (PAM) caused by Nf infection in 2011 and 2013. Following these incidents, public water systems are now monitored for the presence of Nf in Louisiana. From 2014 to 2018, 29% (27/93) of samples collected showed positive for Nf and 68% (63/93) showed all thermophilic amoeba culture. Ten raw water sources and 17 distribution water systems tested positive. The year 2017 showed the highest number of samples with Nf (n = 10) followed by nine samples in 2015. As climate change increases surface water temperatures, continued testing for Nf prevalence will be an important facet of water monitoring and will need to extend into locations farther north than the current most common range.
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Affiliation(s)
- Lauren Ward
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA; Center of Research Excellence in Wastewater based Epidemiology, Morgan State University, Baltimore, MD, USA E-mail:
| | - Samendra P Sherchan
- Department of Environmental Health Sciences, Tulane University, New Orleans, LA, USA; Center of Research Excellence in Wastewater based Epidemiology, Morgan State University, Baltimore, MD, USA
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Miko S, Cope JR, Hlavsa MC, Ali IKM, Brown TW, Collins JP, Greeley RD, Kahler AM, Moore KO, Roundtree AV, Roy S, Sanders LL, Shah V, Stuteville HD, Mattioli MC. A Case of Primary Amebic Meningoencephalitis Associated with Surfing at an Artificial Surf Venue: Environmental Investigation. ACS ES&T WATER 2023; 3:1126-1133. [PMID: 37213412 PMCID: PMC10193442 DOI: 10.1021/acsestwater.2c00592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. In September 2018, a 29-year-old man died of PAM after traveling to Texas. We conducted an epidemiologic and environmental investigation to identify the water exposure associated with this PAM case. The patient's most probable water exposure occurred while surfing in an artificial surf venue. The surf venue water was not filtered or recirculated; water disinfection and water quality testing were not documented. N. fowleri and thermophilic amebae were detected in recreational water and sediment samples throughout the facility. Codes and standards for treated recreational water venues open to the public could be developed to address these novel venues. Clinicians and public health officials should also consider novel recreational water venues as a potential exposure for this rare amebic infection.
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Affiliation(s)
- Shanna Miko
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer R. Cope
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Michele C. Hlavsa
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Ibne Karim M. Ali
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Travis W. Brown
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer P. Collins
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | | | - Amy M. Kahler
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Kathleen O. Moore
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Alexis V. Roundtree
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
- Chenega Enterprise System & Solutions, 609 Independence Parkway Suite 210, Chesapeake, VA 23320
| | - Shantanu Roy
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Lacey L. Sanders
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Vaidehi Shah
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Haylea D. Stuteville
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Mia C. Mattioli
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
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Rao G, Kahler A, Voth-Gaeddert LE, Cranford H, Libbey S, Galloway R, Molinari NA, Ellis EM, Yoder JS, Mattioli MC, Ellis BR. Microbial Characterization, Factors Contributing to Contamination, and Household Use of Cistern Water, U.S. Virgin Islands. ACS ES&T WATER 2022; 2:2634-2644. [PMID: 36530952 PMCID: PMC9745795 DOI: 10.1021/acsestwater.2c00389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 05/09/2023]
Abstract
Households in the United States Virgin Islands (USVI) heavily rely on roof-harvested rainwater stored in cisterns for their daily activities. However, there are insufficient data on cistern water microbiological and physicochemical characteristics to inform appropriate cistern water management. Cistern and kitchen tap water samples were collected from 399 geographically representative households across St. Croix, St. Thomas, and St. John and an administered survey captured household site and cistern characteristics and water use behaviors. Water samples were analyzed for Escherichia coli by culture, and a subset of cistern water samples (N = 47) were analyzed for Salmonella, Naegleria fowleri, pathogenic Leptospira, Cryptosporidium, Giardia, and human-specific fecal contamination using real-time polymerase chain reaction (PCR). Associations between E. coli cistern contamination and cistern and site characteristics were evaluated to better understand possible mechanisms of contamination. E. coli was detected in 80% of cistern water samples and in 58% of kitchen tap samples. For the subset of samples tested by PCR, at least one of the pathogens was detected in 66% of cisterns. Our results suggest that covering overflow pipes with screens, decreasing animal presence at the household, and preventing animals or insects from entering the cisterns can decrease the likelihood of E. coli contamination in USVI cistern water.
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Affiliation(s)
- Gouthami Rao
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Amy Kahler
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Lee E. Voth-Gaeddert
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Hannah Cranford
- United
States Virgin Islands Department of Health, St. Croix, U.S. Virgin Islands 00820, United States
| | - Stephen Libbey
- Love
City Strong, St. John, U.S. Virgin Islands 00830, United States
| | - Renee Galloway
- Division
of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Noelle-Angelique Molinari
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Esther M. Ellis
- United
States Virgin Islands Department of Health, St. Croix, U.S. Virgin Islands 00820, United States
| | - Jonathan S. Yoder
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Mia C. Mattioli
- Division
of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30329, United States
| | - Brett R. Ellis
- United
States Virgin Islands Department of Health, St. Croix, U.S. Virgin Islands 00820, United States
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Aykur M, Dirim Erdogan D, Selvi Gunel N, Guler A, Biray Avci C, Celebisoy N, Gunduz C, Dagci H. Genotyping and Molecular Identification of Acanthamoeba Genotype T4 and Naegleria fowleri from Cerebrospinal Fluid Samples of Patients in Turkey: Is it the Pathogens of Unknown Causes of Death? Acta Parasitol 2022; 67:1372-1383. [PMID: 35864411 DOI: 10.1007/s11686-022-00597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/07/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey. METHOD A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses. RESULTS The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing. CONCLUSION This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey. .,Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpaşa University, PO Box 60030, Tokat, Turkey.
