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For years, scientists have known that people who use neti pots can become infected with brain-eating amoebas if they use the wrong type of water. On Wednesday, researchers linked a second type of deadly amoeba to nasal washing. The Centers for Disease Control and Prevention has published a report that for the first time, Acanthamoeba infections have been linked to neti pots and other nasal washing devices. Officials also reiterated their warning that flushing nasal passages with ordinary tap water can cause extremely rare, but potentially fatal, consequences.
“We published this study because we want people to be aware of this risk,” said Dr. Julia Heston of the CDC.
What are neti pots?
The neti pot is one of the better known nasal washing devices. They look like small teapots with long spouts, and are usually made of ceramic or plastic.
Users fill them with saline solution, then squirt the liquid into one nostril. It flushes out allergens and other irritating contaminants from the nasal passages.
Market researchers say neti pot use has grown rapidly in the US over the past few decades, partly due to the increased prevalence of allergies and other respiratory diseases.
There are other methods of flushing nasal passages, including specially shaped cups and squeezable plastic bottles.
Why should you not use untreated tap water in neti pots?
Tap water in the US is treated to meet safe drinking standards, but low levels of microorganisms may still be found in it. This is usually not a problem when people drink the water or cook with it, but it can pose a greater threat when tap water is used for other purposes – such as as a humidifier or for nasal irrigation. .
Nearly a third of American adults incorrectly thought tap water was free of bacteria and other microorganisms, CDC officials said, citing a 2021 survey. About two-thirds of people say tap water can be safely used to wash out their sinuses.
The CDC recommends using boiled, sterile or distilled water.
Officials say if tap water is used, it should be boiled for at least one minute – or three minutes at higher altitudes – before being cooled and used.
Rare diseases and runny nose
More than a decade ago, health officials linked a spate of deaths in the US caused by a brain-eating amoeba – named Naegleria fowleri – to nose washing. Recently, they began to note nasal lavage as a common theme in diseases caused by another microscopic parasite, Acanthamoeba.
Acanthamoeba causes a variety of diseases but is still dangerous, with a mortality rate of 85% in reported cases.
“These infections are very serious and even life-threatening,” said Heston, lead author of the report published in the journal Emerging Infectious Diseases.
The new study focused on 10 patients who fell ill between 1994 and 2022, three of whom died. Researchers say they can’t be certain how the patients became infected, but they noticed several similarities: All had weak immune systems and practiced nose washing.
Seven patients reported using nasal washes for relief from chronic sinus infections, and at least two of them used a neti pot. Two other patients washed their noses as part of a cleansing ritual, which is part of Indian tradition.
What is Acanthamoeba?
This amoeba can be found naturally throughout the environment – in lakes, rivers, seawater and soil.
It can cause skin and sinus diseases, and can infect the brain, where it can cause a fatal form of inflammation. The microorganism has also been linked to non-fatal, but sight-threatening, eye infections, sometimes through contaminated contact lens solution.
U.S. health officials have identified about 180 infections from the single-cell organism since it was first diagnosed in 1956.
In most cases, researchers don’t know exactly how people became infected. But in reviewing cases in recent decades, CDC researchers have increasingly found that many of the cases involved nasal lavage, Heston said.
Research has also indicated that this is common in tap water. A study conducted in Ohio in the 1990s found that more than half of the tap water samples studied contained amoeba and similar microorganisms.
“It’s very likely that we are all exposed to Acanthamoeba all the time,” he said.
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