The following post is based on a Telephone Interview from 12/22/2011, on the topic of Amoebic Meningoencephalitis, with Robert W. Tolan, Jr., M. D., FAAP, FIDSA.
You can read more about Dr. Tolan’s impressive credentials below.
To summarize, Dr. Tolan is the real deal, and is perhaps the best-qualified person to answer my question:
Will nasal saline rinses result in death from brain-eating amoeba??
The main points from that conversation are these:
- Using a Neti pot or other methods of doing nasal saline rinses won’t cause your death by brain-eating amoeba.
- Just to be safe, for nasal saline rinses, simply use boiled tap water, or simply buy a jug of distilled water.
There you have it. For the rest of what Dr. Tolan had to say, read on …
As a world-renowned expert on infectious diseases of the central nervous system, I called Dr. Tolan to ask his opinion about the recent cases in the media, specifically cases of “brain-eating Amoeba” – Amoebic Meningoencephalitis (AM), linked to use of a Neti pot.
I wanted to get to the bottom of this because I have colleagues, patients and their families (and readers of this blog), asking me whether it’s safe to be doing nasal saline rinses at all. Are we risking Amoebic Meningitis by doing nasal saline rinses??
There are two reports that I am familiar with, and both have received a lot of attention on the web, in social media like Facebook and Twitter.
Here is what Dr. Tolan had to say:
Boogordoctor: Dr. Tolan, thank you so much for taking time to offer your expert opinion about Amoebic Meningoencephalitis, from Neti pot use.
Dr. Tolan: My pleasure, Dr. Faust, glad to help.
Boogordoctor: Are you familiar with the recent cases of AM linked to Neti pot use?
Dr. Tolan: I am not, since they have not yet been confirmed by the CDC (Centers for Disease Control and Prevention). I have not seen them reported in the MMWR (Morbidity and Mortality Weekly Report). Don’t believe everything that you read on the internet. Many things are sensationalized to boost readership.
On the other hand, there are some important points to make using these examples.
Boogordoctor: Such as?
- The first point for your readers to keep in mind is that AM is incredibly rare. There are usually about 3 cases per year in this country annually.
- Most of those cases occur after swimming in ponds in warm environments – Southern states.
- The next point to keep in mind is that the organism responsible for those cases is usually Naegleria fowleri. It is important to point out that N. fowleri is EVERYWHERE in our environment, including our municipal water supply. It is ubiquitous.
- N. fowleri is difficult to kill, especially in environments where it is happiest – in the South, for example. There is simply no way to chlorinate our water supply in the South to levels that will eliminate all N. fowleri. The farther South you go, the warmer the water, the greater the risk of having N. fowleri in your tap water (and ponds, lakes, etc.).
- My recommendation is, for people using Neti pots or other methods of nasal saline irrigations, USE DISTILLED WATER, or BOILED tap water. Distilled water is not absolutely sterile, but will have much lower risk of containing amoeba species than tap water.
Regarding these cases of AM related to Neti pot use that are reported online, I will be interested to see what the CDC investigators tell us. Regardless, it is important to emphasize how rare these cases are in this country.
Boogordoctor: Dr. Tolan, that is great advice, and supports what I have been telling people: use distilled water for your Neti pot or squeeze-bottle for nasal saline rinses – whether you use a store-bought salt preparation or make your own from a recipe.
Again, thanks so much for lending your expertise.
Dr. Tolan: You are very welcome, call any time.
My take on this: if you are doing nasal saline rinses, you have little to fear from Amoeba, as long as you are using distilled water or boiled tap water. You have a much (much) higher risk of exposure to N. fowleri by swimming in lakes or ponds in Southern states.
- It’s not about the Neti pot, or even about nasal rinses.
- It’s about the water.
- Just be sure your water is safe. How?
- Use distilled or boiled water for your nasal rinses!
The Life-Cycle of N. fowleri
The image below shows how N. fowleri (and some other amoeba species) get into our brains: simply swimming in ponds or lakes with high concentrations of amoeba (think warm, Southern states), can result in amoeba reaching our noses; they crawl through our “olfactory neuroepithelium” – that part of our noses that give us the sense of smell), and enter our brains that way. Bad news!
Please leave a comment / reply and let us know how you are doing nasal saline rinses.
And thanks for visiting!
About Dr. Robert Tolan
Dr. Tolan is a world-renowned expert on infections of the central nervous system.
He is currently Chief, Division of Allergy, Immunology and Infectious Diseases, The Children’s Hospital at Saint Peter’s University Hospital, New Brunswick, New Jersey and Clinical Associate Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
He earned a Master’s Degree in Microbiology before earning his Medical Degree at Washington University School of Medicine. Following his training in Pediatrics, he pursued advanced training and research in Infectious Diseases at Washington University/St. Louis Children’s Hospital. He is board certified in Pediatrics by the American Board of Pediatrics, and also the Sub-Board of Infectious Diseases. He teaches at Drexel University, where he is Associate Clinical Professor.
Dr. Tolan’s research is funded by the NIH; he studies various infections in children and infants, and his list of publications is longer than I am tall.
http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.
Image Credit: All images from the CDC (Centers for Disease Control and Prevention) Image Library, in the Public Domain.
Hi, I’m Russell Faust, author of this medical education blog.
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