| | - Derya Dirim Erdogan
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nur Selvi Gunel
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Ayse Guler
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cigir Biray Avci
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Cumhur Gunduz
- Department of Medical Biology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova/İzmir, Turkey
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7
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Mapili K, Rhoads WJ, Coughter M, Pieper KJ, Edwards MA, Pruden A. Occurrence of opportunistic pathogens in private wells after major flooding events: A four state molecular survey. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 826:153901. [PMID: 35182640 DOI: 10.1016/j.scitotenv.2022.153901] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Private wells can become contaminated with waterborne pathogens during flooding events; however, testing efforts focus almost exclusively on fecal indicator bacteria. Opportunistic pathogens (OPs), which are the leading cause of identified waterborne disease in the United States, are understudied in private wells. We conducted a quantitative polymerase chain reaction survey of Legionella spp., L. pneumophila, Mycobacterium spp., M. avium, Naegleria fowleri, and shiga toxin-producing Escherichia coli gene markers and total coliform and E. coli in drinking water supplied by private wells following the Louisiana Floods (2016), Hurricane Harvey (2017), Hurricane Irma (2017), and Hurricane Florence (2018). Self-reported well characteristics and recovery status were collected via questionnaires. Of the 211 water samples collected, 40.3% and 5.2% were positive for total coliform and E. coli, which were slightly elevated positivity rates compared to prior work in coastal aquifers. DNA markers for Legionella and Mycobacterium were detected in 54.5% and 36.5% of samples, with L. pneumophila and M. avium detected in 15.6% and 17.1%, which was a similar positivity rate relative to municipal system surveys. Total bacterial 16S rRNA gene copies were positively associated with Legionella and Mycobacterium, indicating that conditions that favor occurrence of general bacteria can also favor OPs. N. fowleri DNA was detected in 6.6% of samples and was the only OP that was more prevalent in submerged wells compared to non-submerged wells. Self-reported well characteristics were not associated with OP occurrence. This study exposes the value of routine baseline monitoring and timely sampling after flooding events in order to effectively assess well water contamination risks.
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Affiliation(s)
- Kris Mapili
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA 24061, United States of America
| | - William J Rhoads
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA 24061, United States of America; Eawag - Swiss Federal Institute of Aquatic Science and Technology, Department of Environmental Microbiology, Überlandstrasse 133, 8600 Dübendorf, Switzerland.
| | - Mary Coughter
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA 24061, United States of America
| | - Kelsey J Pieper
- Northeastern University, Civil and Environmental Engineering, 360 Huntington Ave., Boston, MA 02115, United States of America.
| | - Marc A Edwards
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA 24061, United States of America
| | - Amy Pruden
- Virginia Tech, Civil and Environmental Engineering, 418 Durham Hall, Blacksburg, VA 24061, United States of America
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Real-Time PCR Confirmation of a Fatal Case of Primary Amoebic Meningoencephalitis in Turkey Caused by Naegleria fowleri or Brain-Eating Amoeba. Acta Parasitol 2022; 67:697-704. [PMID: 35020127 DOI: 10.1007/s11686-021-00514-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Naegleria fowleri, the causative agent of primary amoebic meningoencephalitis (PAM), is a free-living amoeba. It is a water-borne infection usually detected in children and young people with healthy immune system who swim, dive and perform activities in fresh and hot springs. PURPOSE In this study, it was aimed to raise awareness in the differential diagnosis of meningitis etiopathogenesis by showing that N. fowleri may also be the causative agent, albeit very rarely, in meningitis cases in Turkey. METHODS Our case was an 18-year-old male patient whose relatives stated that he has gone to the hot spring; his headache complaint started after 2 to 3 days after return from the hot spring. Cerebrospinal fluid (CSF) sample taken from the patient was investigated by direct microscopic examination, real-time PCR method and sequence analysis. RESULTS The CSF sample collected was taken into distilled water considering the possibility of transformation of trophozoites to intermediate form and incubated at 37 °C for 1 to 2 h, and pear-shaped non-permanent flagellated forms were observed in the direct microscopic examination, and molecular typing was performed to confirm the diagnosis. This study was a comprehensive case of N. fowleri whose etiological agent was isolated and confirmed by real-time PCR in Turkey. CONCLUSION Clinician awareness would be the key factor in correctly diagnosing PAM. It is also recommended to investigate all likely environmental water sources in Turkey for more detailed information on the distribution and molecular identification of Naegleria species, ultimately to evaluate the potential pathogenic threat to human health and to develop strategies to combat such threats.
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Ženíšková K, Grechnikova M, Sutak R. Copper Metabolism in Naegleria gruberi and Its Deadly Relative Naegleria fowleri. Front Cell Dev Biol 2022; 10:853463. [PMID: 35478954 PMCID: PMC9035749 DOI: 10.3389/fcell.2022.853463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/04/2022] Open
Abstract
Although copper is an essential nutrient crucial for many biological processes, an excessive concentration can be toxic and lead to cell death. The metabolism of this two-faced metal must be strictly regulated at the cell level. In this study, we investigated copper homeostasis in two related unicellular organisms: nonpathogenic Naegleria gruberi and the “brain-eating amoeba” Naegleria fowleri. We identified and confirmed the function of their specific copper transporters securing the main pathway of copper acquisition. Adjusting to different environments with varying copper levels during the life cycle of these organisms requires various metabolic adaptations. Using comparative proteomic analyses, measuring oxygen consumption, and enzymatic determination of NADH dehydrogenase, we showed that both amoebas respond to copper deprivation by upregulating the components of the branched electron transport chain: the alternative oxidase and alternative NADH dehydrogenase. Interestingly, analysis of iron acquisition indicated that this system is copper-dependent in N. gruberi but not in its pathogenic relative. Importantly, we identified a potential key protein of copper metabolism of N. gruberi, the homolog of human DJ-1 protein, which is known to be linked to Parkinson’s disease. Altogether, our study reveals the mechanisms underlying copper metabolism in the model amoeba N. gruberi and the fatal pathogen N. fowleri and highlights the differences between the two amoebas.
