Louisiana Department of Health and Hospitals (DHH) is warning users of nasal irrigation devices to not use them with water straight from the tap. Their warning is in response to the state's second death this year caused by the single-cell protozoa Naegleria fowleri (N. fowleri), sometimes known as the brain-eating amoeba.
In DeSoto Parish, a 51-year-old woman died recently after becoming infected with the deadly amoeba following use of tap water in a neti pot, one type of nasal irrigation device. In June, a 20-year-old St. Bernard Parish man died in the same way.
N. fowleri infection occurs through the nose. Drinking of water poses no risk of infection.
"If you are irrigating, flushing or rinsing your sinuses (...) use distilled, sterile or previously boiled water to make up the irrigation solution," Louisiana State Epidemiologist Dr. Raoult Ratard said. "Tap water is safe for drinking, but not for irrigating your nose."
Nasal irrigation devices are commonly used to sooth nasal tissue inflammation and clean nasal passages and when used safely can benefit sufferers of allergic or chronic sinusitis, according to Age Less Medical Center founder Dr. Carol Twyman, MD.
"They are used widely," she said. "I think they are great. It's something really simple that can be done at home. They have broad applications."
Twyman said that some chronic bronchitis sufferers have found relief through use of nasal irrigation devices. She also said, ironically, that safe use of nasal irrigation devices could help prevent infection, particularly viral infections.
"It can avoid the use of antibiotics if they develop chronic sinusitis," Twyman said. "We are hearing more and more in the news about trying to avoid antibiotics. They can clean (their sinuses) out and avoid a round of antibiotics."
Nasal irrigation can also help sufferers of chronic halitosis, better known as bad breath, she said.
Twyman added that it is equally important to clean the device after each use. Refer to the device manufacturer's website or included care instructions for the given device's specific cleaning regimen.
N. fowleri infection is very rare and typically occurs when people come in contact with contaminated warm freshwater lakes and rivers. In extremely rare instances, infections may also occur from other sources such as tap water or inadequately chlorinated swimming pool water.
Heating of tap water to a minimum 116.6 degrees Fahrenheit before use should eliminate risk of infection. Once distilled water has been open for a period of time it is advised to boil it as well.
Naegleria fowleri causes Primary Amoebic Meningoencephalitis (PAM), a brain infection that results in the destruction of brain tissue.
Early symptoms of PAM are often similar to those of bacterial meningitis, and start one to seven days after infection. They include headache, fever, nausea, vomiting and stiff neck. Later symptoms include confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations.
Once symptoms begin, the disease progresses rapidly and death usually results within one to 12 days.
From 2001 to 2010, 32 infections were reported in the U.S. Of those cases, 30 people were infected by contaminated recreational water and two people were infected by water from a geothermal drinking water supply.