918 - Promoting the Successful Clinical Outcome of Primary Amebic Meningoencephalitis

Reference Committee K   HOD 2015 Interim Meeting

RESOLVED, That our American Medical Association work with the Centers for Disease Control and Prevention on training and education relating to Primary Amebic Meningoencephalitis (PAM) (Directive to Take Action); and be it further

RESOLVED, That our AMA support required national reporting of PAM (New HOD Policy); and be it further

RESOLVED, That our AMA support clinical guidelines and standards of care that promote rapid diagnosis and effective treatment of PAM. (New HOD Policy)

As Submitted:

ntroduced by:  American Association. of Public Health Physicians

Subject:       Promoting the Successful Clinical Outcome of Primary
Amebic Meningoencephalitis

Referred to:   Reference Committee ___



Whereas:      Primary Amebic Meningoencephalitis (PAM), a disease
caused by infection with the amoeba Naegleria fowleri, has a
case fatality rate of 97.8% in the United States; and

Whereas:      The July 2015 monthly global temperature of 16.61°C
(61.86°F) was  the highest in the record that began in January 1880.

Whereas:       PAM cases have now been reported from states
outside of the southern US tier, including Minnesota, Kansas, Indiana, and
Missouri; and

Whereas:      PAM cases in the US have also been associated with water
from domestic drinking water systems, in activities such as:
submersion in bathtubs, the use of a lawn water slide, and for nasal
irrigation using a neti pot or in ritual ablution; and

Whereas:      PAM cases in the US have also been associated with
exposure to water in a municipal park splash pad; and

Whereas:      PAM cases in the US continue to be reported from
recreational activities in traditional freshwater swimming locations
such as lakes, rivers, ponds, and hot springs; and

Whereas:      PAM has been diagnosed in the US in a citizen with an
exposure history from foreign travel; and

Whereas:      Patients with PAM present with symptoms clinically
similar to bacterial meningitis, which lowers the chances of initially
diagnosing PAM; and

Whereas:      The descriptor “rare” -- currently used in training,
education, and general literature -- may result in a lowered clinical
index of suspicion; and

Whereas:      Successful treatment is possible with prompt diagnosis
and treatment including the use of miltefosine (available from CDC
with 24 hour consultation at 770-488-7100), other anti-amebic agents
as well as adjunctive therapies; and

Whereas:      Standards of care include prompt diagnosis which can be
enhanced by an automated electronic flagging system to remind the
physician to ask for freshwater exposure history and proper laboratory
orders when a case is charted; and

Whereas:      Standards of care include correct laboratory procedures
implemented promptly; and

Whereas:      Now is the time to improve medical and public health preparedness
in preparation for the warmer months of 2016;



Therefore, be it

Resolved:     That our AMA will work with the CDC on training and
education relating to Primary Amebic Meningoencephalitis (PAM); and be
it further

Resolved:     That our AMA supports required national reporting of
PAM; and be it further

Resolved:     That our AMA supports clinical guidelines and standards
of care that promote rapid diagnosis and effective treatment of PAM.



References



Lines 8, 13,21 : Diagnosis, Clinical Course, and Treatment of Primary
Amoebic Meningoencephalitis in the United States, 1937–2013, Capewell,
et al,   Journal of the Pediatric Infectious Diseases Society (Advance
Access published October 23, 2014)

Line 11 NOAA National Centers for Environmental Information, State of
the Climate: Global Analysis for July 2015, published online August
2015, retrieved on September 27, 2015 from
http://www.ncdc.noaa.gov/sotc/global/201507

line 16: .Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara
GS, Ratard RC, Hill V, Wilson JD, Linscott AJ, Crager R, Kozak NA,
Sriram R, Narayanan J, Mull B, Kahler AM, Schneeberger C, da Silva AJ,
Beach MJ. Deaths from Naegleria fowleri associated with sinus
irrigation with tap water: a review of the changing epidemiology of
primary amebic meningoencephalitis.  Clin Infect Dis. 2012;1-7.

                Marciano-Cabral F, MacLean R, Mensah A, LaPat-Polasko
L. Identification of Naegleria fowleri in domestic water sources by
nested PCR.External Web Site Icon Appl Environ Microbiol.
2003;69:5864-9.

                   Cope JR, Ratard RC, Hill VR, Sokol T, Causey JJ,
Yoder JS, Mirani G, Mull B, Mukerjee KA, Narayanan J, Doucet M,
Qvarstrom Y, Poole CN, Akingbola OA, Ritter JM, Xiong Z, da Silva A,
Roellig D, Van Dyke R, Stern H, Xiao L, Beach MJ. The first
association of a primary amebic meningoencephalitis death with
culturable Naegleria fowleri in tap water from a U.S. treated public
drinking water system.External Web Site Icon Clin Infect Dis.
2015;doi:10.1093/cid/civ017.

                    CDC. Primary amebic meningoencephalitis
associated with ritual nasal rinsing — St. Thomas, U.S. Virgin
Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013;62(45):903



Line 19:        Boss, J. and Russel, S. (2005). Two Fatal Cases of PAM
in Tulsa County, August2005, Oklahoma State Department of Health
Epidemiology Bulletin, 37(3), 1-2.

Line 24:       Florida child dies after contracting amoeba from Costa
Rican hot springs
http://www.ticotimes.net/2014/08/19/florida-child-dies-after-contracting-amoeba-from-costa-rican-hot-springs

                    Brain-eating Amoeba Victim: Sanford boy 'a ray of
light'  Orlando Sentinel,


http://articles.orlandosentinel.com/2014-07-07/news/os-brain-eating-amoeba-jordan-cole-20140707_1_brain-eating-amoeba-sanford-boy-naegleria

Line 26:        CDC, Naegleria fowleri — Primary Amebic
Meningoencephalitis (PAM) — Amebic Encephalitis, Illness & Symptoms;
http://www.cdc.gov/parasites/naegleria/illness.html





Line 28:       CDC, Naegleria fowleri — Primary Amebic
Meningoencephalitis (PAM) — Amebic Encephalitis, Diagnosis and
Detection; http://www.cdc.gov/parasites/naegleria/diagnosis.html

References, continued:



Line 30:        Linam, et al : Successful Treatment of an Adolescent
With Naegleria fowleri Primary Line Amebic Meningoencephalitis;
PEDIATRICS Volume 135, number 3, March 2015

                 CDC, Naegleria fowleri — Primary Amebic
Meningoencephalitis (PAM) — Amebic

                  Encephalitis,  Treatment,
http://www.cdc.gov/parasites/naegleria/treatment.html

Line 32          Florida Hospital, Orlando, Florida

Line 36         CDC, Naegleria fowleri — Primary Amebic
Meningoencephalitis (PAM) — Amebic

                     Encephalitis, Diagnosis and Treatment;
http://www.cdc.gov/parasites/naegleria/diagnosis.html

Relevant AMA Policy:

H-160.931 Health Literacy

H-460.930 Council on Scientific Affairs Conference: Clinical Research:
Assessing the Future in a Changing Environment

H-460.930 Council on Scientific Affairs Conference: Clinical Research:
Assessing the Future in a Changing Environment

H-310.994 Curriculum Orientation of Medical Staff Membership in
Teaching Programs



H-450.994 Quality Assurance in Health Care

H-450.935 Health Care Standards