N. fowleri is known as a "brain-eating" amoeba because it can enter a patient's nose, infect the brain, and cause primary amebic meningoencephalitis (PAM), a brain-tissue destroying condition.
The first Louisiana patient died of neti pot-induced infection in June. An additional two patients died of N. fowleri infection in August after swimming in warm, fresh water.
The amoeba usually infects patients that submerge their heads in freshwater lakes and rivers, though it can be transmitted through inadequately chlorinated pool water or underheated (less than 116°F) tap water that enters a patient's nose, a statement from the Louisiana Department of Health and Hospitals said.
Patients that irrigate their noses with a neti pot should use distilled, sterile, or previously boiled water, Raoult Ratard, MD, a Louisiana state epidemiologist, said in the statement. He noted that tap water was safe to drink, but may not be safe for nasal cleansing.
Symptoms of PAM include headache, fever, nausea, vomiting, and stiff neck, and may take one to seven days to start. Later symptoms include confusion, lack of attention to environment, loss of balance, seizures, hallucinations, and, in one to 12 days after infection, death. The disease progresses rapidly and symptoms may resemble bacterial meningitis, the statement warned.
The difficulty is that Naegleria is exceedingly rare," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center. "It's difficult to diagnose, and once it's diagnosed, it's also difficult to treat."
Most Naegleria fowleri infections result from diving into warm, stagnant water. There were four deaths linked to the parasite last summer, including one in Louisiana.
"I had not heard of Naegleria being associated with Neti pot use, but it's perfectly biologically plausible, because tap water is not sterile," said Schaffner. "And when you inhale it directly into the sinuses, it's similar to a deep dive into brackish water."
Drinking tap water cannot cause a Naegleria fowleri infection.
The Neti pot is an ancient nasal irrigation system that looks like a gravy boat. When used properly, it can help relieve congestion associated with the common cold, the flu and allergies.
"Particularly in the winter, a lot of people get chronic sinusitis and the Neti pot offers a way for the sinuses to drain," said Schaffner. "Some patients seem to benefit; other don't."
Neti pot popularity has grown in recent years, thanks to celebrity backers like Oprah and Dr. Oz. But a 2009 study presented at the American College of Allergy, Asthma and Immunology's annual meeting suggests that Neti pot overuse could increase the risk of sinus infections.
"There's a degree of controversy about whether it should be recommended generally," said Schaffner. "It's one of those treatments that sort of grew up rather than coming to us through rigorous, evidence-based trials. But there are many people out there who swear by it."
The warning from the Louisiana Department of Health and Hospitals highlights the risks of improper Neti pot use. But when used and cleaned properly, the Neti pot is safe, Schaffner said
"Use sterile, boiled and cooled or distilled water; rinse [the Neti pot] out thoroughly after use; and air-dry it," he said, adding that water left in the Neti pot after use could become a breeding ground for bacteria and parasites that feed on mucus. "You don't have to send it to an autoclave, but it does require some attention to detail.
No comments:
Post a Comment