Thursday, January 26, 2012

Elderly Canadian woman is oldest patient with Baylisascaris infection

Photo/US Fish and Wildlife Service

Infection with the ‘raccoon roundworm’, Baylisascaris procyonis, although a very rare infectious disease with no more than a couple dozen cases reported, it is incredibly devastating and responds very poorly to treatment.
The infection is primarily reported in very young children ;< 2 years of age or in older children and young adults with developmental delay.
In a Letter to the Editor published Sunday in the February 2012 issue of the journal, Emerging Infectious Diseases, the authors from the University of British Columbia, Vancouver, British Columbia report the case of a 73-year-old woman who was discovered to have the roundworm during autopsy. She is the second reported case of Baylisascaris infection in Canada.
She is the oldest known person with confirmed B. procyonis neural larva migrans (NLM). According to the letter, the only previously reported case of B. procyonis NLM in an adult was in a developmentally disabled 21-year-old adult known to exhibit geophagia and pica.
The authors describe the case in the letter:
We report the case of a 73-year-old female nursing home resident with a 10-year history of moderately severe Alzheimer-type dementia. She was well-educated, had no other medical problems, and had previously resided with her husband in a rural part of British Columbia. Apart from mild confusion and poor memory, she was in good health and able to ambulate and communicate. There had been no recent change in her medical condition, and she voiced no concerns about medical problems before dying suddenly of cardiopulmonary arrest.
Microscopic examination of the brain showed Alzheimer-type pathology that was sufficiently severe to account for the patient’s dementia. In addition to this finding, lesions were seen with the larval nematode surrounded by inflammation.
The authors suggest that the woman’s dementia may have masked any neurological symptoms of this apparent mild infection with the parasitic infection.
They also suggest that her dementia may have contributed to her acquiring the infection:
The combination of confusion and poor hygiene and ambulatory state in the patient may have predisposed her to acquiring B. procyonis roundworms through ingestion of contaminated soil.

Tuesday, January 24, 2012

Chinese company ready to roll out hepatitis E vaccine

Researchers in China announced Friday, after 14 years of research and work, the successful development of the world’s first hepatitis E vaccine.
A representative from Xiamen Innovax Biotech in Fujian Province said the vaccine would be very cost effective compared to the cost of medical treatment of the viral disease.
According to a report, general manager of the company said:
"In the past, people infected with hepatitis E had to receive medical treatment that would usually cost them around 20,000 yuan (approximately $3,200). But a vaccine that costs several hundred yuan will help to prevent you against infection. It is a product that has a good performance but a relatively low price."
In December, the vaccine got official approval and will go into mass production this June.
The World Health Organization estimates there are about 6.5 million cases seen annually in South and East Asia and many more worldwide.
Infection with Hepatitis E, like Hepatitis A, is typically through ingesting contaminated food and water. 


Monday, January 23, 2012

Genetic code for bladder fluke revealed: could lead to new drugs, vaccine

Photo/CDC-Dr. Edwin P. Ewing Jr

Schistosomiasis is a neglected tropical disease that is second only to malaria in socioeconomical importance with 200 million people infected with one or more of the parasites worldwide.

Schistosoma haematobium is one species of schistosome, which causes urinary schistosomiasis. It is found throughout Africa and parts of the Middle East. This blood fluke is linked to bladder cancer and is considered a predisposing factor for HIV/AIDS.

According to a University of Melbourne news release Wednesday, researchers from the university in conjunction with an international team including researchers from the Beijing Genomics Institute sequenced the nuclear genome of S. haemotobium from a single pair of tiny worms. The research is published in the latest issue of Nature Genetics.

According to lead researcher, Dr. Neil Young from the University of Melbourne’s Faculty of Veterinary Science,  “This genome was the missing piece of a puzzle in schistosomiasis research. By revealing the genetic blueprint of Schistosoma haematobium, we now have a biological road map of the three major parasite species responsible for human schistosomiasis globally. Most importantly, the genome of Schistosoma haematobium will offer insights into how the intimate relationship between a parasite and its human host can induce malignant bladder cancer.”

