What If You Got A Brain-Eating Amoeba From A Pool?
16
November

By Adem Lewis / in , , , , , , , , , , , , /


– Jane is a 19 year old female with no significant past medical history, who presents to the hospital with nausea, vomiting, headache, and a single known episode of fainting. She tells the doctor
that all of her symptoms started yesterday after
she visited a water park. She had just finished her freshman year at the University of Arizona, and was looking to have a fun summer. She had gotten straight A’s this semester after many hours of dedication. However, she recently broke up with her boyfriend of one
year and was feeling down. To cheer her up, she thought
it would be a good idea to go to the waterpark with her friends before she headed home for summer break. And while going to waterparks
wasn’t something new for her, she had gone many times has a kid, and was eager for that nostalgia
to make her feel better. A mere three hours after
returning from the waterpark, she started noticing some nausea. It was just difficult for
her to keep some food down, and she eventually vomited the little bit she was able to eat. And, as time passed, she vomited again, and again, and again. By 9 p.m. at night that day, she had vomited as much as 14 times. Thinking it was due to
a common stomach bug, she initially brushed it off and started watching her favorite television program, The Bachelor. But unfortunately, not even
the dramatic relationships on the show could distract
her from her symptoms. She felt a pounding headache, and the screen even began to blur. Maybe it’s better to
sleep it off, she thought. So, she took some Tylenol
and headed to bed. But unfortunately, the
acidic taste of bile woke her up at 7 a.m. the next morning. Furthermore, her headache
had significantly worsened. It was as if her brain was
trying to get out of her skull. She quickly phoned a friend to tell her what was going on, and the next thing she knew
she woke up in the hospital. Her parents drove 3
hours from their hometown just to see her, and were
desperate for a cure. They had never seen Jane like this before, and knew something was definitely wrong. – My neck was so stiff it
hurt to turn in any direction. I hated the light. It felt better to sit in the dark. I felt like my insides were pouring out, and I was praying for it to stop. – A quick look at her vital signs revealed that she had a temperature
of 100.3 degrees Fahrenheit, much higher than the body’s normal core temperature of 98.6 degrees. Simply put, Jane had a fever. Furthermore, basic laboratory blood work revealed that she had an elevated white blood cell count, or
leukocytosis, of 32,000. White blood cells are
a marker of infection, so whenever they are increased, it’s likely that there’s a
foreign pathogen in our body. A physical exam then revealed that she had a positive Brudziński’s sign. A Brudziński’s sign is typically positive when the meninges, a membrane that surrounds the brain and
spinal cord, are inflamed. This inflammation results in rigidity, so when something upwards on
the spinal cord is flexed, like the neck, then something
downwards on the spinal cord, like the hips, will be flexed as well. Based on these findings, it was very likely that
Jane had a meningitis, or inflammation of the meninges. This diagnosis is a cause of concern, because it is a
life-threatening emergency. Well, why exactly is that? In order to properly answer that question, we first must examine some
basic human immunology. So, if you get a cut on your hand, the first thing that happens
is that it turns red, gets swollen, and starts to feel warm. This is because the damage caused by a cut causes certain chemicals called
cytokines to be released. The release of these cytokines
results in two things: one, they attract white blood cells, and two, they result in vascular dilation. This vascular dilation actually explains the the redness and
swelling we get after a cut. This process is how the body typically deals with an infection. However, unlike our hand,
which is open to the air, the brain is encased in the skull. Therefore, when it starts
to swell it results in an increase in intercerebral pressure, causing symptoms like nausea and vomiting. If the pressure gets too high, it can actually result in brain herniation and lead to death. Furthermore, this inflammation
that can lead to scarring similar to a pinkish
wound we get after a cut. This scarring can irreversibly damage brain tissue and nerves, leading to deafness, epilepsy, and hydrocephalus, or water in the head. Therefore, it is critical to diagnose meningitis early and accurately. The gold standard for
diagnosing meningitis is actually a lumbar puncture, otherwise known as a spinal tap. This procedure involves numbing
the back of the patient, and inserting a five and a
half inch hypodermic needle into the spinal cavity in order to remove cerebrospinal fluid for analysis. – I was pretty scared about
having a lumbar puncture. The doctor was gonna stick
a huge needle in my back, and one wrong move could
paralyze me for life. But I was determined to find out what was wrong with me, so I agreed. – After the procedure, Jane
had a horrible headache, but was told by the doctors that things have to get worse before they get better. But would they even get
better, Jane thought. Things seemed very desolate at this point. So, why did the doctors take
Jane’s cerebrospinal fluid? Cerebrospinal fluid is a
fluid that contains protein, glucose, and white blood cells, and functions to cushion the
brain like a shock absorber. Variations of the numbers
of white blood cells, glucose, and proteins, are actually used to determine the etiology of infection. There are three main sources of this, bacterial, viral, and fungal. If the meningitis is due
to a bacterial cause, then the amount of neutrophils, a type of white blood cell, are increased, while the glucose is decreased. If the cause of the meningitis is viral, then the amount of lymphocytes, also a type of white blood cell, are increased while the amount
of glucose stays the same. And if the cause of the
meningitis is fungal, then the amount of lymphocytes
are also increased. However, the amount of
