Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Ritual Nasal Rinsing & Ablution

Use safe water to protect yourself from a deadly brain infection.

nasal irrigation - illustration of sniffing the water from the hands during ritual ablution.

Many people perform ritual nasal rinsing. This practice is included in Yogic, Ayurvedic, and Islamic traditions. Within the Islamic faith, ritual nasal rinsing is included in a cleansing process called "wudu" or "ablution." It is usually performed several times a day in preparation for prayer.

Many tiny germs live in warm water. Naegleria fowleri is a water-loving ameba (very small germ) that is often found around the world in ponds, lakes, and rivers 1, 2. It also can hide in pipes connected to tap water 3-6.

Naegleria is so small, even water that looks, smells, and tastes clean can have the amebae swimming in it. Nasal rinsing with unsafe water can lead to infection 3-6.

Infections from Naegleria are deadly and rare.

When water tainted with Naegleria is sniffed up the nose, the ameba can travel to the brain  4-6. This causes the disease primary amebic meningoencephalitis (PAM), which destroys brain tissue and usually results in death 1, 2.

  • Infections are deadly: Of 132 people known to be infected in the United States from 1962—2013, only three people have survived 1.
    • Most Naegleria infections are due to swimming in warm lakes or rivers.
  • Infections are rare: There has only been one reported Naegleria infection associated with ritual nasal rinsing in the U.S. 5
    • More infections linked to ritual nasal rinsing have been reported globally 6.
    • Two infections have been linked to using neti pots or similar devices to rinse sinuses with salt solutions made from contaminated tap water 4.
illustration of a faucet with a drop of water magnified showing the amebas in the water

This image shows Naegleria about 1,000 times bigger than it really is.


Talk to your doctor if you have concerns.


Naegleria infection may be mild at first and include headache, fever, nausea, or vomiting. Later symptoms may include stiff neck, confusion, seizures, and hallucinations 2. The disease generally causes death within about 5 days after symptoms start 1.


References
  1. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75.
  2. Visvesvara GS. Free-living amebae as opportunistic agents of human disease. [PDF - 13 pages] J Neuroparasitol. 2010;1.
  3. Dorsch MM, Cameron AS, Robinson BS. The epidemiology and control of primary amoebic meningoencephalitis with particular reference to South Australia.  Trans R Soc Trop Med Hyg. 1983;77(3):372-7.
  4. Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, Hill VR, Wilson JD, Linscott AJ, Crager R, Kozak NA, Sriram R, Narayanan J, Mull B, Kahler AM, Schneeberger C, da Silva AJ, Poudel M, Baumgarten KL, Xiao L, Beach MJ. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012;55(9):e79-85.
  5. CDC. Primary amebic meningoencephalitis associated with ritual nasal rinsing — St. Thomas, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013;62(45):903.
  6. Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F, Ali F, Visvesvara GS, Zafar A. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011;17(2):258-61.
  7. Pellerin J, Edmond MB. Infections associated with religious rituals. Int J Infect Dis. 2013;17(11):e945-8.
 
Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC–INFO
  • Page last reviewed: May 27, 2014
  • Page last updated: May 27, 2014
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC-INFO