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10
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Prevalence of opportunistic pathogens in a school building plumbing during periods of low water use and a transition to normal use. Int J Hyg Environ Health 2022; 241:113945. [PMID: 35182850 DOI: 10.1016/j.ijheh.2022.113945] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
The spread of opportunistic pathogens via building water supply and plumbing is of public health concern. This study was conducted to better understand microbial water quality changes in a LEED-certified school building during low water use (Summer) and normal water use (Autumn). The copper plumbed building contained water saving devices, a hot water recirculation system, and received chloraminated drinking water from a public water system. Three separate sampling events were conducted during the summer break inside the building and another three sampling events were conducted after the school returned to session. Using quantitative PCR, Legionella spp. were detected in all water samples, followed by Mycobacterium spp. (99%). Mycobacterium avium (75%) and Acanthamoeba spp. (17.5%) throughout the building water system. Legionella pneumophila and Naegleria fowleri were not detected in any of the samples. The mean concentrations of Legionella spp., Mycobacterium spp., Mycobacterium avium, and Acanthamoeba spp. detected in water samples were 3.9, 5.7, 4.7, and 2.8 log10 gene copies per 100 ml, respectively. There was a statistically significantly difference in the mean concentrations of Legionella spp., Mycobacterium spp. and M. avium gene markers in water samples between school breaks and when school was in session. Cultivable Legionella were also detected in water samples collected during periods of low water use. This study highlights the need for routine proactive water quality testing in school buildings to determine the extent of drinking water quality problems associated with plumbing and direct action to remediate microbial colonization.
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11
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Aykur M, Dagci H. Evaluation of molecular characterization and phylogeny for quantification of Acanthamoeba and Naegleria fowleri in various water sources, Turkey. PLoS One 2021; 16:e0256659. [PMID: 34437614 PMCID: PMC8389491 DOI: 10.1371/journal.pone.0256659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Free-living amoeba (FLA) is widely distributed in the natural environment. Since these amoebae are widely found in various waters, they pose an important public health problem. The aim of this study was to detect the presence of Acanthamoeba, B. mandrillaris, and N. fowleri in various water resources by qPCR in Izmir, Turkey. A total of (n = 27) 18.24% Acanthamoeba and (n = 4) 2.7% N. fowleri positives were detected in six different water sources using qPCR with ITS regions (ITS1) specific primers. The resulting concentrations varied in various water samples for Acanthamoeba in the range of 3.2x105-1.4x102 plasmid copies/l and for N. fowleri in the range of 8x103-11x102 plasmid copies/l. The highest concentration of Acanthamoeba and N. fowleri was found in seawater and damp samples respectively. All 27 Acanthamoeba isolates were identified in genotype level based on the 18S rRNA gene as T4 (51.85%), T5 (22.22%), T2 (14.81%) and T15 (11.11%). The four positive N. fowleri isolate was confirmed by sequencing the ITS1, ITS2 and 5.8S rRNA regions using specific primers. Four N. fowleri isolates were genotyped (three isolate as type 2 and one isolate as type 5) and detected for the first time from water sources in Turkey. Acanthamoeba and N. fowleri genotypes found in many natural environments are straightly related to human populations to have pathogenic potentials that may pose a risk to human health. Public health professionals should raise awareness on this issue, and public awareness education should be provided by the assistance of civil authorities. To the best of our knowledge, this is the first study on the quantitative detection and distribution of Acanthamoeba and N. fowleri genotypes in various water sources in Turkey.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpasa University Tokat, Tokat, Turkey
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
- * E-mail:
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
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Stahl LM, Olson JB. Environmental abiotic and biotic factors affecting the distribution and abundance of Naegleria fowleri. FEMS Microbiol Ecol 2020; 97:6006869. [PMID: 33242082 PMCID: PMC8068756 DOI: 10.1093/femsec/fiaa238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Naegleria fowleri is a free-living protozoan that resides in soil and freshwater. Human intranasal amoebae exposure through water or potentially dust particles can culminate in primary amoebic meningoencephalitis, which generally causes death. While many questions remain regarding pathogenesis, the microbial ecology of N. fowleri is even less understood. This review outlines current knowledge of the environmental abiotic and biotic factors that affect the distribution and abundance of N. fowleri. Although the impacts of some abiotic factors remain poorly investigated or inconclusive, N. fowleri appears to have a wide pH range, low salinity tolerance and thermophilic preference. From what is known about biotic factors, the amoebae preferentially feed upon bacteria and are preyed upon by other free-living amoebae. Additional laboratory and environmental studies are needed to fill in knowledge gaps, which are crucial for surveillance and management of N. fowleri in freshwaters. As surface water temperatures increase with climate change, it is likely that this amoeba will pose a greater threat to human health, suggesting that identifying its abiotic and biotic preferences is critical to mitigating this risk.
