Becker's Hospital Review

46 CMO / CARE DELIVERY Seattle woman dies of brain-eating amoeba after using tap water in neti pot By Mackenzie Bean C linicians at Seattle-based Swed- ish Medical Center witnessed the nation's first fatal case of a Bal- amuthia mandrillaris brain infection linked to improper nasal irrigation with tap water, according to a case study pub- lished in the International Journal of Infectious Diseases. In January 2018, a 69-year-old woman presented at the hospital's emergency de- partment aer experiencing a seizure. She also had a red rash on her nose that had been incorrectly diagnosed as rosacea. A CT scan revealed what physicians initially thought was a tumor in the woman's brain. "When I operated on this lady, a section of her brain about the size of a golf ball was bloody mush," Charles Cobbs, MD, a neurosurgeon at Swedish, told e Seattle Times. "ere were these amoeba all over the place just eating brain cells. We didn't have any clue what was going on, but when we got the actual tissue we could see it was the amoeba." Physicians suspect a rare, brain-eating amoeba entered the woman's brain aer she used tap water in a neti pot to irrigate her sinuses, instead of filtered water. "Despite aggressive and novel anti- amoebic treatment, she died as a result of a Balamuthia mandrillaris brain infection," physicians wrote in the case study. e infection marks the second ever re- ported in Seattle and the first fatal case linked to nasal irrigation. Between 1974 and 2016, there have been 109 report- ed cases of the amoeba in the U.S., 90 percent of which were fatal, according to a separate study published in Clinical Infectious Diseases. n Stressed surgeons make up to 66% more mistakes, study finds By Mackenzie Bean S urgeons who are stressed out in the operating room may make up to 66 percent more errors, according to a study published in the British Journal of Surgery. For the study, researchers analyzed continuous electrocardiogram data from an attending surgeon at Stanford (Calif.) Medical Center. The surgeon wore a Hexoskin Smart Shirt under his scrubs during surgery, which measures electri- cal impulses that stimulate heart beats. Researchers used this data to assess the variation in time between heartbeats to determine the surgeon's stress levels. They also collected laparoscopic video recordings in the operating room to identify surgical mistakes. The surgeon made up to 66 percent more surgical errors during periods of high stress compared to lower stress intervals. "I was surprised by that, as well as by the amount of distractions in the operat- ing room," lead study author Peter Dupont Grantcharov, a master's student at the Data Science Institute at New York City-based Columbia University, said in a press release. "My hope is that other researchers will build upon our work to make further strides in learning about the causes of stress on surgical person- nel. If our study helps make the OR a safer place for patients, I'd be thrilled." n Why this family heirloom could reveal how 1918 flu pandemic spread By Mackenzie Bean H uman tissue slides passed down to descendants of a British military physician and shared with researchers could help unearth new informa- tion about the 1918 Spanish flu, reported STAT. The hunt for the samples started after Michael Worobey, PhD, a professor of ecology and evolutionary biology at Tucson-based University of Arizona, dis- covered a report written by World War I British military physician and patholo- gist William Rolland in 1917 — a year before the Spanish flu outbreak occurred. The report detailed a fatal respiratory illness that was infecting soldiers. Dr. Worobey used the internet to hunt down William Rolland's descendants and see if any tissue samples existed from the physician's century-old research. This search led him to Dr. Jim Cox, a retired family medicine physician in England who is married to William Rolland's granddaughter. Dr. Cox had an entire col- lection of human tissue slides he was willing to lend Dr. Worobey. "I almost fell out of my chair, for real," Dr. Worobey told STAT. "I actually did cry real tears." Dr. Worobey has a theory the pandemic flu was infecting people before the 1918 outbreak. In a quest for answers about the pandemic's origin and how it spread, Dr. Worobey and his team will take partial specimens from the tissue slides for analysis. "It would be really interesting to me if this horrible virus was really circulating under the radar for so long before the fall of 1918 when it really had its peak effects," he told STAT. "It would tell us that there's a whole lot we have to learn about the forces that keep pandemic viruses simmering at a low level before they explode." n

• Cover