USA: Fatal brain infection by Balamuthia mandrillaris amoeba reported in Seattle, WA woman who used home-filtered tap water in Neti pot - possible co

[Emily]

Note that she did filter her water. I saw some public health advice here that says filtered water is OK for neti pots. Maybe a certain kind of filter would work, but obviously filters in general will NOT make neti pot water safe from parasites.
This case is very sad because the victim was a cancer survivor and should not have had to die like this.

https://www.kiro7.com/news/local/doc...-pot/884605557

 

[Ronan Kelly]

The infection was actually Balamuthia mandrillaris, not Naegleria fowleri. This leads to certain questions as outlined in the twitter thread below. - Ro

https://www.seattletimes.com/seattle...sible-repeats/

• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  OK, it's somewhat moved out of the news cycle, but I'd like to take a minute to talk about some problems with the #Balamuthia "brain-eating #amoeba from a Neti pot" story from last week. 1/n[/FONT]
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  Rich Davis Retweeted Ilan Schwartz MD PhD
  First, the big takeaways from this story have been: - Everyone: use only sterile (NOT filtered!) water for nasal lavage! - Doctors: be aware of free-living amoebas in your diagnoses - #Balamuthia is a real, serious pathogen All these are VERY TRUE! 2/n
  
  Rich Davis added,
  

  

  
  
  

  

  
  
  

  

  
  
  
  
  
  
  Ilan Schwartz MD PhD @GermHunterMD
  Epidemiology and Clinical Features of Balamuthia mandrillaris Disease in the United States, 1974 ? 2016. Clin Infect Dis Review of 109 cases of #Balamuthia disease in the US. 99% had granulomatous amebic encephalitis, 90% died. #EmergingInfections http://bit.ly/2QMmILt[/FONT]
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  You should DEFINITELY only use sterile water in Neti pots. Free-living amoebas Acanthamoeba, Balamuthia and Naegleria have all been implicated in encephalitis and death. This is very serious stuff. 3/n https://www.cdc.gov/dpdx/freelivingamebic/index.html?[/FONT]
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  But ? THIS ? particular study. The title of the publication is: "Fatal Balamuthia mandrillaris brain infection associated with improper nasal lavage." Some things don't quite add up with that statement. 4/n Free, open access text here:[/FONT]
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  First what DO we know: The CDC confirmed via PCR and antibody staining (IFA) that what was in this woman's brain was Balamuthia mandrillaris. Not Naegleria, not Acanthamoeba. So we know that that was the cause of death. No questions there. 5/n (pathology image from the article)
  
  

  

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[FONT=&quot]Rich Davis‏ @richdavisphd FollowFollow [/FONT]

[FONT=&quot]@richdavisphd[/FONT]​

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So here's the problem. How do they connect THIS amoeba encephalitis infection with Neti-pot usage? Well, they don't, really. This is the sentence from the discussion: 6/n

4:40 PM - 11 Dec 2018[/FONT]

• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  I'm fine with an article saying they were "led to suspect" a pathway for infection. Not when you TITLE the paper (and give news interview to this effect) in such a way as to ESTABLISH an unestablishable pathway. It's ... a stretch. 7/n[/FONT]
  
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  Naelgeria and Neti-pots/nasal lavage: known association. They live in warm water, enter through the sinuses and can be found along nerves leading to the brain. 8/n[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  Balamuthia on the other hand: - no KNOWN water-brain association - live in soil (& probably water) - travel in the body via the blood It's suspected that Balamuthia spores enter the body via inhalation or through open wounds. 9/n (great article here: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy813/5104175#.W6PAHDlpWIA.twitter?)[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  This patient's course of disease: - chronic sinus problems, started using a Neti pot - developed rash/lesion OUTSIDE the nose (???) 1 mth later - this was biopsied 3 times - 1yr later, seizure - brain imaging showing what turned out to be #Balamuthia 10/n[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  The CDC PCR showed Balamuthia in both the brain AND in biopsy tissue from the nose lesion. So it WAS in the nose lesion. But what is unclear (unlikely?) is how Balamuthia would seed a patch of skin on the OUTSIDE of the nose via nasal lavage with amoeba-containing water. 11/n[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  Which biopsy did they confirm via PCR the presence of the ameoba in the (again, I keep stressing this because it's weird) external nose lesion? Was it the first one? Or did a lesion form and, when systemic amoebiasis happen, it got seeded at that point? 12/n[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  The timeline seems strange too. One of the reasons clinicians need to be aware of free-living amoebas in their differentials is because onset and death can happen very quickly. Having Balamuthia for a full year before causing encephalitis? That's ? unusual. 13/n[/FONT]
  
  
  
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• [FONT=&quot]Rich Davis‏ @richdavisphd 13h13 hours ago More
  
  
  
  Recap: Did she died of #Balamuthia? Yes. No question. Do we know she got it from nasal lavage from non-sterile water. No. And frankly there are problems with that timeline. But again, SHOULD you use sterile water for nasal lavage. HECK YES. 14/14[/FONT]​
• [FONT=&quot]https://twitter.com/richdavisphd/sta...91923507019777[/FONT]

 

[Emily]

Thanks, Ronan! I corrected title. This infection seems to be a mystery.

 

[alert]

When I first read this story, I had my suspicions that the initial media report was not going to be correct.

We've actually seen a handful of such errant reports in the national and international media over the past decade that seem to fit this pattern. An illness or death is reported in a sensational way and the story goes viral. The illness is typically a gruesome illness associated with a common object, perhaps used in an improper or unorthodox way. Off the top of my head, I think of the two people who died in Indiana after cleaning a barn, the man who became ill after stealing a cell phone from an Ebola treatment center in Uganda during an outbreak, the Florida man who died after eating dozens of cockroaches, the three babies who died in Egypt after using rubbing alcohol on their forehead to reduce a fever, and now this one. The stores went viral, especially on social media, for weeks or months, despite being locally discarded practically immediately as the illnesses found alternative explanations.

Unfortunately, the media loves a sensational story. And when the story appears to be that a common object can kill you in a painful or gruesome way, the truth often lags far behind.

 

[sharon sanders]

In the current global climate of disease news suppression it is better to post an item so we can evaluate. In this case, a lot of valuable public health information about Neti pots was disemminated.