glucose is decreased. Now, here was the conundrum, when Jane’s CSF return from the lab, there was neither an increase in the amount of
neutrophils or lymphocytes. Instead, there is an increase
in the amount of eosinophils, an extremely rare type of white blood cell Normally, they are
present at less than 10% in the cerebrospinal fluid, but Jane had an amount of 30%. Eosinophils are typically only elevated in asthma, allergic reactions,
and parasitic infections. It was now clear to the medical team that Jane had a fourth type
of meningitis, parasitic. But which parasite was the culprit? There are hundreds of possible causes. Finding the specific organism was just too difficult to pinpoint. Testing for them is highly specific, and each one must be done individually. Furthermore, they often
need to be cultured, or run under a PCR, or
Polymerase chain reaction, which can take days to result, and our patient did not
have that much time. The clock was ticking. But wait. Where was it that she
mentioned she was yesterday? It was a water park, correct? An acute onset parasitic
meningitis in a patient that was recently
exposed to a water source was sounding eerily
similar to another patient. Several years ago, there
was a nine year old boy who died from a meningitis
caused by Naegleria Fowleri. When the medical team found the organism, it was just too late. It spread too far and the
damage was already done. Not wanting to risk having our patient have a similar outcome, the medical team decided to act quickly. Even though there was no proof that Jane had a Naegleria
Fowleri infection, they decided to treat her for it anyway. Naegleria Fowleri is
a single-celled amoeba that inhabits Lakes, ponds,
and poorly chlorinated pools. It enters its victim’s body
by traveling through the nose, along the olfactory nerve,
into the cribriform plate, and then onto the brain. Once it’s there, it
feeds on the fatty tissue available to it, and multiplies rapidly. The mortality rate from a Naegleria Fowleri infection is 96%. Furthermore, as of the
making of this video, there is no formal cure. This is due to the fact
that Naegleria Fowleri is notoriously difficult to kill. It is excellent at avoiding
the body’s immune system, because when white blood
cells try to attack it, it simply forms a protective coat. When the white blood cells
attack that protective coat, it merely sheds it and keeps on moving, causing more damage and destruction. Faced with the reality
of this deadly organism, the medical team wanted to do everything they could
to save Jane’s life. Realizing that Naegleria
Fowleri is thermophilic, they decided to induce
Jane into a medical coma, and lower her body temperature. Although there is no experimental evidence that this therapy could
work, it had to be tried. So, Jane was given sedative
medications and intubated. Furthermore, a nasogastric
tube was inserted through her nose and into her stomach to provide her with nutrition. This therapy is theorized to work in cases of neurological edema, because it stabilizes
the blood-brain barrier. This stabilization prevents the entry of inflammatory molecules into the brain, thereby preventing the
worsening of Jane’s symptoms. However, there was more than just cooling that needed to be done. First, Jane was started
on IV corticosteroids, which blocked enough Kappa Beta, an up regulator of the
inflammatory cascade. Next, Jane was started on an experimental drug called miltefosine. At the time, miltefosine was not approved for the treatment of Naegleria Fowleri. It was a drug primarily used to treat an infection from an organism
called leishmaniasis. Furthermore, obtaining it
was extremely difficult. It wasn’t available in
commercial pharmacies, and had to be obtained from
the manufacturer itself. But fortunately, thanks to the persistence and hard work of Jane’s medical team, they were able to obtain
it and start it early. Now, the combination of
cooling, IV corticosteroids, and miltefosine was just the beginning. Because Jane was in a
medically-induced coma, she required a mechanical ventilator in order to breathe for her. Furthermore, Jane was transferred
to the intensive care unit so neurological exams could
be performed every 4 hours. This was done in order to make sure there was no deterioration
of Jane’s mental status. One week after all of this was done, PCR testing of Jane’s CSF was positive for Naegleria Fowleri. The medical team took a sigh of relief. They had made the right decision by starting the therapy
early and could continue it. On July 6th, approximately six weeks after Jane’s initial ER visit, the medical team made the
decision to reverse Jane’s coma. So, they turned off the ventilator, pulled the nasogastric tube,
and reversed the sedation. Upon awakening, Jane was found to have no focal neurological deficits. Essentially, she was cured and had no permanent brain damage. However, her muscles
atrophied significantly because she was bedridden for so long. But alas, Jane had survived. Jane required one year of physical therapy in order to return to
her baseline function. Furthermore, she had to
take a lot of extra classes and participate in tutoring in order to be reintegrated
into the school system. However, 1 and a half years later, Jane made a full recovery and
was back to her normal life. – I’m so grateful to be alive. I hope nobody goes through what I had to go through ever again. Thank you so much to the
medical team for saving my life. – To this day, it is unclear how she contracted Naegleria
Fowleri from the water park. The owners of the waterpark complied with all federal regulations,
including the chlorination. Jane is extremely fortunate to have survived this condition. Not everyone is so lucky. Because it is so rare and treatment is so difficult,
prevention is the best bet. Therefore, the CDC recommends to use nose clips
whenever you go swimming. Naegleria Fowleri travels
through the olfactory nerve, and can only be contracted with exposure of the nose in water. This can occur either by swimming or using an infected neti pot. Remember, you cannot get Naegleria Fowleri by drinking contaminated water. So please, be careful. Naegleria Fowleri is out
there, lurking in the water. It’s waiting for its next
victim, and don’t let it be you. (relaxed electronic music)