There is not a vaccine available for prevention of this parasite and only one drug, praziquantel, available for treatment.

Dr. Young notes that revealing the schistosomes genetic blueprint provides an unprecedented resource for the design of new disease interventions, including drugs and vaccines.

The research was jointly funded by the Australian Research Council, BGI-Shenzhen and the National Health and Medical Research Council.

Friday, January 20, 2012

Experts warn of the dangers of fake malaria drugs

Photo/CDC-James Gathany

While there has been some progress in the battle against the parasitic scourge, malaria, as recently reported in the World Malaria Report 2011, an international team of researchers from Oxford University say that the emergence of counterfeit malaria drugs could put millions at risk in Africa and globally.

According a Wellcome Trust press release Monday, the research is published in the latest issue of the Malaria Journal, which demonstrates a dramatic increase in counterfeit and poor-quality antimalarial drugs have been seen in Africa.

In the study, researchers examined antimalarials from 11 African countries from 2002 to 2010 that were suspicious as being counterfeit was examined chemically and botanically. The packaging of the drugs was also examined.

What they found can be considered sinister and downright dangerous and could put millions in danger of the life-threatening infection.

Some of the counterfeit drugs examined contained a mixture of the incorrect active ingredients which could alleviate the symptoms but would not cure the disease.

In addition to inadequate treatment, the ingredients found in the fake drugs have the ability to cause serious side-effects with other medications the patient may be taking, like certain HIV drugs.
Other counterfeit samples tested revealed only small amounts of artemisinin derivatives that probably wouldn’t completely rid the body of the parasite, thus likely to cause resistant strains of the parasite. This was likely used to pass “authenticity tests” according to the authors.

Many of these counterfeit drugs were produced in China, and pollen found in some of the drugs analyzed were Asian in origin.

According to lead researcher Dr. Paul Newton of Oxford University, 'Public health organizations must take urgent, coordinated action to prevent the circulation of counterfeit and substandard medicines and improve the quality of the medicines that patients receive’.

He goes on to say, 'The enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure.

'Malaria can be readily treated with the right drugs of good quality, but poor quality medicines, as well as increasing mortality and morbidity, risk exacerbating the economic and social impact of malaria on societies that are already poor. Worse still, they encourage drug resistance, potentially resulting in the failure of artemisinin treatments, with profound consequences for public health in Africa.'

Thursday, January 19, 2012

Alaska DHSS report increase in RSV infections

Photo/CDC-Dr. H. Craig Lyerla

The Alaska State Public Health Laboratory reported last week an increase in positive respiratory syncytial virus (RSV) in samples received during the first week of January.

During the first week of January, the state lab confirmed that of the 44 samples received for analysis from sick children, 23 were confirmed positive for the respiratory virus.

This follows the 18 cases confirmed in the last week of December.

According to the US Centers for Disease Control and Prevention (CDC), RSV is the most common cause of bronchiolitis and pneumonia in children under 1 year of age in the United States with around 100,000 of kids in this age group requiring hospitalization.

RSV typically causes mild, cold-like symptoms where most children and adults recover from the illness in one to two weeks. However, the infection can cause severe infection mostly in very young children.

Premature infants, children less than 2 years of age with congenital heart or chronic lung disease, and children with compromised (weakened) immune systems due to a medical condition or medical treatment, plus the elderly are at highest risk for severe disease.

RSV, like the common cold, enters your body through your eyes, nose or mouth. It spreads easily when infectious respiratory secretions from coughing or sneezing are inhaled or passed to others through direct contact such as shaking hands. The virus can survive for several hours on inanimate objects.

There is no specific treatment for RSV infection. 

