Guardians of the Public's Health

918 - Promoting the Successful Clinical Outcome of Primary Amebic Meningoencephalitis

  • 08 Nov 2015 6:54 PM
    Message # 3623651
    Anonymous

     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


    Last modified: 09 Nov 2015 5:54 AM | Anonymous
    Moved from AMA Resolutions: 09 Nov 2015 5:44 AM
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