100 thoughts on “What If You Got A Brain-Eating Amoeba From A Pool?

  1. Thank you for doing this! Timing couldn’t have been more perfect. We we are covering diseases of the brain right now in microbiology. Please do more of these. This is what is making me want to become a physician.

  2. This was a really cool video! You should make more like this one. I especially liked the part where you talked about how to figure out which type of meningitis it is based on glucose and which white blood cells are most concentrated

  3. Hi doc, it was really an awsom presentation pls do more videos like this.. Medicos lik me can learn a lot.

  4. Demand of nose clips rose 10,000% after this video. In lieu of this video, Dr. Kailas and his video production team bought stock in all nose clip manufacturers.

  5. Love these vids! Im in 2nd year medical uni, it makes me feel like studying anatomy, microbiology, physiology actually makes sense. 😀

  6. This video was so intriguing. I learned so many new things. I have a question regarding the virus/bacteria. Does it live in the Ocean too? What specific bodies of water is it usually found/ live in?

  7. Wow dr Ajay…this vedio was too good. ..it's really interesting and informative for we medicos….pls do more vedios like this…. Thank u Dr Ajay..

  8. Hey bro 😁 excellent vid and really appreciate your work !
    what do you suggest to those who no longer study as medical students ? Thanks

  9. On my way to Texas to check out a 4 year. Leave the 13th! Wish me luck. Finals went very well. Thanks DOC for your videos. YOU helped me get thru my semester!

  10. How is unlikely? Chlorination may not kill all the amoebas. Naegleria is actually very common whats rare is infection. Notice hoe it affects children the most who have underdeveloped immune systems. Studies have shown that many people have protection against this amoeba. Millions swim in lakes all over the world and thousands of muslims wash their noses with water. Notice how is more common in the isa than third world countries. Could it be because kids from the first world are sheltered?

  11. That's awful I can't even belive what her parents were feeling,see this is why I have hypochondria cuz of stuff like this I don't want to make my parents cry or make them scared cuz of some freaking disease that shouldn't even exist😢😢😢

  12. You should be ashamed of this Video. Full of lies! Stop scaring People, what is The probability of this Happening?!?

  13. Hmmm… No mention about her bf that pretty much started this nightmare for her🤔 Oh well, bet she's just happy to be back to normal lol.

  14. Thank you for this incredible video Dr. Ajay. We should all thank God for brilliant and hardworking doctors like you!

  15. This sounds like the Kali Hardig case….if it is, she was swimming at Willow Springs Park in the Little Rock Arkansas, which was basically pond water……I swam there when I was a child. It's now permanently closed. This amoeba can kill no matter water fresh water is ingested through the nose, and I also feel the significance of where Kali was swimming is important.😔

  16. Thank you Ajay your medical mystery videos are really amazing! Its such a fun way too learn . Please keep making them and you are doing a great job 👍🏻

  17. They need to have impavido delivered by United States Strike-drones. The state had a case called in for stock pile delivery and the State police had to deliver this drug via patrol car doing 140mph+ for nearly 400+ miles.

  18. I’m surprised I only hear cases about this on like instances where people go swim in lakes I imagine cause it’s stagnant that causes the bacteria to form . But even chlorine doesn’t kill it ?

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