Health officials are warning people about the potential dangers of using tap water for sinus irrigation after two neti pot users in Louisiana died from infection with Naegleria fowleri, a “brain-eating” amoeba.
“If you are irrigating, flushing or rinsing your sinuses, for example, by using a neti pot, use distilled, sterile or previously boiled water to make up the irrigation solution,” Louisiana state epidemiologist Raoult Ratard, MD, MPH, said in a press release. “Tap water is safe for drinking, but not for irrigating your nose.”
N. fowleri enters the body through the nose and causes primary amebic meningoencephalitis (PAM). The infection is rare in the U.S., with 32 cases reported from 2001 to 2010, the most recent resulting in the death of a 51-year-old DeSoto Parish woman after she used tap water in a neti pot to irrigate her sinuses.
In June, a 20-year-old St. Bernard Parish man died from N. fowleri contracted in the same way, and in August two more patients died of N. fowleri infection after swimming in warm, fresh water.
Initial PAM symptoms are similar to those observed in bacterial meningitis and typically occur one to seven days after infection. They include headache, fever, nausea, and vomiting and stiff neck.
Later symptoms consist of confusion, lack of attention to people and surroundings, loss of balance, seizures and hallucinations. After symptoms start, N. fowleri infection progress rapidly, and most patients die within one to 12 days.
N. fowleri usually infects people who go swimming and submerge their heads in freshwater lakes and rivers, though it can be transmitted through inadequately chlorinated pool water or underheated (less than 116°F) tap water that enters the nose.
Among the 32 cases reported to the CDC during the past decade, 30 people became infected by contaminated recreational water, with just two cases contracted from the geothermal drinking water supply.
The Louisiana Department of Health and Hospitals and the CDC urge patients to rinse neti pots after each use and to dry them thoroughly in open air.