The Alaska Department of Health and Social Services recommends the following steps be taken to prevent the spread of RSV:

·         Wash your hands frequently with soap and hot running water.
·         If you don't have soap and water available, use a waterless hand cleaner. (This does not replace hand washing, but will help when soap and water are not available.
·         Avoid sharing cups, glasses and eating utensils.
·         When you’re sick, avoid kissing children and infants directly on their lips (kiss them on the top of their heads).
·         Cough into your sleeve, not into your hands.
·         Wash your hands after blowing your nose.
·         Wash toys, doorknobs and telephones frequently with a sanitizing solution or wipe.
·         If you are sick, stay home. You risk infecting others. Get rest and drink plenty of fluids; especially water and juices.
·         If you haven’t already, get your influenza and pneumonia vaccines. It’s not too late to vaccinate!
·         Keep infants and young children at home; avoid large crowds. Children 3 years old and younger are at increased risk for serious complications from RSV, flu, and colds. 

Tuesday, January 17, 2012

Report: Injectable ‘Bath Salts’ results in serious case of necrotizing fasciitis

“Bath Salts” are an increasingly popular drug which goes by a number of names including "Ivory Wave," "Purple Wave," Vanilla Sky," and "Bliss."  

The drug is a chemical synthetic stimulant, most commonly methylenedioxypyrovalerone (MDPV), but others like mephedrone and methylone are known to cause intoxication in users, and the effects include paranoia, delusions, suicidal tendencies and chest pains. The drug is taken by oral, smokable, snortable means and now to achieve a quicker high, injection is becoming more common.

Besides the psychiatric effects of these “designer drugs”, the injectable version has resulted in a very serious, potentially life-threatening infection as described in a Case Report by researchers from the Louisiana State University Health Sciences Center that was published late last week in the online journal Orthopedics.

The case was about a 34-year-old woman who went to seek medical attention after two days of right forearm pain and redness. The reddening extended from the middle of her upper arm to the finger joints. She didn’t have a fever. A red puncture wound was also visible which she later admitted was from a needlestick. She later admitted injecting bath salts intramuscularly after more questioning.

Doctors proceeded to treat her presumed cellulitis with broad-spectrum antibiotics.

After some improvement the next day the her admission to the use of bath salts and several other drugs she took a turn for the worse where the reddening worsened and the injection site demonstrated a skin sloughing and a malodorous drainage, doctors diagnosed the rapidly spreading and potentially life-threatening condition, necrotizing fasciitis.

Immediately she underwent surgical debridement and was placed on more specific antibiotics, Penicillin G and Clindamycin.

What the surgeons found during debridement was a rapidly spreading infection and a lot of tissue destruction.

The patient in the end had her right arm amputated; tissue from her shoulder removed and a right radical mastectomy were all performed to stop the progression of the infection. The woman did survive the infection.

According to the case report, cultures revealed a polymicrobic infection, which included the following isolates: alphahemolytic Streptococcus, Streptococcus viridans, Peptostreptococcus micros, Gemella morbillorum, and Actinomyces odontolyticus

The authors say injectable drugs of any kind can cause, albeit rare, fatal infections. In addition, they note that physicians must monitor patients with cellulitis with a history of needle use vigilantly since the average time to surgery for survivors of necrotizing fasciitis is 25 hours, so time is of the essence.

The authors of the report believe this is the first reported case of streptococcal necrotizing fasciitis from intramuscular injection of bath salts.

Friday, January 13, 2012

India’s major milestone: one-year polio free

January 13, 2011.

CDC/Dr. Fred Murphy, Sylvia Whitfield
That is the date one year ago today, when a 2-year-old girl in the West Bengal state fell ill of the crippling disease polio. That was the last case of polio in India.

Moreover, calling this a major milestone is putting it mildly. This is an unprecedented achievement for India, which not long ago was considered the epicenter for polio.

The World Health Organization (WHO) Director-General Margaret Chan said of this achievement, “India’s success is arguably its greatest public health achievement and has provided a global opportunity to push for the end of polio.”

Bill Gates of the Bill and Melinda Gates Foundation noted, “This is a major milestone in the global fight against polio. Children in India are now protected against this debilitating, but preventable disease, bringing us one step closer to saving and improving the lives of all children.”

