Fatal Case of Splash Pad–Associated Naegleria fowleri Meningoencephalitis — Pulaski County, Arkansas, September 2023

Abstract

A fatal case of primary amebic meningoencephalitis (PAM), an infection caused by Naegleria fowleri, was diagnosed in Arkansas in a young child in September 2023. A public health investigation was completed, with epidemiologic, laboratory, and environmental data suggesting that a splash pad (an interactive water play venue that sprays or jets water on users and has little or no standing water) with inadequately disinfected water was the most likely site of the patient's N. fowleri exposure. This case is the third occurrence of splash pad-associated PAM reported in the United States; all three cases involved inadequately disinfected water. PAM should be considered in patients with acute meningoencephalitis and a history of recent possible exposure to fresh water, including treated recreational water (e.g., in splash pads or pools), via the nasal passages. Proper design, construction, operation, and management of splash pads can help prevent illnesses, including N. fowleri infections. Increased awareness, collaboration, and communication among clinicians, hospitals, laboratories, CDC, health departments, the aquatics sector, and the public can help support N. fowleri infection identification, treatment, prevention, and control efforts.