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Affiliation(s)
- Leigha M Stahl
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Julie B Olson
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL 35487, USA
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Mattioli MC, Benedict KM, Murphy J, Kahler A, Kline KE, Longenberger A, Mitchell PK, Watkins S, Berger P, Shanks OC, Barrett CE, Barclay L, Hall AJ, Hill V, Weltman A. Identifying septic pollution exposure routes during a waterborne norovirus outbreak - A new application for human-associated microbial source tracking qPCR. J Microbiol Methods 2020; 180:106091. [PMID: 33137355 DOI: 10.1016/j.mimet.2020.106091] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/13/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022]
Abstract
In June 2017, the Pennsylvania Department of Health (PADOH) was notified of multiple norovirus outbreaks associated with 179 ill individuals who attended separate events held at an outdoor venue and campground over a month period. Epidemiologic investigations were unable to identify a single exposure route and therefore unable to determine whether there was a persistent contamination source to target for exposure mitigation. Norovirus was detected in a fresh recreational water designated swimming area and a drinking water well. A hydrogeological site evaluation suggested a nearby septic leach field as a potential contamination source via ground water infiltration. Geological characterization revealed a steep dip of the bedrock beneath the septic leach field toward the well, providing a viral transport pathway in a geologic medium not previously documented as high risk for viral ground water contamination. The human-associated microbial source tracking (MST) genetic marker, HF183, was used as a microbial tracer to demonstrate the hydrogeological connection between the malfunctioning septic system, drinking water well, and recreational water area. Based on environmental investigation findings, venue management and local public health officials implemented a series of outbreak prevention strategies including discontinuing the use of the contaminated well, issuing a permit for a new drinking water well, increasing portable toilet and handwashing station availability, and promoting proper hand hygiene. Despite the outbreaks at the venue and evidence of ground water contamination impacting nearby recreational water and the drinking water well, no new norovirus cases were reported during a large event one week after implementing prevention practices. This investigation highlights a new application for human-associated MST methods to trace hydrological connections between multiple fecal pollutant exposure routes in an outbreak scenario. In turn, pollutant source information can be used to develop effective intervention practices to mitigate exposure and prevent future outbreaks associated with human fecal contaminated waters.
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Affiliation(s)
- Mia C Mattioli
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA.
| | - Katharine M Benedict
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Amy Kahler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Kelly E Kline
- Pennsylvania Department of Health, Division of Infectious Disease Epidemiology, USA
| | - Allison Longenberger
- Pennsylvania Department of Health, Division of Infectious Disease Epidemiology, USA
| | - Patrick K Mitchell
- Pennsylvania Department of Health, Division of Infectious Disease Epidemiology, USA; Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Watkins
- Pennsylvania Department of Health, Division of Infectious Disease Epidemiology, USA
| | - Philip Berger
- U.S. Environmental Protection Agency, Office of Ground Water and Drinking Water, Washington, DC, USA
| | - Orin C Shanks
- U.S. Environmental Protection Agency, Office of Research and Development, Cincinnati, OH, USA
| | - Catherine E Barrett
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Leslie Barclay
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Aron J Hall
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Vincent Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, USA
| | - Andre Weltman
- Pennsylvania Department of Health, Division of Infectious Disease Epidemiology, USA
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Grechnikova M, Ženíšková K, Malych R, Mach J, Sutak R. Copper detoxification machinery of the brain-eating amoeba Naegleria fowleri involves copper-translocating ATPase and the antioxidant system. INTERNATIONAL JOURNAL FOR PARASITOLOGY-DRUGS AND DRUG RESISTANCE 2020; 14:126-135. [PMID: 33096396 PMCID: PMC7578549 DOI: 10.1016/j.ijpddr.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022]
Abstract
Copper is a trace metal that is necessary for all organisms but toxic when present in excess. Different mechanisms to avoid copper toxicity have been reported to date in pathogenic organisms such as Cryptococcus neoformans and Candida albicans. However, little if anything is known about pathogenic protozoans despite their importance in human and veterinary medicine. Naegleria fowleri is a free-living amoeba that occurs naturally in warm fresh water and can cause a rapid and deadly brain infection called primary amoebic meningoencephalitis (PAM). Here, we describe the mechanisms employed by N. fowleri to tolerate high copper concentrations, which include various strategies such as copper efflux mediated by a copper-translocating ATPase and upregulation of the expression of antioxidant enzymes and obscure hemerythrin-like and protoglobin-like proteins. The combination of different mechanisms efficiently protects the cell and ensures its high copper tolerance, which can be advantageous both in the natural environment and in the host. Nevertheless, we demonstrate that copper ionophores are potent antiamoebic agents; thus, copper metabolism may be considered a therapeutic target. N. fowleri employs the combination of copper efflux and antioxidant system to ensure a high copper tolerance. Copper efflux in N. fowleri is mediated by a copper-translocating P-type ATPase. Copper ionophores have amoebicidal effect against N. fowleri and thus may be potentially used as antiamoebic agents. Iron-binding proteins hemerythrin and protoglobin are highly upregulated in N. fowleri under copper overload.
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Affiliation(s)
- Maria Grechnikova
- Department of Parasitology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Kateřina Ženíšková
- Department of Parasitology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Ronald Malych
- Department of Parasitology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Jan Mach
- Department of Parasitology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic
| | - Robert Sutak
- Department of Parasitology, Faculty of Science, Charles University, BIOCEV, Vestec, Czech Republic.
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Diagnostic evaluation of fatal Balamuthia mandrillaris meningoencephalitis in a captive Bornean orangutan (Pongo pygmaeus) with identification of potential environmental source and evidence of chronic exposure. Primates 2020; 62:51-61. [PMID: 32920664 DOI: 10.1007/s10329-020-00860-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
A female Bornean orangutan (Pongo pygmaeus) aged 11 years and 6 months was examined by veterinarians after caretakers observed lethargy and facial grimacing. Within 72 h the primate had left-sided hemiparesis that worsened over the next week. An MRI revealed a focal right-sided cerebral mass suspected to be a neoplasm. Ten days after onset of clinical signs, the orangutan died. On postmortem exam, the medial right parietal lobe was replaced by a 7 × 4 × 3.5 cm focus of neuromalacia and hemorrhage that displaced the lateral ventricle and abutted the corpus callosum. Histopathology of the cerebral lesion revealed pyogranulomatous meningoencephalitis with intralesional amoeba trophozoites and rare cysts. Fresh parietal lobe was submitted to the Centers for Disease Control and Prevention lab for multiplex free-living amoebae real-time PCR and detected Balamuthia mandrillaris DNA at a high burden. Mitochondrial DNA was sequenced, and a 760-bp locus 19443F/20251R was compared to several human infections of B. mandrillaris and shown to be identical to the isolates from four human cases of encephalitis: 1998 in Australia, 1999 in California, 2000 in New York, and 2010 in Arizona. Indirect immunofluorescent antibody testing of stored serum samples indicated exposure to B. mandrillaris for at least 2 years prior to death. Within 1 week of the orangutan's death, water from the exhibit was analyzed and identified the presence of B. mandrillaris DNA, elucidating a possible source of exposure. B. mandrillaris, first reported in a mandrill in 1986, has since occurred in humans and animals and is now considered an important emerging pathogen.
