Brain-eat­ing amoe­bas kill woman who rinsed si­nuses with tap wa­ter

Tri-City Herald - - News - BY HANNAH RO­DRIGUEZ

When a 69-year-old Seat­tle woman un­der­went brain surgery ear­lier this year at Swedish Med­i­cal Cen­ter, her doc­tors were stumped.

Last Jan­uary, the woman was ad­mit­ted to the hos­pi­tal’s emer­gency depart­ment af­ter suf­fer­ing a seizure. Doc­tors took a CT scan of her brain to de­ter­mine the cause, finding what they ini­tially thought was a tu­mor. But an ex­am­i­na­tion of tis­sue taken from her brain dur­ing surgery a day later showed she was up against a much dead­lier at­tack, one that had been un­der­way for about a year and was lit­er­ally eat­ing her alive.

“When I op­er­ated on this lady, a sec­tion of her brain about the size of a golf ball was bloody mush,” Dr. Charles Cobbs, neu­ro­sur­geon at Swedish, said in a phone in­ter­view. “There were these amoeba all over the place just eat­ing brain cells. We didn’t have any clue what was go­ing on, but when we got the ac­tual tis­sue we could see it was the amoeba.”

The woman died a month later from the rare or­gan­isms that en­tered her brain af­ter be­ing in- jected into her nasal cav­ity by way of a neti pot, a teapot-shaped prod­uct used to rinse out the si­nuses and nasal cav­ity, ac­cord­ing to a case study re­cently pub­lished in the In­ter­na­tional Jour­nal of In­fec­tious Dis­eases.

The study was au­thored by Swedish doc­tors and re­searchers who worked on her case, in­clud­ing Cobbs. The pub­li­ca­tion doesn’t iden­tify the vic­tim.

The woman’s in­fec­tion is the sec­ond ever re­ported in Seat­tle – the first came in 2013 – but the first fa­tal­ity to be caused by it. In 1990, re­searchers first be­came aware that this type of amoeba can cause dis­ease in peo­ple, ac­cord­ing to a study pub­lished in Clin­i­cal In­fec­tious Dis­eases in Novem­ber. That re­port found there have been 109 cases of the amoeba re­ported in the U.S. be­tween 1974 and 2016. Ninety per­cent of those cases were fa­tal.

Amoe­bas are sin­gle­celled or­gan­isms, some of which can cause dis­ease. Since they thrive in warm soil and wa­ter, some lo­cal doc­tors are grow­ing con­cerned that the woman’s deadly in­fec­tion could be among other south­ern­hemi­sphere dis­eases that may be­come spread north­ward to­ward the Pa­cific North­west amid warm­ing tem­per­a­tures. The or­gan­isms are com­monly found in South Amer­ica and Cen­tral Amer­ica, but may now have a bet­ter chance of sur­vival in other, usu­ally cooler places, such as Wash­ing­ton.

“I think we are go­ing to see a lot more in­fec­tions that we see south (move) north, as we have a warm­ing of our en­vi­ron­ment,” said Cyn­thia Ma­ree, a Swedish in­fec­tious-dis­ease doc­tor who co-au­thored the case study about the woman’s con­di­tion. “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 Seat­tle woman, she likely be­came in­fected with the amoe­bas from her tap wa­ter, ac­cord­ing to the re­searchers. Rather than fill­ing her neti pot with sa­line or ster­ile wa­ter, she used tap wa­ter fil­tered through a store­bought wa­ter fil­ter. She then shot the con­tam­i­nated wa­ter far up her nasal cav­ity to­ward ol­fac­tory nerves in the up­per part of her nasal cav­ity, caus­ing the brain-eat­ing in­fec­tion called gran­u­lo­ma­tous amoe­bic 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, said Keenan Piper, a mem­ber of the Swedish team that pro­duced the study.

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