Photo Credit FDA
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Regular readers of this blog are no doubt aware that we saw two fatal cases of PAM (Primary Amoebic Meningoencephalitis) in Louisiana attributed to sinus irrigation using tap water (see Neti Pots & Naegleria Fowleri) last fall.
While rare, most Naegleria fowleri parasite infections occur in young children or teens exposed while swimming along the bottom of warm, often stagnant fresh water lakes or streams.
According to the CDC’s FAQ on Naegleria, we average 2 to 4 infections each year in the United States with this parasite. .
But a few years ago nasal irrigation with N. fowleri contaminated tap water in Karachi, Pakistan was suspected to have caused 13 cases over 18 months. Earlier this summer (see this FluTrackers Thread) a number of new cases were reported in Pakistan, once again with suspicions cast towards contaminated tap water.
In the wake of the first two cases of N. fowleri in the United States associated with use of neti pots, the FDA has released some safety guidelines to reduce (and hopefully) eliminate the risks.
Is Rinsing Your Sinuses Safe?
Little teapots with long spouts have become a fixture in many homes for reasons that have nothing to do with tea.
Called neti pots, they are used to rinse the nasal passages with a saline (salt-based) solution, and have become popular as a treatment for congested sinuses, colds and allergies, and for moistening nasal passages exposed to dry indoor air.
However, the Food and Drug Administration (FDA) has concerns about the risk of infection tied to the improper use of neti pots and other nasal rinsing devices. The agency is informing consumers, manufacturers and health care professionals about safe practices for using all nasal rinsing devices, which include bulb syringes, squeeze bottles, and battery-operated pulsed water devices.
These devices are generally safe and useful products, says Steven Osborne, M.D., a medical officer in FDA’s Center for Devices and Radiological Health (CDRH). But they must be used and cleaned properly.
Most important is the source of water that is used with nasal rinsing devices. Tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse.
Some tap water contains low levels of organisms, such as bacteria and protozoa, including amoebas, which may be safe to swallow because stomach acid kills them. But these “bugs” can stay alive in nasal passages and cause potentially serious infections, according to the Centers for Disease Control and Prevention (CDC).
Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.
<SNIP>
What types of water are safe to use in nasal rinsing devices?
- Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
- Boiled and cooled tap water—boiled for 3-5 minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.
- Water passed through a filter with an absolute pore size of 1 micron or smaller, which traps potentially infectious organisms. CDC has information on selecting these filters, which you can buy from some hardware and discount stores, or online.
How do I use and care for my device?
- Wash and dry hands.
- Check that the device is clean and completely dry.
- Use the appropriate water as recommended above to prepare the saline rinse, either with the prepared mixture supplied with the device, or one you make yourself.
- Follow the manufacturer’s directions for use.
- Wash the device with distilled, sterile, or boiled and cooled tap water, and then dry the inside with a paper towel or let it air dry between uses.
For more on this rare, but generally fatal parasitic infection, you may wish to visit the CDC’s webpage:
Naegleria fowleri - Primary Amebic Meningoencephalitis (PAM)
Photo Credit CDC
Naegleria fowleri (commonly referred to as the "brain-eating ameba or amoeba"), is a free-living microscopic ameba*, (single-celled living organism). It can cause a very rare, but severe, infection of the brain called primary amebic meningoencephalitis (PAM). The ameba is commonly found in warm freshwater (e.g. lakes, rivers, and hot springs) and soil. Naegleria fowleri usually infects people when contaminated water enters the body through the nose. Once the ameba enters the nose, it travels to the brain where it causes PAM, which is usually fatal. Infection typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. In very rare instances, Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated and contaminated tapwater) enters the nose.
And for previous blogs on this fascinating parasite, you may wish to revisit:
The Return Of Naegleria fowleri
Neti Pots & Naegleria Fowleri
Sometimes It’s Zebras