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Cope JR, Murphy J, Kahler A, Gorbett DG, Ali I, Taylor B, Corbitt L, Roy S, Lee N, Roellig D, Brewer S, Hill VR. Primary Amebic Meningoencephalitis Associated With Rafting on an Artificial Whitewater River: Case Report and Environmental Investigation. Clin Infect Dis 2019; 66:548-553. [PMID: 29401275 DOI: 10.1093/cid/cix810] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. Patient exposure to water containing the ameba typically occurs in warm freshwater lakes and ponds during recreational water activities. In June 2016, an 18-year-old woman died of PAM after traveling to North Carolina, where she participated in rafting on an artificial whitewater river. Methods We conducted an epidemiologic and environmental investigation to determine the water exposure that led to the death of this patient. Results The case patient's most probable water exposure occurred while rafting on an artificial whitewater river during which she was thrown out of the raft and submerged underwater. The approximately 11.5 million gallons of water in the whitewater facility were partially filtered, subjected to ultraviolet light treatment, and occasionally chlorinated. Heavy algal growth was noted. Eleven water-related samples were collected from the facility; all were positive for N. fowleri. Of 5 samples collected from the nearby natural river, 1 sediment sample was positive for N. fowleri. Conclusions This investigation documents a novel exposure to an artificial whitewater river as the likely exposure causing PAM in this case. Conditions in the whitewater facility (warm, turbid water with little chlorine and heavy algal growth) rendered the water treatment ineffective and provided an ideal environment for N. fowleri to thrive. The combination of natural and engineered elements at the whitewater facility created a challenging environment to control the growth of N. fowleri.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Murphy
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy Kahler
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Ibne Ali
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lisa Corbitt
- Mecklenburg County Health Department, Charlotte, North Carolina
| | - Shantanu Roy
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole Lee
- North Carolina Department of Health and Human Services, Raleigh
| | - Dawn Roellig
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Vincent R Hill
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cope JR, Kahler AM, Causey J, Williams JG, Kihlken J, Benjamin C, Ames AP, Forsman J, Zhu Y, Yoder JS, Seidel CJ, Hill VR. Response and remediation actions following the detection of Naegleria fowleri in two treated drinking water distribution systems, Louisiana, 2013-2014. JOURNAL OF WATER AND HEALTH 2019; 17:777-787. [PMID: 31638028 PMCID: PMC7075671 DOI: 10.2166/wh.2019.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Naegleria fowleri causes the usually fatal disease primary amebic meningoencephalitis (PAM), typically in people who have been swimming in warm, untreated freshwater. Recently, some cases in the United States were associated with exposure to treated drinking water. In 2013, a case of PAM was reported for the first time in association with the exposure to water from a US treated drinking water system colonized with culturable N. fowleri. This system and another were found to have multiple areas with undetectable disinfectant residual levels. In response, the water distribution systems were temporarily converted from chloramine disinfection to chlorine to inactivate N. fowleri and reduced biofilm in the distribution systems. Once >1.0 mg/L free chlorine residual was attained in all systems for 60 days, water testing was performed; N. fowleri was not detected in water samples after the chlorine conversion. This investigation highlights the importance of maintaining adequate residual disinfectant levels in drinking water distribution systems. Water distribution system managers should be knowledgeable about the ecology of their systems, understand potential water quality changes when water temperatures increase, and work to eliminate areas in which biofilm growth may be problematic and affect water quality.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Amy M Kahler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Jake Causey
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - John G Williams
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jennifer Kihlken
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Caryn Benjamin
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Amanda P Ames
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Johan Forsman
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Yuanda Zhu
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jonathan S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Chad J Seidel
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
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18
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Yu Z, Miller HC, Puzon GJ, Clowers BH. Application of untargeted metabolomics for the detection of pathogenic Naegleria fowleri in an operational drinking water distribution system. WATER RESEARCH 2018; 145:678-686. [PMID: 30212806 DOI: 10.1016/j.watres.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/23/2018] [Accepted: 09/02/2018] [Indexed: 06/08/2023]
Abstract
Found in drinking water distribution systems (DWDSs), swimming pools, and recreational waters, N. fowleri, is the causative agent of primary amoebic meningoencephalitis (PAM). Although cases of N. fowleri infections are rare, the fatality is comparatively high (>95%) and surveillance is essential to minimize N. fowleri infections. However, conventional N. fowleri detection methods are less satisfying owing to their time-consuming and lab intensive characteristics as well as the lack of the ability to determine viability. As a result, an alternative detection approach capable of determining viability as well as species identification is required to better ensure public health. Based on our previous research focusing on distinguishing laboratory cultured N. fowleri from N. lovaniensis and N. italica, this study applies untargeted metabolomics methods to field samples from operational DWDSs. A list of diagnostic features was found to preliminarily discriminate the N. fowleri positive from N. fowleri negative and N. lovaniensis positive field samples with satisfying predictive accuracy. The results outlined in this manuscript further validate and improve the metabolite-based N. fowleri detection approach, potentially aiding water utilities in the detection and management of N. fowleri in drinking water.