There is a good possibility that India will be taken off the polio endemic list depending on laboratory analysis of sewage samples expected to be released in mid-February.

To be declared polio-free by the WHO, India will have to prevent polio from resurfacing for two more years.

According to UNICEF, in 1985, India had 150,000 cases of polio. This had fallen to about 6,000 in 1991, to 741 in 2009 and to just 42 in 2010. In fact, in 2009, India had half of the reported cases of polio worldwide.

There is a lot of kudos to go around on this cautious, but well deserved celebration. The Indian government, Rotary International, WHO and the Gates Foundation contributed heavily in both funding and resources to polio eradication in the country.

In fact, in 2011 alone, the mobilization of millions across the country and the billions of dollars invested for a mass eradication program set out to give every child under five the oral polio vaccine.

As Reuters reports:
Around 900,000 doses of oral polio vaccine were given, immunizing 172 million children and involving 2.3 million vaccinators who visited 200 million homes in 2011 alone.
India has also used mobile vaccination teams that immunize children at bus stops, train stations, inside moving trains and in marketplaces.
In addition, the WHO’s National Polio Surveillance Project instituted the use of the bivalent polio vaccines–targeting both type 1 and type 3 polio viruses, where earlier vaccination attempts targeted only one of the viruses and then the other would surface and spread.

However, as the Indian Ministry of Health and Family Welfare said in a press release, there is no room for complacency.

The threat from imported polio from neighboring endemic nations of Pakistan and Afghanistan will remain an issue for India and the intense vaccination programs cannot slow down.

Polio is caused by the poliovirus types 1, 2 and 3. All three types cause paralysis, with wild poliovirus type 1 being isolated from paralysis cases most often.

This viral infection is primarily spread from person to person through the fecal-oral route. However, in places where sanitation is very good, transmission though throat secretions may be considered more important.

Polio is recognized in about 1 percent of infections by flaccid paralysis, while over 90 percent of infections are unapparent.

Paralysis of poliomyelitis is usually asymmetric and the site of paralysis depends on the location of nerve cell destruction on the spinal cord or brain stem. Legs are affected more often than the arms.

Paralysis of the respiration can be life threatening.

Polio must be differentiated from other paralytic diseases like botulism and Guillain-Barre Syndrome.

The countries that have not succeeded in interrupting polio transmission and are considered endemic include Afghanistan, Nigeria and Pakistan.

Most cases of polio are in children under the age of three.

Prevention of polio is through immunization, either through the live oral poliovirus vaccine (OPV) or the inactivated poliovirus vaccine (IPV).

With just over 1300 cases of polio reported worldwide in 2010, the possibility that polio could be the second infectious disease eradicated off the face of the earth seems more plausible every day.

Wednesday, January 11, 2012

END7 campaign begins: eliminate seven neglected tropical diseases by 2020

Photo/CDC-Dr. Mae Melvin
Did you know that one in six people across the globe are infected with one or more of the seven major neglected tropical diseases (NTDs), including a half billion children?

Did you know that for a mere 50 cents, one person can be treated for these seven debilitating disease for a whole year?

The mission of the END7 campaign, launched Tuesday by the Global Network for Neglected Tropical Diseases and its partners, WHO and the Gates Foundation, is to build awareness of these seven devastating parasitic and bacterial diseases and to eliminate them by the year 2020.

The seven NTDs cause a wide spectrum of devastation ranging from blindness as in the case of trachoma and onchocerciasis, elephantiasis in the case of lymphatic filariasis and hookworm in the case malnutrition and anemia. The other NTDs targeted in this campaign are schistosomiasis, ascariasis and trichuriasis.

Mass drug administration is the method where several of the disease can be treated with a single drug, while others are treated with a combination of drugs for approximate 50 cent person.

Managing Director of the Global Network, Dr. Neeraj Mistry said, “Unlike many global health campaigns, END7 has an end in sight. With enough support and donations we believe we can end the plight of people suffering from these diseases by the end of this decade.”

