Ritual Nasal Rinsing & Ablution

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

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. It also can hide in pipes connected to tap water.

Because 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.

Infections from Naegleria are deadly and rare.

Nasal irrigation illustration

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.

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

  • Infections are deadly: Of 157 people known to be infected in the United States from 1962 through 2022, only four people have survived.
    • Most Naegleria infections are due to swimming in warm lakes or rivers.
  • Infections are rare:
    • Only one Naegleria infection associated with ritual nasal rinsing has been reported in the United States.
      • More infections linked to ritual nasal rinsing have been reported globally.
    • Two additional infections have been linked to using neti pots or similar devices to rinse sinuses with salt solutions made from contaminated tap water.

You cannot get infected from drinking contaminated water. You can only get PAM when contaminated water goes up into your nose.

Use Safe Water to Protect Yourself

illustration of Naegleria fowleri. It is approx. 1000 times larger than Naegleria actually is.

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

You can lower your risk of becoming infected with Naegleria during ritual nasal rinsing by using treated water. It is safest to use boiled, distilled, sterile, or filtered water. If that is not possible, you can disinfect the water using chlorine.

Water Treatment Options for Nasal Rinsing

  • Use water that has been previously boiled for 1 minute and left to cool. At elevations above 6,500 feet, boil for 3 minutes.
  • Use water with a label specifying that it is distilled or sterile water.
  • If boiled, distilled, or sterile water is not available, use a water filter designed to remove harmful germs.
    • Choose a filter that is labeled “NSF 53” or “NSF 58.” Filter labels that read “absolute pore size of 1 micron or smaller” are also effective.
    • Carefully read and follow the manufacturer’s instructions for the water filter you are using.
  • If you are unable to use boiled, sterile, distilled, or filtered water, you can use chlorine bleach to treat the water. Learn how to use bleach to disinfect your water.

Talk to your doctor if you have concerns.

Naegleria symptoms may be mild at first and include headache, fever, nausea, or vomiting. Later symptoms may include stiff neck, confusion, seizures, and hallucinations. 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.
  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. 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.
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