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Oslo woman dies of rare amoeba infection contracted on Thailand trip


Courtesy of Markell and Voge's Medical Parasitology

BANGKOK: -- The Norwegian Institute of Public Health has been informed that a woman from Oslo died in December 2014 after returning from Thailand where she had been infected with the Naegleria fowleri amoeba.

“The source of infection appears to be daily nasal washing with tap water. If you are unsure about the water quality, always use sterile or boiled water for nasal washing, particularly in subtropical and tropical areas”, the institute said.

Thailand’s Bureau of General Communicable Diseases said between 1982 and 2013, there were 13 reported cases of primary amoebic menigoencephalitis (PAM) caused by Naegleria fowleri amoeba in Thailand. Only 8 were tested positive for Naegleria fowleri amoeba infection.

Swimming in warm, freshwater (lakes or rivers) in tropical and subtropical areas, where Naegleria fowleri amoeba exists, also poses a risk, according to a health warning issued by Thai health authorites in 2013.

Travel advice

Always use sterile or boiled water for nasal washing abroad if you are uncertain of the tap water quality, particularly when travelling to subtropical and tropical countries. Only use bottled water if you are sure it is distilled or sterile, unless the bottled water has been boiled.

About Naegleria fowleri

Naegleria fowleri is a free-living amoeba that can attack the brain via the nasal mucosa and the olfactory nerve. It is also known as the “the brain-eating amoeba.” The amoeba lives in freshwater and can reach the brain when contaminated water enters the nose.

The amoeba is usually transmitted when water enters the nose while swimming in lakes, rivers and unchlorinated swimming pools, but nasal washing with contaminated water is also a known risk factor.

Nasal washing is popular in yoga environments and is part of religious washing practices in many countries.

Symptoms appear within 1-7 days. The disease particularly affects young, healthy people causing severe meningoencephalitis, and it has a very high mortality. The disease is not transmitted by drinking contaminated water or spread by human to human contact. Boiling or chlorination of water kills the amoeba.

Naegleria infection is extremely rare, with just over 300 cases documented worldwide.

The amoeba thrives at high temperatures, especially between 25°C and 40°C and can survive for shorter periods at even higher temperatures.

International alert

The Thai health authorities have been made aware of the case and the assumed mode of transmission.

Sources: Norwegian Institute of Public Health and Thailand’s Bureau of General Communicable Diseases

Source: http://scandasia.com/oslo-woman-dies-of-rare-amoeba-infection-contracted-on-thailand-trip/

-- ScandAsia 2015-02-19

[Thian]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

[Dumu Ali]

I see many people swim in canal and very healthy so I dont think you need to worry and they say it is rarer than most diseases so there is no need to panic and no need to get worried over this rare case of brainbola I ever swallowed a mouthful of it when another boat made a big wave slapping my boat on the sinsep canal my whole face was wet, I used my t-shirt as a towel to remove the excess and it seemed that many people got splashed and I am still alive. I would never swim in canal I recommend Kanchanaburi river and waterfalls for cleanwater safe swimming and the best is in the beautiful National Parks where the water is crystal clear and like paradise.

[hanno]

I once made the mistake of looking up water-borne diseases in South East Asia. Not a good idea (I bike, run and Hash so end up in water quite often) and I chose to not take it to heart. 20 years later and I am still alive and kickin'.

[Briggsy]

I would like to know where this woman spent her vacation and where she swam.

[jacky54]

Never been in the sea here (full of excrement) and never in a swimming pool. On my first visit in 1994 a bloke was going home in a wheelchair, caught a similar virus in a swimming pool and completely screwed him up, no thanks.

[FangFerang]

I'm with Thian. In Pattaya during Songkran, the farang buy PVC pipe squirt guns that shoot more than a liter of water, and one nasty Brit bugger in a wet suit shot it up my nose as I was leaving my hotel during the first morning of my vacation. I was subsequently in bed for two days fighting a resistant nasal infection with multiple antibiotics.

When I was better, I dumped eleven bottles of Chang in the hotel room garbage can, the four liter size, let it stew in the tropical sun for a day and night, and dumped it on his head from the rooftop, giving him the one finger salute when he looked up smelling like the shit he was already made of.

Foreigners take a playful holiday and try to make it a blood sport. IDIOTS.

Edited February 19, 2015 by FangFerang

[kieran2698]

I would like to know where this woman spent her vacation and where she swam.

8 cases in over 30 years in Thailand, there is really no need to create any hysteria which would cause a resort or town to lose business, better they do not give locations.