The campaign will be centered at the END7 Facebook page which highlights the animated video, “Our Mission in Just over a Minute”. The video features the British actor known for his roles in films like “Love Actually” and “Harry Potter and the Deathly Hollows”, Bill Nighy.

Nighy said the following about NTDs, “I’m shocked by how much devastation these diseases cause. But what shocks me more is how simple the solution is. Pocket change to provide medicine that can help end not just one disease, but seven". 

Tuesday, January 10, 2012

Traveling to the Philippines: preventing infection

Wikimedia Commons/ASDFGHJ
The Philippines is an archipelago consisting of 7100-plus islands located in the western Pacific Ocean. The country brings in foreign travelers for a diverse number of reasons ranging from the cool climate of Baguio in the mountains to the pristine beaches of Boracay; from the ecotourism opportunities to the nightlife of Manila.

As beautiful as the country is, there are some serious infectious disease risks for the international traveler and education and preparation are a necessity to prevent getting seriously ill.

If you are planning to travel to the Philippines, you should see your personal physician, or preferably a travel medicine physician at least 4 weeks prior to departure but preferably 6-8 weeks prior.

When you see the travel medicine specialist, ensure you give this professional, detailed information about your trip including immunization history, any underlying health issues, what areas of the Philippines you plan on visiting and specific activities you will partake. Given this information, your travel medicine specialist will be able to best determine what you’ll need to protect yourself from a plethora of infectious agents.

I will go over some key diseases, activities and preventive measures that can help you before you travel to the Philippines.

Food and Water

Traveler’s diarrhea (TD) is the most common medical issue that people complain of while traveling in less developed countries.

A number of pathogens are associated with TD including bacteria, parasites and viruses. Vaccination can protect against certain infections like hepatitis A and typhoid fever.

Your travel medicine specialist may prescribe prophylactic antibiotics and antidiarrheals for your trip. However, taking prophylactic antibiotics are not recommended for routine use in preventing TD except in certain circumstances (immunocompromised). However, these drugs should be started if significant diarrhea happens.

Less commonly known parasites can be contracted through eating raw or undercooked foods. The roundworm, Capillaria philippinensis can cause severe intestinal problems and even death. You are infected with this parasite through raw and undercooked fish.

The oriental lung fluke, Paragonimus westermani is also seen in the Philippines and people are infected through eating raw or undercooked crabs.

In addition to the use of vaccination and antibiotics, tropical and travel medicine expert Dr. Elaine Jong offers the following ten tips for selecting safe food and water:

1.    Drink purified water or bottled carbonated water.
2.    Eat foods that are thoroughly cooked, and served piping hot.
3.    Eat fruits that have thick skins (they should be peeled at the table by the traveler).
4.    Do not use ice cubes in any beverages including alcohol.
5.    Only eat or drink dairy products that have been pasteurized.
6.    Avoid salads made with raw vegetables, in particular, leafy greens.
7. Avoid shellfish, and raw or undercooked seafood.
8.    Do not buy or eat food sold by street vendors.
9.    If canned beverages are cooled by submersion in a bucket of ice water or a stream, ensure you dry the outside of the container before drinking.
10.  Use purified water for brushing teeth and taking medications.


According the US Centers for Disease Control and Prevention (CDC) the vaccines that are recommended prior to traveling to the Philippines include:

1.    Routine vaccines such as measles, mumps and rubella (MMR)diphtheria/pertussis/tetanus (DPT), polio and influenza.
2.    Hepatitis A and B
3.    Typhoid if you are visiting smaller towns and villages where exposure may occur via food and water.
4.    If you are planning to visit rural areas, the Japanese encephalitis vaccine might be recommended.
5.    Rabies for travelers who will be involved in outdoor activities like camping or hiking.


Malaria is endemic in Luzon, Mindanao, Mindoro and Palawan in rural areas less than 600m.
Your travel medicine specialist, depending on where you will visit, will recommend prophylactic antimalarials.