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Affiliation(s)
- Zhihao Yu
- Department of Chemistry, Washington State University, P.O. Box 644630, Pullman, WA, 99164, USA
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia, 6913, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia, 6913, Australia
| | - Brian H Clowers
- Department of Chemistry, Washington State University, P.O. Box 644630, Pullman, WA, 99164, USA.
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Xue J, Caton K, Sherchan S. Comparison of next-generation droplet digital PCR with quantitative PCR for enumeration ofNaegleria fowleriin environmental water and clinical samples. Lett Appl Microbiol 2018; 67:322-328. [DOI: 10.1111/lam.13051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/25/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Xue
- Department of Global Environmental Health Sciences; School of Public Health and Tropical Medicine, Tulane University; New Orleans LA USA
| | - K. Caton
- Department of Global Environmental Health Sciences; School of Public Health and Tropical Medicine, Tulane University; New Orleans LA USA
| | - S.P. Sherchan
- Department of Global Environmental Health Sciences; School of Public Health and Tropical Medicine, Tulane University; New Orleans LA USA
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Garner E, McLain J, Bowers J, Engelthaler DM, Edwards MA, Pruden A. Microbial Ecology and Water Chemistry Impact Regrowth of Opportunistic Pathogens in Full-Scale Reclaimed Water Distribution Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:9056-9068. [PMID: 30040385 DOI: 10.1021/acs.est.8b02818] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Need for global water security has spurred growing interest in wastewater reuse to offset demand for municipal water. While reclaimed (i.e., nonpotable) microbial water quality regulations target fecal indicator bacteria, opportunistic pathogens (OPs), which are subject to regrowth in distribution systems and spread via aerosol inhalation and other noningestion routes, may be more relevant. This study compares the occurrences of five OP gene markers ( Acanthamoeba spp., Legionella spp., Mycobacterium spp., Naegleria fowleri, Pseudomonas aeruginosa) in reclaimed versus potable water distribution systems and characterizes factors potentially contributing to their regrowth. Samples were collected over four sampling events at the point of compliance for water exiting treatment plants and at five points of use at four U.S. utilities bearing both reclaimed and potable water distribution systems. Reclaimed water systems harbored unique water chemistry (e.g., elevated nutrients), microbial community composition, and OP occurrence patterns compared to potable systems examined here and reported in the literature. Legionella spp. genes, Mycobacterium spp. genes, and total bacteria, represented by 16S rRNA genes, were more abundant in reclaimed than potable water distribution system samples ( p ≤ 0.0001). This work suggests that further consideration should be given to managing reclaimed water distribution systems with respect to nonpotable exposures to OPs.
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Affiliation(s)
- Emily Garner
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
| | - Jean McLain
- Water Resources Research Center , University of Arizona , Tucson , Arizona 85719 , United States
| | - Jolene Bowers
- Translational Genomics Research Institute , Flagstaff , Arizona 86005 , United States
| | - David M Engelthaler
- Translational Genomics Research Institute , Flagstaff , Arizona 86005 , United States
| | - Marc A Edwards
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
| | - Amy Pruden
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
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Xue J, Lamar FG, Zhang B, Lin S, Lamori JG, Sherchan SP. Quantitative assessment of Naegleria fowleri and fecal indicator bacteria in brackish water of Lake Pontchartrain, Louisiana. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 622-623:8-16. [PMID: 29220778 DOI: 10.1016/j.scitotenv.2017.11.308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
Brackish water samples from Lake Pontchartrain in Louisiana were assessed for the presence of pathogenic amoeba Naegleria fowleri, which causes primary amoebic meningoencephalitis (PAM). In our study, quantitative polymerase chain reaction (qPCR) methods were used to determine N. fowleri, E. coli, and enterococci in water collected from Lake Pontchartrain. N. fowleri target sequence was detected in 35.4% (56/158) of the water samples from ten sites around the lake. Statistically significant positive correlations between N. fowleri concentration and water temperature as well as E. coli (qPCR) were observed. Multiple linear regression (MLR) model shows seasonal factor (summer or winter) has significant effect on the concentration of N. fowleri, E. coli and enterococci (qPCR) concentration. Significant positive relationships between E. coli and enterococci was observed from both qPCR (r=0.25) and culture based method (r=0.54). Meanwhile, significant positive correlation between qPCR and culture based methods for enterococci concentration was observed (r=0.33). In our study, water temperature and E. coli concentration were indicative of N. fowleri concentrations in brackish water environment. Future research is needed to determine whether sediment is a source of N. fowleri found in the water column.
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Affiliation(s)
- Jia Xue
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Frederica G Lamar
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Bowen Zhang
- International Center for Climate and Global Change Research, Auburn University, Auburn, AL 36849, USA
| | - Siyu Lin
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jennifer G Lamori
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Samendra P Sherchan
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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Bellini NK, Santos TM, da Silva MTA, Thiemann OH. The therapeutic strategies against Naegleria fowleri. Exp Parasitol 2018; 187:1-11. [DOI: 10.1016/j.exppara.2018.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 02/07/2018] [Accepted: 02/28/2018] [Indexed: 12/13/2022]
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Zulkifli SN, Rahim HA, Lau WJ. Detection of contaminants in water supply: A review on state-of-the-art monitoring technologies and their applications. SENSORS AND ACTUATORS. B, CHEMICAL 2018; 255:2657-2689. [PMID: 32288249 PMCID: PMC7126548 DOI: 10.1016/j.snb.2017.09.078] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 05/12/2023]
Abstract
Water monitoring technologies are widely used for contaminants detection in wide variety of water ecology applications such as water treatment plant and water distribution system. A tremendous amount of research has been conducted over the past decades to develop robust and efficient techniques of contaminants detection with minimum operating cost and energy. Recent developments in spectroscopic techniques and biosensor approach have improved the detection sensitivities, quantitatively and qualitatively. The availability of in-situ measurements and multiple detection analyses has expanded the water monitoring applications in various advanced techniques including successful establishment in hand-held sensing devices which improves portability in real-time basis for the detection of contaminant, such as microorganisms, pesticides, heavy metal ions, inorganic and organic components. This paper intends to review the developments in water quality monitoring technologies for the detection of biological and chemical contaminants in accordance with instrumental limitations. Particularly, this review focuses on the most recently developed techniques for water contaminant detection applications. Several recommendations and prospective views on the developments in water quality assessments will also be included.
