Infectious Disease

Primary Amoebic Meningoencephalitis

Growing up there was something thrilling and romantic about a swimming hole in the summertime. Creeks, rivers or ponds full of cool water to slip into. I remember when I was little my mom telling me stories of terror around summer swimming holes when polio would come to town. But by the time we were children, much of the world was fully armed with immunity to that and we felt the only possible threat could be of drowning and since we were all avid swimmers we were certain we had absolutely nothing to fear. We were wrong. There are apparently other dangers that lurk deep down unseen in the sandy sediment of these freshwater pools. Dangers that can be deadly. So deadly in fact that if one encounters them they are nearly 99% sure to be dead. Of course we knew nothing about this when we were children and never gave them a thought.

I have always felt that the things you cannot see that can harm you are far scarier than the things you can see. We knew of course to be fearful of sharks and alligators and copperhead snakes. We had all seen JAWS a dozen times. But we also knew that we could see those things and we could identify whether they were out there or not. But the things that are invisible to the naked eye – the things that you cannot see right in front of you- those are the things I am far more fearful of. This is the story of one such thing. A deadly secret swimmer that is floating right next to you in a pond- waiting. You have probably heard about this though may not know it by it’s real name- naegleria fowleri. In the news recently there have been several stories with tantalizing headlines about “brain eating amoebas.” Admittedly these are extremely rare events but make no mistake they are very real and their incidence likely underestimated.

So what is this brain eating amoeba? It’s scientific name is naegleria fowleri and it is not actually a true amoeba but close enough. It’s a thermophilic creature that lives in warm freshwater. It spends most of his life innocently engulfing bacteria down at the silty sandy bottom. But occasionally a human jumps into a warm swimming hole and if that human happens to stir up Naegleria from the bottoms and inhale a gush of water into her nose these amoeba can climb up through tiny holes in the skull above the nose called the cribriform plate and slide along the olfactory bulbs that lead to the brain where the amoeba then begins to feed on human neurons. Occasionally we see humans encounter this little creature in swimming pools that are not properly maintained or during sinus washes. This is when the trouble begins. For a day or so the human is none the wiser. Then he or she was beginning to not feel well. Very rapidly they will develop the typical symptoms that we associate with meningitis which is an inflammation of the lining of the brain. The individual will often appear quite ill having fevers, severe headache, neck stiffness, and lethargy. Quite rapidly the individual who we can now refer to as a patient will be sick enough to be brought to an emergency department. Typically the findings of meningitis are appreciated in an emergency room but given that primary amoebic meeting on cephalitis is incredibly rare most physicians don’t think to test for it. So they order the typical meningitis testing on the spinal fluid that drawn out from a lumbar puncture. This looks for viruses and bacteria but not for amoebas. There is a test of course for the amoebas you just have to have a high index of suspicion to order it early on. This is not usually not done. A history of fresh water swimming is generally never taken. Without this testing and treatment- he natural progression of nearly 99% of these patients will be fulminant illness with rapid progression to coma and death.



The Speckled Monster

Blossom. That is the name if the cow whose hide has been preserved in a home in England for over 150 years. No ordinary cow. A cow that changed the world as we know it. Because it was largely she who rescued us from the most deadly microbe ever known to man – smallpox. Nothing about small pox was diminutive except for its physical size. This deadly variola virus was given its name to differentiate it from its larger cousin “large pox” better known as syphilis.

The Black Death

Trauma

Homicide

Poisonings and Envenomation

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