Bruce Lee

Bruce lee was my hero. As a child I saw his movies and copied him all the time. He has positively influenced many people, including me. Despite the fact that I was born 13 years after his death. His death is considered to be a mystery. No one really knows how he died. Pathologists didn’t issue a definitive report on his death but suggested that his death was ‘due to misadventure.’ 

Bruce Lee died on July 20 1973. He was in Hong Kong, to discuss the script of the film, Game of Death. Lee was at the home of his colleague Betty Ting Pei, a Taiwanese actress, when he complained of a headache. Ting Pei gave him an analgesic, Equagesic, which contained both aspirin and the muscle relaxant meprobamate. Still not feeling better he went to lie down. After that Lee never woke up, his friends came up and called a doctor who tried to revive him. Failing to be revived, Lee was taken to the hospital, but died on the way or by the time he reached there. Lee was 32 years old. A Scotland yard recommended Pathologist suggested that, Lee’s death was caused by an acute cerebral edema due to a reaction to compounds present in the prescription pain killing drug Equagesic. He also concluded it to be "death by misadventure". 

But few days before his death, Lee collapsed while filming, Enter the Dragon. Suffering from seizures and headaches, he was immediately rushed to hospital, where doctors diagnosed cerebral edema. They were able to reduce the swelling through the administration of mannitol. These same symptoms that occurred in his first collapse were later repeated on the day of his death. 

Later Bruce Lee’s Physician and another Neurosurgeon, who saved his life after his first seizure, suggested that Equagesic was not at all involved in Bruce's first collapse and he might have died of different cause. 

There has been many theories regarding Bruce Lee’s death. Many suggest that he was killed by Chinese mafia, The Triads. I have another theory. Is it possible that Bruce lee died of a rare infection, Naegleria fowleri? Lets look at it.

Naegleria Fowleri, also called brain-eating Amoeba, is a parasite that lives in swamps and lakes. It was first described to cause human disease in Australia in 1965. In the years that follow, only about 144 cases have been confirmed in a variety of countries. 

Naegleria Fowleri in Brain

N. fowleri can invade the central nervous system via the nose, more specifically the olfactory mucosa and cribriform plate of the nasal tissues. The penetration initially results in significant necrosis of and hemorrhaging in the olfactory bulbs. From there, amoebae climb along nerve fibers through the floor of the cranium via the cribriform plate and into the brain. The amoebae begin to consume the cells of the brain piecemeal by means of a unique sucker apparatus extended from their cell surface. It then becomes pathogenic, causing primary amoebic meningoencephalitis (PAM or PAME). PAM is a syndrome affecting the central nervous system, characterized by changes in olfactory perception (taste and smell), followed by vomiting, nausea, fever, headache, and the rapid onset of coma and death in two weeks.

Now taking a new look at Bruce Lee’s death we see that he died in Hong kong, Naegleria fowleri is know to be more actively found in warm and temperate regions. It should also be noted that Lee died in July where rainfall is greater and the climate is warmer. It was 20th May when Lee felt first onset of symptoms. May is the most humid month of the year in Hong Kong. There is evidence that N. Fowleri infection increases during rainy seasons. In Pakistan two cases were reported during Floods this year, when a 39 year old man died of N. Fowleri and another medical doctor died due to same cause, who happened to be my friend. 

Before death Lee reported of headache which is a symptom of N . Fowleri infection. 

He also had brain edema that can be associated with meningioencephalitis. 

It is also noted that Lee went into comma before being pronounced dead. 

There was a difference of first symptoms of edema and Lee’s death. The same symptoms repeated the day of his death. In N. Fowleri infections, the similar happens, but the period of latency between death and of onset of first symptom is about two weeks. However, in Lee’s case it was about two months. This also strongly suggests that Lee’s cause of death was not eugesic or cannabis hypersensitivity. 

Although, I have not read Lee’s actual Pathology report. But the reason of misdiagnosing Lee’s death could be the fact that, Naegleria Fowleri manifests itself as higher protein conetnt in CSF and increased neutrophils count, just like bacterial infections! But unlike most bacterial infections it cannot be stained gram positive or negative or any other common stain, like Acid Fast stain etc. But this may be diagnosed by directly observing the histological slides under microscope. N. Fowleri is not necessarily seen in the slides. Failing to ‘see’ any signs of bacterial encephalitis, pathologists considered the second best options, in the given circumstances, that is neutrophilia in the absence of infection and that occurs in hypersensitivity. 

In the end I would like to remember my teacher and friend, Dr. Noman Anwer, Whom I lost last summer to N. Fowleri infection. He was a remarkable teacher and Human being. He is remembered by many. His memories will always stay with me and guide me in making decisions with integrity and wisdom, in the field of medicine and life itself.