[Jeremy50]

I'm with Thian. In Pattaya during Songkran, the farang buy PVC pipe squirt guns that shoot more than a liter of water, and one nasty Brit bugger in a wet suit shot it up my nose as I was leaving my hotel during the first morning of my vacation. I was subsequently in bed for two days fighting a resistant nasal infection with multiple antibiotics.

When I was better, I dumped eleven bottles of Chang in the hotel room garbage can, the four liter size, let it stew in the tropical sun for a day and night, and dumped it on his head from the rooftop, giving him the one finger salute when he looked up smelling like the shit he was already made of.

Foreigners take a playful holiday and try to make it a blood sport. IDIOTS.

Oh god.............is it nearly that time of year again? Time to stock the house with food and books.

[hanno]

Never been in the sea here (full of excrement) and never in a swimming pool. On my first visit in 1994 a bloke was going home in a wheelchair, caught a similar virus in a swimming pool and completely screwed him up, no thanks.

I guess you don't venture on the streets either, seeing how many people get killed in traffic? Or fly?

Seriously, there most be millions of people swimming in pools and the sea in SE Asia at any given moment. I have no statistics but I am sure the vat majority survive their encounters with the water.

[uptheos]

About 18 months ago I developed a really painful ear infection.

Cut a long story short, lab swab showed a rare bacteria achromobacter xyslosoxidans and nothing would move it.

Eventually Dr. Chalerpong at Ram put me on double dose Amoxiclav and double dose Ciprofloxasin.

I was on this for a long time and had some nasty skin side effects which subsided once treatment was stopped for a few weeks.

If this didn't work my only choice left according to the S lab result was IV antibiotics, very expensive!

Thankfully the lab result I was dreading came back negative.

The point is, this rare bacteria is water borne. I don't swim, so can only assume it came through the shower water at home or the gym.

I now use ear plugs when showering and clean my ears with sterile water only.

These bugs can hit you when and where you least expect them to, so it's up to everyone to take what precautions they want.

[TomJoad]

I would like to know where this woman spent her vacation and where she swam.

8 cases in over 30 years in Thailand, there is really no need to create any hysteria which would cause a resort or town to lose business, better they do not give locations.

It appears she got it from plain tap water. She was using it to wash out her sinuses.

Usually a little tap water is okay for brushing teeth, since any microbe accidentally swallowed is probably going to get killed by stomach acidity before it gets a chance to get into the blood. But with sinuses (or even eyes), microbes can have a direct route into the brain via the cranial nerves.

[uptheos]

I would like to know where this woman spent her vacation and where she swam.

8 cases in over 30 years in Thailand, there is really no need to create any hysteria which would cause a resort or town to lose business, better they do not give locations.

It appears she got it from plain tap water. She was using it to wash out her sinuses.

Usually a little tap water is okay for brushing teeth, since any microbe accidentally swallowed is probably going to get killed by stomach acidity before it gets a chance to get into the blood. But with sinuses (or even eyes), microbes can have a direct route into the brain via the cranial nerves.

Use sterile water for ears and eyes, once a rare bug gets in it's bloody bad news!

[TallGuyJohninBKK]

It appears she got it from plain tap water. She was using it to wash out her sinuses.

Usually a little tap water is okay for brushing teeth, since any microbe accidentally swallowed is probably going to get killed by stomach acidity before it gets a chance to get into the blood. But with sinuses (or even eyes), microbes can have a direct route into the brain via the cranial nerves.

That's really the key point here. The mucosa (tissue lining) in your sinusus is porous and can absorb things it comes in contact with.

But that's fairly different from your exterior skin, which isn't likely to absorb some bacteria or amoeba in tap water just because you get some splashed on you.

This problem really is an issue for people who do sinus rinsing...and not so much for most other normal activities.

[orange31]

I would like to know where this woman spent her vacation and where she swam.

Exactly, spot on!

I'm sure I read somewhere that the baths in Bath in England were closed long ago because a women got this. It's like 100% fatal. They should at least mention the whereabouts of where she was staying in Thailand. if it came from tap water then you would expect a few more cases would have occurred.

[MiKT]

I'm with Thian. In Pattaya during Songkran, the farang buy PVC pipe squirt guns that shoot more than a liter of water, and one nasty Brit bugger in a wet suit shot it up my nose as I was leaving my hotel during the first morning of my vacation. I was subsequently in bed for two days fighting a resistant nasal infection with multiple antibiotics.

