Brain-Eating Amoeba and Nasal Rinses?

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 …

brain-eating ameba amoeba

Image: Brain-eating amoeba, N. fowleri (image credit: CDC). The central B&W image is a “phase-contrast” from under the microscope; the pics on either side are stained brain tissue showing infection with amoeba (“Amoebic Meningoencephalitis”)

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?

Dr. Tolan:

  • 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.

Conclusions

  • 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!

life-cycles and forms of ameba amoeba

Image: Life-cycles of amoeba

Please leave a comment / reply and let us know how you are doing nasal saline rinses.

And thanks for visiting!

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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.

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Resources:

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332

http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.

http://phoenix.about.com/od/health/qt/Ameba.htm

http://www.wwltv.com/news/health/Doctors-explain-cause-of-brain-eating-amoeba-128043523.html

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.

Russell Faust, PhD, MD boogordoctor

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Comments

  1. Thanks for writing this article! Good to see some science behind the stories!

    • Russell A. Faust, PhD, MD says:

      Thanks for your kind comments, Lauren! I appreciate your support and encouragement, and especially sharing your thoughts in ‘comments’. Thanks! Boogs

  2. I think I’ll boil the distilled water :)

  3. Thanks for clearing up the confusion about the recent reports questioning the safety of using neti pots. I’m going to share your post on my blog since many of my patients have been asking if they are safe and your post will be helpful getting the facts straight.

    • Russell A. Faust, PhD, MD says:

      Hi Robin!
      Thanks for visiting and sharing!
      And thanks for your excellent articles on acupuncture for children.
      Regarding Neti pot use and brain-eating amoeba, perhaps the online media sensationalized things a little bit? I am grateful to Dr. Tolan for setting things straight, and putting things in perspective. The “fix” is simple: either use distilled water (what I use), or boil tap water.
      Thanks again,
      boogs

  4. What about putting a few drops of grapefruit seed extract in the neti pot along with the saline?

    • Russell A. Faust, PhD, MD says:

      Hi Paula,

      That is a great suggestion, based on some evidence that grapefruit seed extract has anti-microbial properties. One word of caution: in the race to market some of these preparations, some vendors have marketed products that have impurities in them, or high concentrations of preservatives. My recommendation: find a vendor with a great reputation, one that you trust.

      I have not personally used gf seed extract in saline rinses, but want to hear more!

      And thanks for the suggestion. Please check back and let us know if you try this, and how to use it, what the experience was like.
      Thanks!
      boogs

  5. Hi, Dr. Faust!
    The cases may be rare, but, unfortunately, my local area had one such case within the past 3 years that resulted in a boy’s death- from swimming in a local pond. It was tragic.
    So, I am erring on the cautious side and boiling our tap water for my son- now, this involves an extra few steps and I either have to time it perfectly and let it cool enough for him to use- or reheat it the next time he’s due to rinse. Oh, well, small price to pay. I’ve never heard of any cases via ingestion- do our gastric acids kill the amoeba ?
    thanks for keeping us so up to date!

    • Russell A. Faust, PhD, MD says:

      Hi Angela,
      Yes, absolutely tragic! And by my mention of how rare these cases are, I did not mean to diminish their significance!
      I am with you: belt-and-suspenders: boil your distilled water! It’s a small price to pay to be safe.
      I don’t think that ingestion is a problem (from my limited research), due to stomach acid.
      Please let us know if you read differently or find out more!
      Thanks so much for visiting, and for sharing.
      boogs

  6. It’s not the pot… You must choose the water wisely! Just wrote a few tips to Neti Pot use and safety http://bit.ly/H3YHtI

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  8. I have two questions here:

    1. If irrigating with tap water is enough of a risk to warrant boiling, should we be washing our irrigation equipment with boiled water as well? Or is letting it completely dry in between uses sufficient?

    2. I use Grossan’s pulsatile irrigator, having heard that that the pulsatile action is better at s(t)imulating the pulsations of the cillia. However I don’t know how to clean and dry it completely; I do not even know if storing upside down will let all the water dry. And beyond that, how to really clean it out — if I were to run vinegar or dilute chlorine through the system regularly, how often should I? And how diluted?

    • Russell A. Faust, PhD, MD says:

      Hi Lucy,
      Regular cleaning of irrigation equipment, humidifiers, etc., is recommended in order to minimize contamination with bacteria or mold. I use dilute bleach for strong antiseptic cleaning, but regular soap and water does just fine. For questions regarding Dr. Grossan’s irrigator, please contact him directly; I’m sure he’ll reply.
      Best success!

  9. Dear Dr. Tolan
    1. suppose that amoeba is everywhere, why only a few of them infected? I have asked few other doctors, they have no idea.
    2. From CDC, one Symptoms of the stage 1 of the PAM is “Severe frontal headache”, now how “Severe” is the PAM can cause? And is it happened suddenly or slowly become a painful headache?
    3. We still don’t have a effecient treatment of this fatal disease?
    4. To be honest, I was afraid every activity related to water today, and every small headache makes me nervous, I think I should know these things better so I don’t need to be afraid again.

  10. Erin Collins says:

    I live in central Fl beachside and have an outdoor avairy which had gotten quite dirty due to illness. 4 days ago I took a leaf blower to get some of dirt out and dirt went up my nose. I went in used boiled distilled saline netti pot…would that make my chances of getting N. Fowler is worse? I feel ok except for sinus congestion pain at bridge of nose cheekbone and ears are stuffy. I’m frightened I may be infected.

    • Russell A. Faust, PhD, MD says:

      Hi Erin:
      For anyone living in the South, using only boiled water (and even better, boiled distilled, as you describe) is the only safe way to do saline nasal rinses. The risk of N. fowleri in the municipal water supply, and in the pipes in homes, is just too great. If you are concerned, see your doc! An ENT specialist can take a quick (and painless) peak to see whether you have any sign of serious infection.
      Thanks for visiting and for sharing.
      Best success.

  11. Erin Collins says:

    Erin again…I do have sinus problems a lot so I’m hoping that’s what I’m feeling..no major headache or fever…

  12. I just used Figi natural artesian water in my neti pot to do a saline rinse. Am I at risk of contracting the brain-eating amoeba? Can I take any steps to counteract what’s already been done? Now I’m worried after reading several articles.

    • Russell A. Faust, PhD, MD says:

      Hi Sharon:
      Most bottled water is either distilled (best for Neti pot use) or filtered – extremely low risk of amoeba. Distilled is good; boiled is best.

  13. Does soap kill amoeba?

    • Russell A. Faust, PhD, MD says:

      Yes, soap can kill amoeba.
      Chlorine kills amoeba, but nobody wants to drink chlorine in their drinking water, so municipal water supplies try to use just the right balance of chlorine: enough to kill microbes, but not too much that it is toxic for drinking.
      The best water to use for nasal saline rinses is either boiled, or distilled-then-boiled.
      Thanks for visiting, and for your question. Best success!

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