UPDATED: Amoeba didn’t cause swimmer’s death, lab tests say

ST. PAUL -- Laboratory testing has ruled out an amoeba as the cause of death of a 14-year-old Alexandria boy who doctors originally thought died after contracting a rare brain-debilitating condition while swimming in a central Minnesota lake.

The testing conducted by the U.S. Centers for Disease Control and Prevention has determined that Hunter Boutain did not die from suspected primary amoebic meningoencephalitis as reported in early July, but instead from streptococcal meningoencephalitis.

Symptoms of the two diseases are very similar, said Doug Schultz, of  the Minnesota Department of Health communications department.

“They look very similar,” he said.

However, they are two very different infections. He made it clear the boy who died did not get the infection from the lake.

The streptococcal pneumonia infection can attack the lungs, blood stream or cause inflammation in the lining of the brain.

The Alexandria boy suffered from the brain inflammation, he said.

News that Boutain possibly died of amoeba brought on a wave of concern among swimmers and parents of children who like to play in Minnesota lakes.

He died at the University of Minnesota Masonic Children’s Hospital, where he was treated both for PAM and many kinds of more common bacterial infections. The doctor who treated him said it was never assumed that Boutain had PAM, though they suspected it because he had recently been swimming in a lake.

“From the minute he was brought into the hospital, he was treated for everything,” said Dr. Mark Schleiss, director of the infectious diseases division at the hospital.

Schleiss said PAM also was suspected because the hospital’s standard tests showed no signs of the microorganisms that cause bacterial infection. He said that’s a testament to the potency of the antibiotics Boutain got in his treatment.

Schleiss said he has asked himself whether he could have done anything differently in Boutain’s treatment.

The teen’s illness came on quickly and his condition deteriorated rapidly in just a few hours, Schleiss said. His family also said he had suffered a head injury in a recent skateboarding accident, and that would have made him more vulnerable to all kinds of brain infection.

Boutain received a battery of drugs targeting both bacteria and amoeba.

One of the treatments was an experimental drug that has showed some promise in treating PAM, which is nearly always fatal. It arrived by charter jet from the CDC after an urgent late-night call from the Minnesota Department of Health, Schleiss said.

“We tried to go the extra mile and leave no stone unturned, especially knowing he had contact with freshwater,” Schleiss said. “We cast a very broad net, but the outcome was tragic. No change of therapy could have altered that, unfortunately.”

Ehresmann said there is a childhood vaccine available that prevents 13 strains of the streptococcal bacteria that is fairly new.

There’s also a vaccine for adults, often called the “pneumonia shot.”

Ehresmann said the two vaccines are not as well known as the flu shot, for example, but can be helpful.

She said Boutain likely didn’t have the vaccine available to him in his younger years.

The department of health, which made the original information about Boutain public July 7, said in announcing the change in cause of death Monday that the suspected case was based on initial clinical findings reported by the child’s health care team, including preliminary laboratory testing from the health care facility and based on the fact that he had been swimming in a lake.

It was thought the Alexandria middle school student got the infection while swimming in Lake Minnewaska near Glenwood, a small town south of Alexandria.

Ehresmann and other health department officials made a trip to Glenwood on Monday to meet with community leaders to talk about the issue. She said the public announcement and the meeting was held simultaneously after the extensive CDC tests, the autopsy and notification of the family was made.

She said the meeting in Glenwood was positive and a way to talk about ways things could be done better if such an incident surfaces again.

After the meeting, Glenwood Mayor Scott Formo, who said the scare greatly affected his town’s tourism, said in a statement, “The fact of the matter remains, a child died and it affected the community as well as the family. Without forgetting that fact, locally we are relieved to know that the fear of what was suspected as a case of PAM contracted from Lake Minnewaska is not the case. Lake Minnewaska is and has been open and with the initial fears and suspicions relieved with the final confirmation, we certainly welcome everyone to come and enjoy Lake Minnewaska.

“The initial media reports and fears did have an impact on the community, but hopefully the message that it wasn't a case of PAM contracted from Lake Minnewaska gets out to everyone in the same fashion and magnitude.” he said.

The  testing conducted at CDC is standard to check on an initial finding involving amoeba. In this case, the laboratory testing did not corroborate the initial finding, the department said.

“It takes a number of tests,” Schultz said.

However, he said the results  do not change the fact that there is always a very low-level risk of infection with the amoeba called Naegleria fowleri when swimming in fresh water in the summer, although most cases are reported in the southern United States in extremely warm water conditions.

The organism can strike when swimmers in fresh water get water in their nose. Health officials are trying to develop tests to detect if amoeba is in the water, but so far those tests take weeks to show results.

There were 35 cases of the amoeba infection in the U.S. in the last 10 years. There have been only two cases of confirmed deaths from the organism in Minnesota -- both in Stillwater’s Lily Lake -- in 2010 and 2012.

Jamie DeLage of the St. Paul Pioneer Press contributed to this report