It was a brain surgery like no other for Dr. Charles Cobbs.
"It's something I've never seen before … pathologists could not determine what it was because the tissue was virtually destroyed," said Cobbs, a neurosurgeon at the Swedish Medical Center in Seattle.
Cobbs was operating on the patient last January for what he thought was a brain tumor. When he opened it, the damage was so severe that he sent a party to the test.
It turns out that a rare amoeba had eaten her alive.
Cobbs believes it was the patient's use of a lota, a teapot-shaped product used to alleviate the nasal cavity that placed the amoeba in his brain. He says she used tap water, as opposed to boiled or saline water suggested.
The patient had a rare brain infection called Balamuthia mandrillaris. It is a free-living amoeba found in soil and fresh water and generally does not cause harm to humans.
Dr. Cobbs wrote about the case of a recent issue of the International Journal of Infectious Diseases.
The publication does not identify the patient.
The report says the rare amoeba was discovered in 1986 in an autopsy of the brain of a mandrel monkey at the San Diego Zoo and was declared a new species in 1993.
He also says there were only about 200 cases of human infection recorded worldwide, and at least 70 in the US. The mortality rate from Balamuthia infection is almost 100%.
"If you injected it directly into the nasal passages, if there were enough, you could set up an infection," Cobbs explained.
"I suspect it was in their nasal passages and skin on the nose, and, after a while, enough was around that entered the bloodstream and probably went to the brain."
According to the newspaper, the infection first appeared as a skin lesion on the woman's nose. Doctors treated for about a year, as if it were the common skin condition, rosacea.
Cobbs says that the rarity of the amoeba made diagnosis difficult. Eventually, the patient had a stroke, then the doctors did a CT scan. At that point, they diagnosed her with a brain tumor.
It was not until she underwent surgery that they diagnosed the infection. Despite removing amoeba-damaged parts, the patient died within a month of diagnosis.
Notice of nasal rinse
Cobbs encourages those who use a nasal lavage to flush containers properly.
"I suspect it was probably a container that was sitting around … an amoeba could set up a store there and then the tap water might have stayed around and maybe grown up on it," he said.
He says neti pots are a good way for those with sinus problems or the flu to get relief if used properly.