https://www.cidrap.umn.edu/misc-emerging-topics/woman-dies-brain-ameba-after-flushing-nose-rv-water
Woman dies from brain ameba after flushing nose with RV water
Jim Wappes
Today at 2:39 p.m.
Misc Emerging Topics
A previously healthy 71-year-old woman in Texas died within 2 weeks of using tap water from a recreational vehicle (RV) for nasal irrigation. She was diagnosed as having primary amebic meningoencephalitis (PAM) a rare, often fatal brain infection caused by the ameba Naegleria fowleri, according to a report yesterday in Morbidity and Mortality Weekly Report.
CDC and Texas investigators said the woman developed severe neurologic symptoms, including fever, headache, and an altered mental state, within 4 days of using a nasal irrigation device filled with tap water from an RV's water system at a campground in Texas.
Despite medical treatment for suspected PAM, the patient developed seizures and later died 8 days after she first had symptoms. CDC lab testing confirmed the presence of N fowleri in the woman's cerebrospinal fluid.
Cautions about nasal rinsing
People use nasal irrigation, often with a long-spouted neti pot or squirt bottle, to relieve symptoms of colds, sinus infection, or allergies. Ritual nasal rinsing can also be a part of religious practices, including in Islam, as well as in yoga and ayurveda.
The Food and Drug Administration cautions people to "rinse only with distilled, sterile, or previously boiled water," to follow instruction for irrigation devices, and to avoid the practice in young children. The CDC says, "Seek medical attention right away if you or a loved one develops a headache, fever, confusion, or vomiting after rinsing your sinuses or nasal passages."
In a fact sheet, the agency adds, "You cannot get infected from drinking contaminated water. You can only get PAM when contaminated water goes up into your nose."
Investigating the source
A follow-up epidemiologic investigation conducted by the Texas Department of State Health Services found that the woman had no recreational exposure to fresh water, such as swimming, but she had reportedly performed nasal irrigation several times using nonboiled water from the RV water faucet during the 4 days before she fell ill.
This practice suggested two potential water sources for the N fowleri infection. The first was the RV's water tank for drinking, which flowed directly to the faucets and shower. The tank had been filled with water collected on an unknown date before the patient bought the RV 3 months earlier.
The second possible source of contamination was the municipal water system, which was connected by a hose and water filter to the RV's potable water system, bypassing the tank, at the time the woman used it for nasal irrigation.
To explore these potential sources further, investigators collected 12 environmental samples. These included samples from the squirt bottle that the woman used for nasal rinsing, water from the RV water heater, swabs from the shower head and bathroom and kitchen sink faucets, water from the RV's potable water tank, and water from the campsite's municipal water supply.
This case reinforces the potential for serious health risks associated with improper use of nasal irrigation devices.
Although the scientists did not find N fowleri DNA or viable ameba in the samples, they found that the water supply was not adequately disinfected.
An unfortunate cautionary tale
The authors note, "Failure to isolate the organism from the samples collected might be explained by the fact that sampling occurred 23 days after the patient used the water for nasal irrigation, and the environmental conditions might have differed from those present when infection occurred.
"In addition, the pathogen might have been present at the time of sampling but at levels below the detection limit. Whether the municipal water system or the RV potable water tank was the source of contamination is unknown, because the tank might have contaminated the RV potable water system before connection to the campground municipal water system."
They conclude, "This case reinforces the potential for serious health risks associated with improper use of nasal irrigation devices, as well as the importance of maintaining RV water quality and ensuring that municipal water systems adhere to regulatory standards."
Woman dies from brain ameba after flushing nose with RV water
Jim Wappes
Today at 2:39 p.m.
Misc Emerging Topics
A previously healthy 71-year-old woman in Texas died within 2 weeks of using tap water from a recreational vehicle (RV) for nasal irrigation. She was diagnosed as having primary amebic meningoencephalitis (PAM) a rare, often fatal brain infection caused by the ameba Naegleria fowleri, according to a report yesterday in Morbidity and Mortality Weekly Report.
CDC and Texas investigators said the woman developed severe neurologic symptoms, including fever, headache, and an altered mental state, within 4 days of using a nasal irrigation device filled with tap water from an RV's water system at a campground in Texas.
Despite medical treatment for suspected PAM, the patient developed seizures and later died 8 days after she first had symptoms. CDC lab testing confirmed the presence of N fowleri in the woman's cerebrospinal fluid.
Cautions about nasal rinsing
People use nasal irrigation, often with a long-spouted neti pot or squirt bottle, to relieve symptoms of colds, sinus infection, or allergies. Ritual nasal rinsing can also be a part of religious practices, including in Islam, as well as in yoga and ayurveda.
The Food and Drug Administration cautions people to "rinse only with distilled, sterile, or previously boiled water," to follow instruction for irrigation devices, and to avoid the practice in young children. The CDC says, "Seek medical attention right away if you or a loved one develops a headache, fever, confusion, or vomiting after rinsing your sinuses or nasal passages."
In a fact sheet, the agency adds, "You cannot get infected from drinking contaminated water. You can only get PAM when contaminated water goes up into your nose."
Investigating the source
A follow-up epidemiologic investigation conducted by the Texas Department of State Health Services found that the woman had no recreational exposure to fresh water, such as swimming, but she had reportedly performed nasal irrigation several times using nonboiled water from the RV water faucet during the 4 days before she fell ill.
This practice suggested two potential water sources for the N fowleri infection. The first was the RV's water tank for drinking, which flowed directly to the faucets and shower. The tank had been filled with water collected on an unknown date before the patient bought the RV 3 months earlier.
The second possible source of contamination was the municipal water system, which was connected by a hose and water filter to the RV's potable water system, bypassing the tank, at the time the woman used it for nasal irrigation.
To explore these potential sources further, investigators collected 12 environmental samples. These included samples from the squirt bottle that the woman used for nasal rinsing, water from the RV water heater, swabs from the shower head and bathroom and kitchen sink faucets, water from the RV's potable water tank, and water from the campsite's municipal water supply.
This case reinforces the potential for serious health risks associated with improper use of nasal irrigation devices.
Although the scientists did not find N fowleri DNA or viable ameba in the samples, they found that the water supply was not adequately disinfected.
An unfortunate cautionary tale
The authors note, "Failure to isolate the organism from the samples collected might be explained by the fact that sampling occurred 23 days after the patient used the water for nasal irrigation, and the environmental conditions might have differed from those present when infection occurred.
"In addition, the pathogen might have been present at the time of sampling but at levels below the detection limit. Whether the municipal water system or the RV potable water tank was the source of contamination is unknown, because the tank might have contaminated the RV potable water system before connection to the campground municipal water system."
They conclude, "This case reinforces the potential for serious health risks associated with improper use of nasal irrigation devices, as well as the importance of maintaining RV water quality and ensuring that municipal water systems adhere to regulatory standards."