Ritual Nasal Rinsing & Ablution
Use safe water to protect yourself from a deadly brain infection.
Print-and-Go Fact Sheet
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 133 people known to be infected in the United States from 1962—2014, 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
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.
- 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.
- Visvesvara GS. Free-living amebae as opportunistic agents of human disease. [PDF - 13 pages] J Neuroparasitol. 2010;1.
- 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.
- 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.
- 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.
- 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.
- Pellerin J, Edmond MB. Infections associated with religious rituals. Int J Infect Dis. 2013;17(11):e945-8.