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Affiliation(s)
| | - Herlina Abdul Rahim
- Faculty of Electrical Engineering, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
| | - Woei-Jye Lau
- Advanced Membrane Technology Research Centre (AMTEC), Faculty of Chemical and Energy Engineering, Universiti Teknologi Malaysia, 81310 Skudai, Johor, Malaysia
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Waso M, Dobrowsky PH, Hamilton KA, Puzon G, Miller H, Khan W, Ahmed W. Abundance of Naegleria fowleri in roof-harvested rainwater tank samples from two continents. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:5700-5710. [PMID: 29230646 DOI: 10.1007/s11356-017-0870-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/28/2017] [Indexed: 05/24/2023]
Abstract
Roof-harvested rainwater (RHRW) has been used as an alternative source of water in water scarce regions of many countries. The microbiological and chemical quality of RHRW has been questioned due to the presence of bacterial and protozoan pathogens. However, information on the occurrence of pathogenic amoeba in RHRW tank samples is needed due to their health risk potential and known associations with opportunistic pathogens. Therefore, this study aims to determine the quantitative occurrence of Naegleria fowleri in RHRW tank samples from Southeast Queensland (SEQ), Australia (AU), and the Kleinmond Housing Scheme located in Kleinmond, South Africa (SA). In all, 134 and 80 RHRW tank samples were collected from SEQ, and the Kleinmond Housing Scheme, Western Cape, SA, respectively. Quantitative PCR (qPCR) assays were used to measure the concentrations of N. fowleri, and culture-based methods were used to measure fecal indicator bacteria (FIB) Escherichia coli (E. coli) and Enterococcus spp. Of the 134 tank water samples tested from AU, 69 and 62.7% were positive for E. coli, and Enterococcus spp., respectively. For the SA tank water samples, FIB analysis was conducted for samples SA-T41 to SA-T80 (n = 40). Of the 40 samples analyzed from SA, 95 and 35% were positive for E. coli and Enterococcus spp., respectively. Of the 134 water samples tested in AU, 15 (11.2%) water samples were positive for N. fowleri, and the concentrations ranged from 1.7 × 102 to 3.6 × 104 gene copies per 100 mL of water. Of the 80 SA tank water samples screened for N. fowleri, 15 (18.8%) tank water samples were positive for N. fowleri and the concentrations ranged from 2.1 × 101 to 7.8 × 104 gene copies per 100 mL of tank water. The prevalence of N. fowleri in RHRW tank samples from AU and SA thus warrants further development of dose-response models for N. fowleri and a quantitative microbial risk assessment (QMRA) to inform and prioritize strategies for reducing associated public health risks.
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Affiliation(s)
- Monique Waso
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Penelope Heather Dobrowsky
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Kerry Ann Hamilton
- Drexel University, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- CSIRO Land and Water, Ecosciences Precinct, 41 Boggo Road, Brisbane, QLD, 4102, Australia
| | - Geoffrey Puzon
- CSIRO Land and Water, Private Bag No.5, Wembley, WA, 6913, Australia
| | - Haylea Miller
- CSIRO Land and Water, Private Bag No.5, Wembley, WA, 6913, Australia
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Warish Ahmed
- CSIRO Land and Water, Ecosciences Precinct, 41 Boggo Road, Brisbane, QLD, 4102, Australia.
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25
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Assessment of Water Quality in Roof-Harvested Rainwater Barrels in Greater Philadelphia. WATER 2018. [DOI: 10.3390/w10020092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Wang H, Bédard E, Prévost M, Camper AK, Hill VR, Pruden A. Methodological approaches for monitoring opportunistic pathogens in premise plumbing: A review. WATER RESEARCH 2017; 117:68-86. [PMID: 28390237 PMCID: PMC5693313 DOI: 10.1016/j.watres.2017.03.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/19/2017] [Accepted: 03/22/2017] [Indexed: 05/06/2023]
Abstract
Opportunistic premise (i.e., building) plumbing pathogens (OPPPs, e.g., Legionella pneumophila, Mycobacterium avium complex, Pseudomonas aeruginosa, Acanthamoeba, and Naegleria fowleri) are a significant and growing source of disease. Because OPPPs establish and grow as part of the native drinking water microbiota, they do not correspond to fecal indicators, presenting a major challenge to standard drinking water monitoring practices. Further, different OPPPs present distinct requirements for sampling, preservation, and analysis, creating an impediment to their parallel detection. The aim of this critical review is to evaluate the state of the science of monitoring OPPPs and identify a path forward for their parallel detection and quantification in a manner commensurate with the need for reliable data that is informative to risk assessment and mitigation. Water and biofilm sampling procedures, as well as factors influencing sample representativeness and detection sensitivity, are critically evaluated with respect to the five representative bacterial and amoebal OPPPs noted above. Available culturing and molecular approaches are discussed in terms of their advantages, limitations, and applicability. Knowledge gaps and research needs towards standardized approaches are identified.
