Ritual Nasal Rinsing & Ablution

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.

References
  1. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008.external icon Epidemiol Infect. 2010;138(7):968-75.
  2. Visvesvara GS. Free-living amebae as opportunistic agents of human disease.external icon 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.external icon 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.external icon 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.external icon Int J Infect Dis. 2013;17(11):e945-8.