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Brain Infection from Swimming is Rare, but Surviving Patient is a Miracle

June 04, 2014

By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital

It was almost impossible to miss the headlines about a very special ACH patient last summer. Kali Hardig of Benton became only the third person known to have survived a very rare form of meningitis caused by an ameba she contracted while swimming in lake water.

She is without a doubt a miracle. Researchers and physicians alike have referred to the parasite, Naegleria fowleri, as "nearly always fatal." Kali's recovery last year is a testament to her family's quick intervention, equally fast diagnosis, excellent medical care and her own sheer will to survive.

This summer, families in Arkansas may be wondering how they can prevent their children from experiencing the same disease.

The first thing to understand is that primary amebic meningoencephalitis or PAM – the disease that made Kali so sick – is exceedingly rare. According to the Centers for Disease Control and Prevention, just 130 cases of this illness have been recorded since the 1960s.

The parasite that causes the disease, however, is quite common. Naegleria fowleri is occasionally found in treated water systems, and occurs naturally in bodies of warm fresh water like lakes, springs and rivers. You cannot develop this infection by drinking water contaminated with this ameba.

Instead, the parasite can enter the body when contaminated water is forced up into the nose. But it is still rare that people develop an infection from Naegleria fowleri. In those cases, however, the ameba travels to the brain, where it causes swelling and catastrophic infection.

While hundreds of millions of visits occur at swimming venues each summer, fewer than eight cases of PAM are documented by the CDC each year. Some years, no cases are documented. To compare, nearly 40,000 people die by drowning in those same bodies of water in a decade.

"It is unknown why certain persons become infected with the amebae while millions of others exposed to warm recreational fresh waters do not, including those who were swimming with people who became infected," according to information on the CDC's website.

Symptoms of PAM come on suddenly. Within a week of exposure, these patients develop severe headaches, high fevers, neck stiffness, nausea and excessive sleepiness. These symptoms are similar to other forms of meningitis and if present require medical evaluation.

Kali's mother has told media outlets that she simply knew something was very wrong with her daughter. So she acted quickly to get her to emergency care. This, combined with a unique experimental drug, undoubtedly saved Kali's life.

Physicians at Arkansas Children's Hospital caution parents to remember that it is highly unlikely that their children will ever experience PAM. But it is always important to monitor your child's symptoms and know that if their activity level, breathing and color have changed, it's time to head to the ER.

The CDC does provide the following prevention tips, which can be helpful to parents as they prepare their children for a summer filled with visits to local swimming holes:

  • Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater.
  • Avoid putting your head under the water in hot springs and other untreated thermal waters.
  • Avoid water-related activities in warm freshwater during periods of high water temperature.
  • Avoid digging in, or stirring up, the sediment while taking part in water-related activities in shallow, warm freshwater areas.

Today, Kali is doing well and gearing up for a fun summer. She says she'll go swimming again and has been glad to be back in school since the fall.

She and her mother had one more tip for families when they participated in a news conference about her recovery in September.

"If I could say one thing to other kids," Kali remarked, "it would be use your nose plugs."

That's good advice from an odds-defying miracle!

Another tip: The MyACH iPhone app available from the Apple iTunes store can help you keep all your children's medical information in one safe place in the event of an emergency. Download it free today.

Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email

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