---
cited_by:
  - publication: /report/usgcrp-climate-human-health-assessment-2016/chapter/water-related-illnesses
    publication_type: chapter
    reference: /reference/2316e212-8f26-4828-8c38-86827dc8771e
  - publication: /report/usgcrp-climate-human-health-assessment-2016
    publication_type: report
    reference: /reference/2316e212-8f26-4828-8c38-86827dc8771e
contributors: []
description: 'Background. Naegleria fowleri is a climate-sensitive, thermophilic ameba found in the environment, including warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In 2011, 2 adults died in Louisiana hospitals of infectious meningoencephalitis after brief illnesses.      Methods. Clinical and environmental testing and case investigations were initiated to determine the cause of death and to identify the exposures.      Results. Both patients had diagnoses of PAM. Their only reported water exposures were tap water used for household activities, including regular sinus irrigation with neti pots. Water samples, tap swab samples, and neti pots were collected from both households and tested; N. fowleri were identified in water samples from both homes.      Conclusions. These are the first reported PAM cases in the United States associated with the presence of N. fowleri in household plumbing served by treated municipal water supplies and the first reports of PAM potentially associated with the use of a nasal irrigation device. These cases occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Virginia. These infections introduce an additional consideration for physicians recommending nasal irrigation and demonstrate the importance of using appropriate water (distilled, boiled, filtered) for nasal irrigation. Furthermore, the changing epidemiology of PAM highlights the importance of raising awareness about this disease among physicians treating persons showing meningitislike symptoms. '
display_name: Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water
doi: 10.1093/cid/cis626
files: []
href: http://52.38.26.42:8080/article/10.1093/cid/cis626.yaml
identifier: 10.1093/cid/cis626
journal_identifier: clinical-infectious-diseases
journal_pages: e79-e85
journal_vol: 55
notes: ~
parents:
  - display_name: "Chapter 6: Climate Impacts on Water-Related Illnesses (in 'The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment')"
    reference: /reference/2316e212-8f26-4828-8c38-86827dc8771e
    relationship: cito:isCitedBy
    uri: /report/usgcrp-climate-human-health-assessment-2016/chapter/water-related-illnesses
  - display_name: 'The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment'
    reference: /reference/2316e212-8f26-4828-8c38-86827dc8771e
    relationship: cito:isCitedBy
    uri: /report/usgcrp-climate-human-health-assessment-2016
references: []
title: Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water
type: article
uri: /article/10.1093/cid/cis626
url: ~
year: 2012