The CDC says the following drugs can be used as prophylaxis for malaria in the Philippines: Atovaquone-proguanil, doxycycline, or mefloquine.

The CDC specifically notes that Chloroquine is not an effective antimalarial to take prior to traveling to the Philippines.

In addition, it is strongly advised to buy your antimalarial drugs prior to travel due to counterfeit drugs.

Antimalarials should be used in combination with using insect repellents, sleeping in screened  rooms or using bednets. This will not only help in preventing malaria, but also other mosquito-borne diseases found in the Philippines such as dengue fever and lymphatic filariasis.

The website MD Travel Health offers the following recommendations in insect protection:

Wear long sleeves, long pants, hats and shoes (rather than sandals). For rural and forested areas, boots are preferable, with pants tucked in, to prevent tick bites. Apply insect repellents containing 25-50% DEET (N,N-diethyl-3-methylbenzamide) or 20% picaridin (Bayrepel) to exposed skin (but not to the eyes, mouth, or open wounds). DEET may also be applied to clothing. Products with a lower concentration of either repellent need to be repplied more frequently. Products with a higher concentration of DEET carry an increased risk of neurologic toxicity, especially in children, without any additional benefit. Do not use either DEET or picaridin on children less than two years of age. For additional protection, apply permethrin-containing compounds to clothing, shoes, and bed nets. Permethrin-treated clothing appears to have little toxicity. Don't sleep with the window open unless there is a screen. If sleeping outdoors or in an accomodation that allows entry of mosquitoes, use a bed net, preferably impregnated with insect repellent, with edges tucked in under the mattress. The mesh size should be less than 1.5 mm. If the sleeping area is not otherwise protected, use a mosquito coil, which fills the room with insecticide through the night.


Swimming, kayaking and other fresh water recreational activities should be avoided due to schistosomiasis. Schistosoma japonicum is still endemic in parts of the Philippines. According to the CDC, because there is no practical way for the traveler to distinguish infested from noninfested water, travelers should be advised to avoid wading, swimming or other contact with freshwater in disease-endemic countries.

In addition to the above risks, there are many others including leptospirosis (waterborne), strongyloides and sexually transmitted infections.

See also:

‘Achilles heel’ in Plasmodium parasite that could lead to monumental vaccine

Malaria, the mosquito-borne parasitic disease, has been a huge scourge on mankind killing untold millions over the many years, has been very elusive to vaccine development until recently.
For the people of Africa and Asia that suffer from this deadly affliction, particularly young children and pregnant women, the main weapon in prevention has been bed nets.

However, progress towards preventive vaccinations has showed some promise recently. Earlier this year, a vaccine known as RTS,S appeared to protect about half of people vaccinated from malaria according to early clinical trials.

Now, researchers from Oxford University, the Wellcome Trust Sanger Institute and the Kenyan Medical Research Institute-Wellcome Trust Programme in Kilifi, Kenya, say they have produced a vaccine that induces an antibody response in animal models that is capable of neutralizing all the strains they tested of the malaria parasite Plasmodium falciparum.

Their findings are published in the journal, Nature Communications.

According to researchers, the ‘Achilles heel’ is a substance known as PfRh5 (P. falciparum reticulocyte-binding protein homologue 5) that allows the malaria parasite to invade the red blood cell where it grows and replicates, and frequently in the case of Plasmodium falciparum, causes a deadly outcome.

Lead researcher Dr Sandy Douglas of the University of Oxford said in an news release last week, ‘We have created a vaccine that confirms the recent discovery relating to the biology of RH5, given it can generate an immune response in animal models capable of neutralizing many – and potentially all – strains of the P. falciparum parasite, the deadliest species of malaria parasite. This is an important step towards developing a much-needed vaccine against one of the world’s major killers.’

Professor Adrian Hill, director of the Jenner Institute at the University of Oxford adds, ‘Vaccines against malaria are notoriously difficult to develop because the parasites’ antigens – the target of vaccines – tend to be genetically so diverse. The RH5 antigen doesn’t show this diversity, making it a particularly good target for a vaccine to exploit. Our next step will be to begin safety tests of this vaccine. If these prove successful, we could see clinical trials in patients beginning within the next two to three years.’

