A similar case, this one in a 51-year-old woman in northern Louisiana, occurred three months later.
The woman was admitted to a hospital on Sept. 28 with nausea, vomiting, neck stiffness and "altered mental status."
She died Oct. 2 and an autopsy revealed amebic meningoencephalitis.
Again, the woman's parents reported that their daughter had had no freshwater exposure in the past two weeks but also regularly used a neti pot.
In both cases, N. fowleri was found in the tap water of the individuals' homes.
Although N. fowleri cannot survive in salt water, the saline solutions used in these neti pots was unable to kill the organisms.
Despite the severity of the infection, "very simple measures could prevent it," Falsey said.
Yoder recommended using boiled or filtered water when preparing to use a neti pot.
"Even though tap water is safe . . . for drinking, showering and bathing, it's certainly not sterile water and we don't think it's appropriate for something like nasal irrigation," he said.
And there are other reasons not to use tap water for nasal irrigation, including the presence of E. coli and the bacteria legionella, Falsey said.
Officials don't know why these two cases occurred in Louisiana, but there is some evidence that N. fowleri may be expanding its reach, particularly into northern areas, which are experiencing warmer weather. A case of primary amebic meningoencephalitis was reported for the first time in Minnesota in 2010 and also in Kansas in 2011.
The U.S. Centers for Disease Control and Prevention has more on N. fowleri and primary amebic meningoencephalitis.
SOURCES: Jonathan Yoder,
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