When I was better, I dumped eleven bottles of Chang in the hotel room garbage can, the four liter size, let it stew in the tropical sun for a day and night, and dumped it on his head from the rooftop, giving him the one finger salute when he looked up smelling like the shit he was already made of.

Foreigners take a playful holiday and try to make it a blood sport. IDIOTS.

Good idea, shame that's about the best thing you can do with Chang!

[Jonmarleesco]

'The amoeba thrives at high temperatures ... and can survive for shorter periods at even higher temperatures.. Then one would have thought freezing water would prove more effective than boiling.

[Squeegee]

When I catch a cold in Thailand I regularly wash out my nose with the tap water. It's cleaner, doesn't lead to a red patch from all the blowing with tissue, is environmentally more friendly etc.

Then I saw this OP. Yikes.

Good job I read the replies to keep life in perspective. I think my motorbike taxi commute each day is far more likely to kill or hospitalize me.

Seems no matter what we do it could be harmful to us. Nasal rinsing in moderation, then.

[PattayaKlang]

I would like to know where this woman spent her vacation and where she swam.

Exactly, spot on!

I'm sure I read somewhere that the baths in Bath in England were closed long ago because a women got this. It's like 100% fatal. They should at least mention the whereabouts of where she was staying in Thailand. if it came from tap water then you would expect a few more cases would have occurred.

This is the report from the finding of this bacteria in Bath and elsewhere.

http://aem.asm.org/content/61/6/2071.full.pdf

They also found it in Australian tap water in more than one location.

[sangenuer]

This isn't just a developing country kind of thing. In the US, a few people get it every year. It's got a 97% mortality rate. :-o In Florida, where I used to live, the schools would send home warnings every spring when the water temps start rising, telling parents not to let kids swim in fresh water or to make them use nose clips. People have also gotten it there by using tap water in neti pots.

[AnotherOneAmerican]

Nasal washing!

Is this something normal people do?

And if so why?

Just wondering because I've never heard of it before.

[JDGRUEN]

This disease is fairly well known in American - in the warmer south. Swimming in ponds and river/creek pools ... It is somewhere between not very common and rare...

I suspect the amoebae exist around the world in warmer climates or in warm summer climates ...

[JDGRUEN]

Nasal washing!

Is this something normal people do?

And if so why?

Just wondering because I've never heard of it before.

Very common - look up neti pot ....

And without neti pot just called nasal irrigation. Very helpful to many if done with mild saline water.

Saline nasal irrigation is a good preventative for colds and flu

[elgordo38]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

I guess I will have to swim in bottled water from now on and bath with it as well.

[DaddyWarbucks]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

I guess I will have to swim in bottled water from now on and bath with it as well.

Taking a shower is dangerous now?

Does soap kill it?

[uptheos]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

I guess I will have to swim in bottled water from now on and bath with it as well.

Taking a shower is dangerous now?

Does soap kill it?

I would not say that taking a shower is dangerous, but in my earlier post the infection I contracted could only have come from shower water. Now I still take showers of course but wear ear plugs and keep my eyes shut tight. Haven't resorted to wearing goggles yet.

[SantiSuk]

I once made the mistake of looking up water-borne diseases in South East Asia. Not a good idea (I bike, run and Hash so end up in water quite often) and I chose to not take it to heart. 20 years later and I am still alive and kickin'.

Hashers are immune from infections while on a run. The beer will protect

OnOn!

[TallGuyJohninBKK]

'The amoeba thrives at high temperatures ... and can survive for shorter periods at even higher temperatures.. Then one would have thought freezing water would prove more effective than boiling.

Water boils at about 100 degrees C. That's enough to kill any organisms in the water, including the one being discussed here. It's also a temperature much higher than the ranges mentioned in the part above that you partially quoted.

Boiled and then cooled water is safe for nasal rinsing and other purposes. Just don't use water straight out of the tap for nasal rinsing.

[Thai at Heart]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

You reckon its safe?

[rametindallas]

I have never swum in thai rivers/lakes. But have been sprayed by fountains (or sprinklers with lakewater) many times. Also during songkran the Thai spray with water out of the klongs.

Is that dangerous as well?

This amoeba was introduced into her body when she put water up her nose to wash inside it. This is, as the article states, is rare but happens in the US also.

Deadly Amoeba Found For First Time In Municipal Water Supply

http://www.npr.org/blogs/health/2013/09/15/222197599/deadly-amoeba-found-for-first-time-in-municipal-water-supply