Rural communities warned to chlorinate after waterborne brain-eating parasite kills three children (Nov 9 2015)

https://www.abc.net.au/news/2015-11-09/rural-children-at-risk-of-parasite-thriving-in-fresh-water/6922432

Regional communities are being advised to chlorinate their house water after a third child death from a “brain-eating parasite”.

The amoeba, Naegleria fowleri, thrives in warm fresh water across large parts of inland Australia.

While authorities say infection is very rare, medics warn survival is even rarer.

“It causes catastrophic meningitis encephalitis, and by the time these kids are diagnosed the treatments are usually ineffective,” public health physician Dr Steven Donohue said.

“We think that probably 98 per cent of cases die even in the best of hands, even in the most modern intensive care units.”

One-year-old Cash Keough, from Judith Royl station in north-west Queensland, died in April this year.

While his parents are yet to come to terms with their loss they felt compelled to share their experience on Australian Story, in a bid to warn other families of the potential dangers.

“We owe it to him to let people know,” Cash’s father Laine Keough said.

“You don’t want this to happen to another family.”

The toddler’s mother, Jodi Keough, suspects he was infected while playing with a garden hose filled with untreated water.

“That day always stands out in my mind because I insisted all three of my kids have a hose each to play with, thinking I was being a good mum,” Ms Keough said.

“But I was actually putting my kids in some form of danger.”

Cash is the third child to die in the Winton-Richmond area — half-way between Townsville and Mount Isa — in Queensland.

“One is a fluke; two, that’s a coincidence,” Dr Donohue said.

“But three? That’s when you really start thinking, what’s going on here?”

His mother said she believed a sprinkler on their homestead, 100 kilometres from the Keough’s property, was the source of infection.

“It started with a bit of a fever. The next day he was unresponsive,” James’ mother Margie Elliott said.

It was not until James’ half-sister, 19-month-old Anabella Elliott, died eight years later, having bathed in untreated water on the same property, that doctors could conclude the cause was Naegleria fowleri.

“When Anabella got sick, I think I went into denial and I sort of shut down on a lot of it,” Gerald Elliott, James and Anabella’s father, said.

“I just knew it was the place of dread, it’s the place of horror.

“You accept you’ve got to bury your parents, but to bury your child is a place that no-one wants to be.”

Naegleria fowleri was first identified in South Australia in the 1960s and has since caused 300 known deaths worldwide, mostly youth and children.

It is not only communities from north-west Queensland at risk.

The amoeba thrives in water temperatures above 25 degrees Celsius and has been discovered in lakes, creeks, dams, bores and rain water tanks across the country.

Authorities stress infection from Naegleria fowleri cannot occur from drinking, cooking or washing clothes in the water.

The danger arises when contaminated water enters the nose.

“It gets into the brain through the nose and it’s usually a form of pressured water, from jumping into water or having water sprayed into your nose,” paediatric intensivist Dr Greg Wiseman said.

Clinical microbiologist Dr Robert Norton said: “On the inside there is a very thin sliver of bone that separates the outside brain from the surface, and in children this bone is underdeveloped.

“And for some reason the Naegleria tends to pass through this.

“We get children like the way Cash came in literally every day.

“Children coming in with fevers, seizures and confusion and it could be one of about 20 things, so we start at the top and work our way down.

“In order to make the diagnosis you have to get fluid from around the brain and sadly, even when the diagnosis is made early, treatment is very rarely effective.”

While the likelihood of infection had once been considered extremely rare, authorities now suspect the death rate could be much higher considering diagnosis is so difficult.

“Nobody’s keeping records. It’s not a nationally notifiable disease and we also know perhaps the majority of cases are missed,” Dr Donohue said.

The Queensland Government has launched an awareness campaign, with health officials travelling across the state to educate both doctors and families in regional communities.

With no proven cure, the message will focus on prevention.

“I think people should start to think about disinfecting the water and filtering it, particularly in the water that kids are playing and washing in,” Dr Donohue said.

“We’ll reduce the risk, but we won’t get rid of it.”

Doctors warn of another group at risk — young adults — who often dive into dams and rivers.

“People should take care when putting their head underwater if it’s untreated water,” Dr Donohue said.

“If they dive in they really should hold their nose.

“But these activities and behaviours are very hard for us to have much impact on.

“At least with young children parents can have some control over what water they come in contact with.

Unfortunately the advice comes too late for the Keough and Elliott families.

“The whole set-up for our homestead, with 12 months’ worth of filters, was about $3,500,” Mr Keough said.

“And when you put it like that, to a little boy’s or to anyone’s life, for $3,500 it could have changed a lot.

“We had one wonderful year of Cash in our lives which brought much joy and happiness and now I believe we will have a lifetime of sadness not having him in our life,” Ms Keough says.

“I do feel like it’s up to me to try and prevent our nightmare becoming someone else’s reality.”