Two recent Louisiana deaths from the ‘brain-eating amoeba’ Naegleria fowleri have been attributed to the usage of tap water for nasal irrigation employing neti pots. These follow on the 2010 death of a Pakistani who practiced wudu, a form of deep nasal irrigation, using tap water.
The yoga nasal irrigation technique, called Jala Neti in Sanskrit, is a Shatkarma (purification practice) used to cleanse the nasal passages of mucus and particulates. Modern users typically employ a teapot-looking device to pour salt water solution into one nostril and allow it to run out the other while the mouth is kept open to breathe. This practice has been shown effective for ease of symptoms related to hay fever, sinusitis, and other nasal conditions.
Infections from Naegleria fowleri are rare, and almost always fatal. Infection typically occurs while swimming or bathing in warm freshwater lakes or rivers, particularly when the water is low and in muddy areas. Infections have also been reported from bathing in inadequately chlorinated swimming pools and nasal irrigation with inadequately treated drinking water.
The amoeba enters through the nostrils and then bores through the skull, where it emits two enzymes to dissolve protein-rich brain tissue for consumption. Initial stages may appear similar to bacterial meningitis which includes headache, fever, nausea, vomiting, and stiff neck. Later symptoms progress to confusion, loss of balance, seizures, and hallucinations. Initial onset of symptoms occurs 1-7 days following infection, after which death usually occurs within 1-12 days.
Louisiana officials stipulate the amoeba poses no danger in drinking water, and only becomes fatal when allowed to enter through the nasal passages. While true, other sources claim the amoeba cannot survive in properly treated municipal water, suggesting the Louisiana sources of drinking water responsible for these deaths may have been inadequately treated.
Naegleria fowleri cannot survive in salt water, which has led some to speculate that the usage of tap water for neti is safe if adequate salt is added. This is based on the assumption that salt will hypothetically “kill” the amoeba. Given that failure to use salt in one’s neti pot results in burning and stinging, it is unlikely the deceased didn’t use it. However, no sources comment on whether salt was used.
Health authorities now recommend that boiled, distilled, or purified water always be used for nasal irrigation, echoing longstanding recommendations by neti pot manufacturers.
If a brain-eating amoeba isn’t inspiration enough to use distilled water in your neti pot, the varying standards of US tap-water purity should be equally motivating. Using neti with unpurified water may introduce harmful chemicals or elements into the nasal cavities, and potentially exacerbate the allergens or mucousa the practice is believed to attenuate.
Are you a neti pot user? Have you used tap water in your neti pot before?
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