Tap water in neti pot blamed for deadly amoebic infection

Over the past few years, it seems like everyone and their mother has been begging — nay, imploring — you to get a neti pot, the teapot-esque vessel designed to flush out congested nasal passages. And why not? They’re small! They’re portable! They’re well-designed! They’re extremely effective snot-suckers!

Well, as it turns out, neti pots don’t come without risks. At the very least, you should read the instructions very, very carefully before using one. Per NBC News, a 69-year-old woman from Seattle died after contracting Balamuthia mandrillaris, a rare, brain-eating amoebic infection — reportedly from using a neti pot.

According to a report in the International Journal of Infectious Diseases, the woman, who suffered from sinus infections, used the neti pot for about a month before she started developing a strange rash on her nose. Initially, her dermatologist chalked it up to rosacea, a common skin condition. But the rash didn’t go away, and then the woman started having seizures, which brought her to the hospital.

A surgeon who examined her brain tissue later told the Seattle Times that “a section of her brain about the size of a golf ball was bloody mush. There were these amoeba all over the place just eating brain cells.” Her condition deteriorated, and she fell into a coma and died.

At first, doctors were baffled as to how the woman contracted the amoeba, which is found in fresh water and soil and can enter the body through an open wound or cut. They later discovered that the woman had used Brita-filtered tap water in her neti pot, instead of sterile water, as is recommended. While the researchers did not have the chance to test the water to confirm their hypothesis, they suspected that the infection was due to “improper nasal lavage.”

A woman using a neti pot.
Toronto Star via Getty Images

Neti pots are often used by people with allergies and sinus infections. The practice is called nasal irrigation, and it reportedly has its roots in ancient Ayurvedic medicine. But it wasn’t until neti pots got a plug from Dr. Oz on Oprah Winfrey’s show in 2007 that nasal irrigation achieved mainstream popularity.

For the most part, studies have demonstrated that nasal irrigation is an effective means of treatment for colds, allergies, and sinus infections. (Though one 2009 study did find that long-term use is associated with a higher incidence of sinus infection, possibly because it reduces the mucosal lining of the nose, making it more vulnerable to infection.)

And because amoebal infections like Balamuthia mandrillaris are so rare, public health experts are reassuring the public that neti pots are perfectly safe for use, provided you follow the directions.

But this is not the first time that neti pots have been linked to such infections. In 2011, two people in Louisiana died of encephalitis caused by Naegleria fowleri, another amoeba found in fresh water that attacks brain tissue. It was initially suspected that the two victims had been swimming in freshwater lakes or rivers and gotten water up their noses, which is how the infection is typically contracted. (It is not possible to contract the infection from swallowing fresh water, as stomach acid usually kills the amoeba, but it can survive in the nasal passages and travel up to the brain.) But it was later found that both victims had used tap water in their neti pots, which was confirmed when the water tested positive for Naegleria fowleri.

As recently as last year, the Food and Drug Administration issued a statement warning people against using tap water in neti pots due to the risks of contracting Naegleria fowleri, recommending that neti pot users opt for “distilled, sterile, or previously boiled” water or use a heavy-duty water filter (i.e., not a Brita filter, which will do little to filter out potentially dangerous microorganisms).

It’s important to note that both Balamuthia mandrillaris and Naegleria fowleri are pretty rare: There were 34 reported cases of the latter amoebic infection in the United States between 2008 and 2017, only three of which were due to using tap water in a neti pot, according to data from the Centers for Disease Control and Prevention. But cases of such infection are usually fatal, the case study authors write.

If you’re a neti pot devotee, it’s crucial to follow instructions for proper use. That includes ensuring that your water is sterile by boiling it for 3 to 5 minutes and letting it cool before using it. (You can also use sterile or distilled water, which you can buy in stores.) You should also clean and dry your neti pot thoroughly using boiled water before and after every use. And don’t go sharing your neti pot with others, because that’s just nasty.

And if you want to totally eliminate the risks associated with neti pot use? Just don’t use one at all. Contrary to what some wellness devotees may tell you, using a neti pot regularly doesn’t “flush” toxins out of your nose — it’s just a fairly effective way to relieve congestion.

Updated to clarify that the scientists were not able to test the water in the home of the woman who died but suspect the neti pot was the culprit.

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