Florida health officials say a man recently died from a brain-eating amoeba called Naegleria fowleri—an infection likely caught from rinsing his sinuses with tap water. These infections are incredibly rare but almost always lethal, and they have been previously linked to nasal rinsing, such as through the use of neti pots. As a result, it’s recommended that people only use sterile or recently boiled water when performing this activity.
In late February, the Florida Department of Health in Charlotte County reported on a case of a resident infected with N. fowleri, adding that the person had possibly contracted the infection through nasal rinsing with tap water. Local media outlet Fox 4 subsequently reached out to the health department as well as the Centers for Disease Control and Prevention, both of which provided more details. The resident was a man who died of his infection on February 20. And he reportedly rinsed his sinuses with unboiled tap water every day.
N. fowleri is a shapeshifting amoeba that commonly lives in soil and warm freshwater environments. It normally feeds on bacteria, and when it’s accidentally ingested through water, it can’t cause any trouble. But when it enters the body through the nose, it can migrate up to the brain. Once inside, the amoeba quite literally eats brain cells and also triggers massive inflammation, resulting in a condition called primary amebic meningoencephalitis, or PAM. Initial symptoms include severe headaches, fever, and nausea, which then quickly progress to neurological problems like seizures, hallucinations, and coma.
There have only been around 150 reported cases of PAM in the U.S. since the discovery of the amoeba in the 1960s, with between zero to five cases reported annually. But the infection has a fatality rate of over 97% once symptoms start, with death typically arriving within two weeks after exposure. This latest case is the first reported case of N. fowleri to occur this year and the first case linked to tap water documented in Florida, according to the CDC. It’s also the first case in the U.S. reported during the winter, which is usually when the amoeba transforms out of the stage of life that can infect humans and becomes dormant.
Most cases of N. fowleri are thought to happen when people get water up their nose while swimming in natural warm freshwater environments like lakes. But the amoeba can survive in drinking water systems or poorly chlorinated pools. And in a few cases, like this one, it has entered a person’s brain through intentional nasal rinsing with contaminated water. Nasal rinsing is practiced as a spiritual ritual in some areas, but in the U.S. it’s probably more commonly performed to clear the sinuses and provide some relief from sinus infections, allergies, or the cold and flu.
Florida officials say they’re investigating the possible source of water contamination where the man might have contracted the amoeba. If it is found in a local system, it can be flushed out through the increased use of disinfectants. But it’s long been recommended that people not use water straight from the tap for nasal rinsing, for this exact reason. Officials are telling residents who rinse their sinuses to use only distilled or sterile water if possible, and if they do want to use tap water, then they should boil it for a full minute. It’s also good to avoid letting bathing or swimming water get up your nose in general, especially in lakes, and to make sure your pools are properly cleaned.