Neti pots, Naegleria and you

Kurt Yoder/Wikimedia Commons
After two reported deaths in Louisiana last year from “brain-eating amoebas” after using neti pots, health authorities and the manufacturer of nasal wash device are warning the public not to use unsterilized tap water when using the neti pot.

The Louisiana Department of Health and Hospitals announced earlier in the month that a 51-year-old DeSoto Parish woman died recently after using tap water in a neti pot to irrigate her sinuses. In June, a 20-year-old St. Bernard Parish man also died, both because of infections with the nearly 100% deadly amoeba, Naegleria fowleri.

What is a Neti Pot?

According to Mayo Clinic asthma and allergy specialist, James T C Li, M.D., Ph.D., a neti pot is a container designed to rinse the nasal cavity. You might use a neti pot to treat nasal allergies, sinus problems or colds.

In addition to Louisiana health officials, Dr. Ketan C. Mehta, MD, CEO of NeilMed Pharmaceuticals Inc., the manufacturer of the NasoFlo Neti Pot issued a release Thursday emphasizing the safe use of the Neti Pot.

Dr. Mehta says in the release:

As a physician, I feel that nasal irrigation is safe and very effective for nasal and sinus symptoms as long as directions are followed as described in our product brochure.
NeilMed has learned about recent news and internet articles concerning the improper use of unfiltered or contaminated tap water with neti pots. We emphasize when used as directed, NeilMed’s nasal wash devices are safe, affordable and effective. From the beginning, NeilMed’s directions of use have always stressed the importance of using clean and previously boiled, distilled or filtered water through a 0.2 micron filter for nasal irrigation. Our product brochure clearly notes that using tap water is not recommended. Please do not use tap or faucet water when using NeilMed’s nasal wash devices unless it has been previously boiled and cooled down. NeilMed brochures also provide clear instructions for disinfecting our nasal irrigation devices. The neti pot devices are designed to allow for microwave disinfection as they do not contain any metal parts.

Can I use the tap water for nasal rinsing if it is labeled safe to drink?

No, we do not recommend using drinking tap water for nasal rinsing unless you boil it or run through a filter of 0.2 micron size. Tap water is not always safe depending on its environmental source, and it is impossible to designate all areas as water safe for nasal irrigation.

Naegleria fowleri is a relatively rare, pathogenic amoeba found in warm or hot freshwater like lakes, rivers and hot springs. It is also possible to get it from dirty unchlorinated or under-chlorinated swimming pools. This parasite is found worldwide and in the United States, it is found  mainly in the southern-tier states.

People typically get it by swimming, jumping or playing in freshwater and get the water up their nose. From there the parasite travels to the brain and spinal cord and necrotizes or basically eats brain tissue. The disease is known as primary amoebic meningoencephalitis (PAM) and it has a very rapid progression. Typical symptoms may start after a day or two; headache, fever, nausea and vomiting. Later symptoms may include seizures, irrational behavior, hallucinations and finally coma and death. The course of the disease typically last about a week. Because the symptoms are very similar to bacterial meningitis, PAM may not even be considered in the diagnosis.

Fortunately, it’s a pretty rare disease, with only approximately 30 cases in the past decade. 

Unfortunately, treatment is usually unsuccessful with only a handful of people surviving infection.

You should always assume there is some risk when swimming in freshwater. The location and number of amoeba present in a body of water varies from time to time. The Centers of Disease Control and Prevention recommends these four steps to reduce your risk of infection:

• Avoid water-related activities in bodies of warm freshwater, hot springs, and thermally-polluted water such as water around power plants.
• Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
• Hold the nose shut or use nose clips when taking part in water-related activities in bodies of warm freshwater such as lakes, rivers, or hot springs.
• Avoid digging in or stirring up the sediment while taking part in water-related activities in shallow, warm freshwater areas.