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Affiliation(s)
- Hong Wang
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Emilie Bédard
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Anne K Camper
- Center for Biofilm Engineering and Department of Civil Engineering, Montana State University, Bozeman, MT 59717, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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Yu Z, Miller HC, Puzon GJ, Clowers BH. Development of Untargeted Metabolomics Methods for the Rapid Detection of Pathogenic Naegleria fowleri. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:4210-4219. [PMID: 28290675 DOI: 10.1021/acs.est.6b05969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite comparatively low levels of infection, primary amoebic meningoencephalitis (PAM) induced by Naegleria fowleri is extremely lethal, with mortality rates above 95%. As a thermophile, this organism is often found in moderate-to-warm climates and has the potential to colonize drinking water distribution systems (DWDSs). Current detection approaches require days to obtain results, whereas swift corrective action can maximize the benefit of public health. Presently, there is little information regarding the underlying in situ metabolism for this amoeba but the potential exists to exploit differentially expressed metabolic signatures as a rapid detection technique. This research outlines the biochemical profiles of selected pathogenic and nonpathogenic Naegleria in vitro using an untargeted metabolomics approach to identify a panel of diagnostically meaningful compounds that may enable rapid detection of viable pathogenic N. fowleri and augment results from traditional monitoring approaches.
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Affiliation(s)
- Zhihao Yu
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Brian H Clowers
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
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Cope JR, Ali IK. Primary Amebic Meningoencephalitis: What Have We Learned in the Last 5 Years? Curr Infect Dis Rep 2016; 18:31. [PMID: 27614893 DOI: 10.1007/s11908-016-0539-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary amebic meningoencephalitis (PAM) is a devastating infection of the brain caused by the thermophilic free-living ameba, Naegleria fowleri. Infection can occur when water containing the ameba enters the body through the nose, usually during recreational water activities such as swimming or diving. Historically, in the USA, cases were mostly reported from the warmer southern-tier states. In the last 5 years, several notable changes have been documented in PAM epidemiology including a northward expansion of infections and new types of water exposures. The recent reports of two PAM survivors provide hope for improved outcomes with early diagnosis and aggressive treatment. Advanced molecular laboratory tools such as genome sequencing might provide more insight into the pathogenicity of N. fowleri. Clinicians treating patients with meningitis and warm freshwater exposure are encouraged to consider PAM in their differential diagnoses.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA.
| | - Ibne K Ali
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS C-09, Atlanta, GA, 30329, USA
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29
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Comparison of real-time PCR methods for the detection of Naegleria fowleri in surface water and sediment. Parasitol Res 2015; 114:1739-46. [PMID: 25855343 DOI: 10.1007/s00436-015-4359-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
Naegleria fowleri is a thermophilic free-living ameba found in freshwater environments worldwide. It is the cause of a rare but potentially fatal disease in humans known as primary amebic meningoencephalitis. Established N. fowleri detection methods rely on conventional culture techniques and morphological examination followed by molecular testing. Multiple alternative real-time PCR assays have been published for rapid detection of Naegleria spp. and N. fowleri. Foursuch assays were evaluated for the detection of N. fowleri from surface water and sediment. The assays were compared for thermodynamic stability, analytical sensitivity and specificity, detection limits, humic acid inhibition effects, and performance with seeded environmental matrices. Twenty-one ameba isolates were included in the DNA panel used for analytical sensitivity and specificity analyses. N. fowleri genotypes I and III were used for method performance testing. Two of the real-time PCR assays were determined to yield similar performance data for specificity and sensitivity for detecting N. fowleri in environmental matrices.
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30
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Cope JR, Ratard RC, Hill VR, Sokol T, Causey JJ, Yoder JS, Mirani G, Mull B, Mukerjee KA, Narayanan J, Doucet M, Qvarnstrom Y, Poole CN, Akingbola OA, Ritter JM, Xiong Z, da Silva AJ, Roellig D, Van Dyke RB, Stern H, Xiao L, Beach MJ. The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a US treated public drinking water system. Clin Infect Dis 2015; 60:e36-42. [PMID: 25595746 DOI: 10.1093/cid/civ017] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Naegleria fowleri is a climate-sensitive, thermophilic ameba found in warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and migrates to the brain via the olfactory nerve. In August 2013, a 4-year-old boy died of meningoencephalitis of unknown etiology in a Louisiana hospital. METHODS Clinical and environmental testing and a case investigation were initiated to determine the cause of death and to identify potential exposures. RESULTS Based on testing of cerebrospinal fluid and brain specimens, the child was diagnosed with PAM. His only reported water exposure was tap water; in particular, tap water that was used to supply water to a lawn water slide on which the child had played extensively prior to becoming ill. Water samples were collected from both the home and the water distribution system that supplied the home and tested; N. fowleri was identified in water samples from both the home and the water distribution system. CONCLUSIONS This case is the first reported PAM death associated with culturable N. fowleri in tap water from a US treated drinking water system. This case occurred in the context of an expanding geographic range for PAM beyond southern states, with recent case reports from Minnesota, Kansas, and Indiana. This case also highlights the role of adequate disinfection throughout drinking water distribution systems and the importance of maintaining vigilance when operating drinking water systems using source waters with elevated temperatures.
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Affiliation(s)
- Jennifer R Cope
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raoult C Ratard
- Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge
| | - Vincent R Hill
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Sokol
- Louisiana Department of Health and Hospitals, New Orleans and Baton Rouge
| | | | | | - Gayatri Mirani
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Bonnie Mull
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Meggie Doucet
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Charla N Poole
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Jana M Ritter
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zhenggang Xiong
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | - Dawn Roellig
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Harlan Stern
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Lihua Xiao
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael J Beach
- Centers for Disease Control and Prevention, Atlanta, Georgia
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31
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Bartrand TA, Causey JJ, Clancy JL. Naegleria fowleri:An emerging drinking water pathogen. ACTA ACUST UNITED AC 2014. [DOI: 10.5942/jawwa.2014.106.0140] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Jonathan Jake Causey
- DHH-OPH Engineering Services, Louisiana Department of Health and Hospitals, Office of Public Health
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