Fatal Primary Amebic Meningoencephalitis in Nebraska: Case Report and Environmental Investigation, August 2022.

Primary amebic meningoencephalitis (PAM) is a rare and lethal infection caused by Naegleria fowleri. We report an epidemiological and environmental investigation relating to a case of PAM in a previously healthy boy age 8 years. An interview of the patient's family was conducted to determine the likely exposure site and to assess risk factors. Data from the United States Geological Survey site at Waterloo, NE, on the Elkhorn River were used to estimate water temperature and streamflow at the time and site of exposure. Data from the National Weather Service were used to estimate precipitation and ambient air temperature at the time and site of exposure. Despite conventional treatment, the patient died 2 days after hospital admission. The patient participated in recreational water activities in the Elkhorn River in northeastern Nebraska 5 days before symptom onset. In the week before exposure, water and ambient air high temperatures reached annual highs, averaging 32.4°C and 35.8°C, respectively. The day before infection, 2.2 cm of precipitation was reported. Streamflow was low (407 ft3/s). Infections in several northern states, including Nebraska, suggest an expanding geographic range of N. fowleri transmission, which may lead to increased incidence of PAM in the United States. Similar environmental investigations at suspected exposure sites of future cases will allow data aggregation, enabling investigators to correlate environmental factors with infection risk accurately.

Adult vision screenings in Omaha, Nebraska.

PURPOSE: The purpose of this study was to examine the association between risk factors and failing vision screening tests to better identify populations at high risk for age-related eye diseases and vision impairments. METHODS: A retrospective review of 839 vision screening forms from an ongoing vision screening program in Omaha, Nebraska, was conducted. Univariate and multivariate logistic regression analyses were used. RESULTS: Sex, age, ethnicity, and persistent pain were independently associated with failing the visual field test in multivariate analysis. Persistent pain and glaucoma diagnosis were independently associated with failing the visual acuity test. CONCLUSIONS: Female sex, age older than 65, African American or Hispanic ethnicity, glaucoma diagnosis, and persistent eye pain were significant risk factors for failing a vision screening test. Vision screenings should focus on targeting populations that exhibit these risk factors.