Researchers said the woman probably contracted amoebae using tap water to fill a neti pot, rather than using salty or sterile water. The organisms entered his brain after the water reached the nerves in his upper nasal cavity.
When a 69-year-old woman from Seattle underwent brain surgery at the start of this year at the Swedish Medical Center, her doctors were baffled. the woman was admitted to the hospital emergency room after suffering an attack. The doctors did a CT scan of his brain to determine the cause, finding what they initially thought was a tumor. But an examination of the tissue taken from his brain during surgery the next day showed that he was facing a much more lethal attack, one that had been going on for about a year and was literally eating it alive.
"When I worked on this lady, a golf ball-sized brain section was cursed mush," said Dr. Charles Cobbs, a Swedish neurosurgeon, in a telephone interview. "There were these amoebas everywhere that ate only brain cells. We had no idea what was going on, but when we got the actual fabric we could see it was amoeba."
The woman died a month after the rare organisms that entered the brain after being injected into its nasal cavity by means of a neti pot, a teapot-shaped product used to rinse the sinuses and nasal cavity, according to a case study recently published in the International Journal of Infectious Diseases. [1
The woman's infection is the second ever recorded in Seattle – the first arrived in 2013 – but the first fatality was caused by it. In 1990, researchers realized that this type of amoeba can cause disease in people, according to a study published in clinical infectious diseases in November. The report found that there were 109 cases of amoeba reported in the United States between 1974 and 2016. 90% of these cases were fatal.
Amebidae are unicellular organisms, some of which can cause disease. Since they thrive on land and warm water, some local doctors are growing worried that the deadly infection of the woman could be among the other diseases of the southern hemisphere that could spread northward, towards the Pacific Northwest, at hot temperatures. Organisms are commonly found in South America and Central America, but now they can have a better chance of survival in other, generally cooler places like Washington.
" I think we are going to see more infections that we see in the south (move) to the north, since we have a warming of our environment," said Cynthia Maree, a Swedish doctor suffering from infectious diseases that is co-author of the case study on women's conditions. "Considering the mortality associated with this infection, my hope was that I was wrong, but my fear was that I was right."
In the case of the woman from Seattle, she was probably infected by the amoebae. tap water, according to the researchers. Rather than filling his neti pot with salty or sterile water, he used tap water filtered through a filter of water purchased from the store. Then he fired contaminated water on his nasal cavity to the olfactory nerves in the upper part of the nasal cavity, causing the brain to get called granulomatous encephalitis (GAE).
Researchers are also "limited in our understanding" of the factors that increase the likelihood of contracting the disease, which may include a compromised immune system, genetics and environmental factors, Keenan Piper, a member of the Swedish team who produced I study.
Amoebe can be found in freshwater Puget Sound sources like wells, but they are not present in the waters treated in the city, according to Liz Coleman, spokesperson for the Environmental Public Health division of the State Department of Health. The researchers were unable to test the woman's tap water, but people can not be infected simply by swallowing water contaminated with amoebae, according to Cobbs.
After contracting the amoebas, the woman developed a red wound on her nose. For about a year, the wound was misdiagnosed and treated as a common and treatable skin condition known as rosacea, the study said. Cobbs said that this is probably the first symptom of the amoeba, but its rarity makes the amoeba difficult to diagnose quickly.
"It's such a rare disease that it was not on anyone's radar that this initial nose ache would be connected to his brain," Piper said.
The woman's infection is the first to be linked to improper nasal lavage, according to Piper. Although the risk of brain infection is extremely low, people who use neti or other nasal irrigation devices can almost eliminate it by following the instructions printed on the devices, including the use of saline or sterilized water, he said Maree.
Three types of amoebae have been identified as causing fatal brain infections, according to Jennifer Cope an epidemiologist with the Centers for Disease Control and Prevention Centers dealing with foodborne illnesses , water and environment.
While infections remain rare, the woman from Seattle dies from the least known of all: Balamuthia mandrillaris. This is a type of amoeba that moves slower and may take weeks or months to cause death. The other slow-moving amoeba is called Acanthamoeba spp.
Naegleria fowleri is the most documented, says Cope, because it acts quickly, causing an infection that leads to death within a few days. New Jersey health officials linked the death of a man to N. fowleri in October. It was believed to have become infected while sailing in an indoor water park in Texas. N. fowleri is present in the waters of Puget Sound and other sources of fresh water, said Maree. He was not immediately aware of other local cases of infection.
Cope said that the three types of amoeba have similar prevalence rates, but Balamuthia mandrillaris is the least recognized by the medical community because it is rarely documented, providing limited research opportunities.
Amoebas are thought to be primarily ground-based, but "the exact environmental niche is really unknown," Cope said in an e-mail.
"From my understanding it's everywhere – there are molds and fungi that can kill you if they infect your brain." MRSA (a treatable bacterial infection) is everywhere, but we do not have a mechanism to inject it into our brains, "Cobbs said. " It will always be an uphill battle because people learn by seeing things over and over again, but I do not think there will be an increase in cases in the future, at least I hope not."