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Rare Brain Eating Amoeba kills woman who filled her neti pot with tap water



Microscopic image of a sample from the woman's brain, with arrows for the amoebae.
Photo: KJ Piper et al., 2018 / International Journal of Infectious Diseases

A 68-year-old Seattle woman who died after a study with a rare brain-eating amoeba, according to a new study using regular tap water to her Flush sinuses.

As stated in a recent case study from the International Journal of Infectious Diseases, the infection was initially diagnosed as a brain tumor. During the operation to remove the suspected tumor, chief neurosurgeon Charles Cobbs of the Swedish Medical Center in Seattle was surprised by how big the brain damage was. So he brought out a sample for further testing.

"When I operated on this woman, a section of her brain the size of a golf ball was bloody pulp," Cobbs told The Seattle Times. "There were these amoebas everywhere that were eating brain cells. We had no idea what was going on, but when we got the actual tissue we could tell it was the amoeba.

Indeed, the following biopsy report showed that the woman was infected with a rare brain amoeba called Balamuthia mandrillaris . These types of infections are quite rare, but what is unique about this incident is that it is the "first case of [[Balamuthia mandrillaris] [ofBalamiamandrillaris suspected of nasal rinsing," states the case study of Swedish scientists and the doctors who worked on the case, including Cobbs.

In nasal rinsing, researchers refer to the use of a neti pot – a teapot-shaped device that relieves sinus pressure by flushing water through the nasal cavity. Researchers said the patient had used tap water filtered through a commercially purchased water filter instead of the recommended boiled or salted water.

As a user of neti pots, this is a shock to me. While I did not know that boiled or salty water should be used instead of tap water, I suspect that this is a surprise to many.

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B. mandrillaris is a free-living amoeba that lives in soil and freshwater. This unicellular organism should not be confused with Naegleria fowleri another brain-eating amoeba that also lives in fresh water. However, unlike N. fowleri which kills its human prey within a few days, the B. mandrillaris amoebas require more time to cause their damage. In this case, the woman lived about one year after the infestation, after she had become infected.

These amoebas traditionally live in the warm climate of South and Central America, but climate change can open up new habitats – even in the North, US states like Washington. B. mandrillaris was first discovered in 1986 in a mandrill monkey kept in the San Diego Zoo. According to the report, in 1993 it was declared a separate species. So far, only 200 infections have been reported worldwide, of which 70 have occurred in the United States. Alarmingly, the death rate is practically 100 percent.

Usually additional efforts are required to cause infection; It can not be drunk by contaminated water. In cases of N. fowleri for example, humans have become ill with the amoeba by jumping into a lake and throwing water in their nostrils. In this case, however, it was the Neti flushing devices that pumped the amoebae into their nasal passages and olfactory nerves via infected tap water, the researchers said.

For this poor woman who died of a brain infection last February, the condition first manifested as a rash on her nose. Unaware of anything, her doctors diagnosed rosacea, a common skin condition, with treatments that lasted about a year. Only when the woman suffered a stroke and performed CT scans of her brain, the brain tumor was diagnosed – more precisely: was misdiagnosed . The woman's brain operation and subsequent biopsy finally showed the true nature of her condition.

"Despite aggressive anti-amoebic therapy, the condition of the patient continued to deteriorate," noted the authors of the report. "Within a week she was sleepy [sleepy] and then in a coma. Repeated CT scans showed further bleeding in the original resection cavity. At this point, the family decided to withdraw the support.

The patient died about a month after receiving the correct diagnosis.

The incident shows how notoriously difficult it is to properly diagnose this type of infection. As the researchers noted in the case study, there is still much to learn about the nature and causes of these infections, such as the impact of an impaired immune system, environmental factors and genetics. In the meantime, the scientists recommend doctors perform amoebic tests on nasal wounds and ring-promoting brain lesions.

Importantly, the scientists said we should not miss out on Neti pots, as the devices are a great way to get a nasal discharge. As long as we wash the containers properly and use either boiled or salt water, we should be fine.

[International Journal of Infectious Diseases]


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