Does Terror Lurk in Your Neti Pot?

Brain Disease

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Almost certainly not. But let’s start by taking a close look at the truly hair-raising news reported recently by the Food and Drug Administration. They described two cases in Louisiana of a rare disease called primary amebic meningoencephalitis (PAM) that was contracted by patients who used tap water in their neti pots. PAM is a fatal brain infection caused by Naegleria fowleri, an amoeba found in freshwater lakes, rivers, and hot springs that, despite the milllions of Americans who swim every year in recreational fresh water, very rarely causes disease (only 32 infections were reported in the US between 2002 to 2011).

When Naegleria does cause disease, it does so by entering the body through the nasal passages and traveling to the brain, where it wreaks havoc, destroying brain tissue. Symptoms of PAM begin one to seven days after infection, initially resembling the flu or an acute gastroenteritis, but progressing rapidly to cause meningismus (a stiff neck), confusion, delerium, imbalance, and seizures. Death usually occurs within five days. Drug therapy has not proven effective, and infection is almost uniformly fatal. Naegleria infection cannot be passed from person to person.

Who would have suspected that an innocent-looking little teapot, filled with water and used to clean out one’s nasal passages, could be so dangerous? In the two cases in Louisiana, the tap water was contaminated with Naegleria, and the neti pot essentially poured the organism right into the region where it is most dangerous (it’s worth noting that drinking water that has been contaminated with Naegleria is not dangerous, because the ameba is destroyed by acid in the stomach).

Millions of people use neti pots to treat allergies, nasal and sinus congestion, and upper respiratory infections such as the common cold. Proper technique, as outlined by the FDA, includes leaning over a sink with your head tilted sideways, then inserting the spout into the upper nostril so the liquid can drain out of the lower nostril. You can then repeat on the other side. To ensure that you’re not exposing yourself to any dangerous infections, however rare, such as Naegleria, here are the precautions you should take when using a neti pot:

  •     Use either filtered or distilled water (you can usually buy this in your local pharmacy) or
  •     Use tap water that you have boiled for at least one minute (longer if you are at a higher elevation)
  •     When you’re done, rinse the net pot with the boiled, filtered or distilled water, and then air dry

Used in this way, a neti pot is a safe and effective way to clear out your nasal passages. Similar precautions should be used with any nasal irrigation device, such as a squeeze bottle or bulb syringe.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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