{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T02:31:45Z","timestamp":1774405905583,"version":"3.50.1"},"reference-count":14,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,2]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Primary amebic meningoencephalitis (PAM) is a rare and lethal infection caused by <jats:italic>Naegleria fowleri<\/jats:italic>. We report an epidemiological and environmental investigation relating to a case of PAM in a previously healthy boy age 8 years. An interview of the patient\u2019s family was conducted to determine the likely exposure site and to assess risk factors. Data from the United States Geological Survey site at Waterloo, NE, on the Elkhorn River were used to estimate water temperature and streamflow at the time and site of exposure. Data from the National Weather Service were used to estimate precipitation and ambient air temperature at the time and site of exposure. Despite conventional treatment, the patient died 2 days after hospital admission. The patient participated in recreational water activities in the Elkhorn River in northeastern Nebraska 5 days before symptom onset. In the week before exposure, water and ambient air high temperatures reached annual highs, averaging 32.4\u00b0C and 35.8\u00b0C, respectively. The day before infection, 2.2\u2009cm of precipitation was reported. Streamflow was low (407 ft<jats:sup>3<\/jats:sup>\/s). Infections in several northern states, including Nebraska, suggest an expanding geographic range of <jats:italic>N. fowleri<\/jats:italic> transmission, which may lead to increased incidence of PAM in the United States. Similar environmental investigations at suspected exposure sites of future cases will allow data aggregation, enabling investigators to correlate environmental factors with infection risk accurately.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0211","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T15:20:09Z","timestamp":1689607209000},"page":"322-326","source":"Crossref","is-referenced-by-count":9,"title":["Fatal Primary Amebic Meningoencephalitis in Nebraska: Case Report and Environmental Investigation, August 2022"],"prefix":"10.4269","volume":"109","author":[{"given":"Patrick","family":"Maloney","sequence":"first","affiliation":[{"name":"Nebraska Department of Health and Human Services, Lincoln, Nebraska;"},{"name":"University of Nebraska Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clayton","family":"Mowrer","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center, Omaha, Nebraska;"},{"name":"Children\u2019s Hospital and Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Jansen","sequence":"additional","affiliation":[{"name":"Nebraska Department of Health and Human Services, Lincoln, Nebraska;"},{"name":"Centers for Disease Control and Prevention, Division of Workforce Development, Atlanta, Georgia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tess","family":"Karre","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital and Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiri","family":"Bedrnicek","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital and Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen K.","family":"Obaro","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital and Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter C.","family":"Iwen","sequence":"additional","affiliation":[{"name":"Nebraska Public Health Laboratory, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"McCutchen","sequence":"additional","affiliation":[{"name":"Nebraska Public Health Laboratory, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad","family":"Wetzel","sequence":"additional","affiliation":[{"name":"Douglas County Health Department, Omaha, Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Frederick","sequence":"additional","affiliation":[{"name":"Douglas County Health Department, Omaha, Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Salman","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Nebraska Department of Health and Human Services, Lincoln, Nebraska;"},{"name":"University of Nebraska Medical Center, Omaha, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Donahue","sequence":"additional","affiliation":[{"name":"Nebraska Department of Health and Human Services, Lincoln, Nebraska;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"FEMS Immunol Med Microbiol","first-page":"1","article-title":"Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea","volume":"50","author":"Visvesvara","year":"2007"},{"key":"b2","series-title":"Antimicrob Agents Chemother","first-page":"6677","article-title":"Naegleria fowleri: pathogenesis, diagnosis, and treatment options","volume":"59","author":"Grace","year":"2015"},{"key":"b3","series-title":"Clin Infect Dis","first-page":"e19","article-title":"Epidemiology and clinical characteristics of primary amebic meningoencephalitis caused by Naegleria fowleri: a global review","volume":"73","author":"Gharpure","year":"2021"},{"key":"b4","year":"2023"},{"key":"b5","series-title":"Clin Infect Dis","first-page":"805","article-title":"Fatal Naegleria fowleri infection acquired in Minnesota: possible expanded range of a deadly thermophilic organism","volume":"54","author":"Kemble","year":"2012"},{"key":"b6","series-title":"Emerg Infect Dis","first-page":"271","article-title":"Geographic range of recreational water-associated primary amebic meningoencephalitis, United States, 1978\u20132018","volume":"27","author":"Gharpure","year":"2021"},{"key":"b7","series-title":"J Protozool","first-page":"422","article-title":"Seasonal distribution of thermotolerant free-living amoebae: I. Willard\u2019s Pond","volume":"33","author":"Kyle","year":"1986"},{"key":"b8","series-title":"Infect Genet Evol","first-page":"1520","article-title":"Origin and evolution of the worldwide distributed pathogenic amoeboflagellate Naegleria fowleri","volume":"11","author":"De Jonckheere","year":"2011"},{"key":"b9","series-title":"Epidemiol Infect","first-page":"968","article-title":"The epidemiology of primary amoebic meningoencephalitis in the USA, 1962\u20132008","volume":"138","author":"Yoder","year":"2010"},{"key":"b10"},{"key":"b11"},{"key":"b12","series-title":"JAMA","first-page":"161","article-title":"Primary amebic meningoencephalitis \u2013 Arizona, Florida, and Texas, 2007","volume":"300","year":"2008"},{"key":"b13","series-title":"Emerg Infect Dis","first-page":"1835","article-title":"Fatal Naegleria fowleri meningoencephalitis, Italy","volume":"10","author":"Cogo","year":"2004"},{"key":"b14","series-title":"IDCases","first-page":"e00524","article-title":"Lethal encounters: the evolving spectrum of amoebic meningoencephalitis","volume":"15","author":"Gompf","year":"2019"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/2\/article-p322.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/2\/article-p322.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/2\/article-p322.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T13:14:06Z","timestamp":1690982046000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/109\/2\/article-p322.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,2]]},"references-count":14,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0211","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,2]]}}}