1626. A Primary Amebic Meningoencephalitis Case Associated with Surfing in an Inland Surf Park

BACKGROUND: Naegleria fowleri is a thermophilic ameba that is found in freshwater and causes primary amebic meningoencephalitis (PAM; 0–8 infections per year in the United States) when it enters the nose and migrates to the brain. Patient exposure to water containing the ameba typically occurs in warm freshwater lakes and ponds during recreational water activities. In September 2018, a 29-year-old man died of PAM after visiting a Texas inland surf park. METHODS: To determine water exposures, we reviewed medical records and conducted interviews with family and individuals who had traveled with the patient. To further investigate the inland surf park as a possible exposure source, we visited the facility and collected water, biofilm, and sediment samples from the surf park and other venues (water slides, lazy river, and cable park) within the facility. We assessed water sources and treatment practices, performed water quality tests, and tested for the presence of N. fowleri by culture and real-time PCR. RESULTS: Interviews revealed that the case-patient’s most probable water exposure in the 10 days before becoming ill occurred while surfing in an inland freshwater surf park where he fell off the surfboard into the water multiple times. The on-site investigation of the facility revealed a practice of manual chlorine treatment with monitoring, but no water filtering or record keeping to document water quality. Surf park water temperature was warm (25°C) and chlorine residual was negligible. N. fowleri was detected in 1 water and 1 sediment sample collected at the cable park venue, and viable thermophilic amebae were detected in all samples collected from the surf park, water slide, and cable park venues, as well from the sediment in the open-air groundwater reservoir feeding the venues. CONCLUSION: This investigation documents a novel exposure in an inland surf park as the likely exposure causing PAM. Conditions in the surf park were conducive to amebic growth. Novel types of recreational water venues that do not meet traditional definitions of swimming pools, such as this surf park, might not meet the water quality standards for pools or similar treated venues. Clinicians and public health officials should remain vigilant for nontraditional exposures to water. DISCLOSURES: All authors: No reported disclosures.