Here's why you should never use tap water with your neti pot

linavita/ShutterstockA woman (not the one pictured) died after using non-sterile water to clean out her sinuses, doctors say.
  • A 69-year-old woman died after contracting an amoeba infection in her brain, LiveScience reported.
  • Doctors suspected that she got the infection because she repeatedly cleaned out her sinuses with non-sterile tap water.
  • Other people have died after using amoeba-contaminated tap water in neti pots, a common device used for clearing sinuses.
  • Experts say a neti pot should be used with boiled and cooled tap water or distilled, sterile water purchased at a store.

A 69-year-old Seattle woman died after contracting a brain-infecting amoeba – and doctors suspect that her use of non-sterile water to clear her sinuses was to blame.

The woman’s story was detailed in a case report published in September by International Journal of Infectious Diseases, LiveScience reported Thursday.

At first, the woman was diagnosed with a simple sinus infection. But when a course of antibiotics didn’t improve her symptoms, doctors recommend that she try saline nasal irrigation – an at-home remedy in which a saline solution is poured into the nose to clean mucus or allergens out of the sinuses. It can be performed with a handful of different devices, but the best known is probably the teapot-shaped neti pot.

Experts recommend using sterile saline or water for nasal irrigation, but the woman instead used tap water that had been filtered using an at-home water purifier, the report said.

A month later, she developed a quarter-sized rash on her nose that didn’t go away despite several dermatologist visits. Then, a year after she starting using the neti pot, she had a seizure, and scans revealed a lesion in her brain. After two surgeries and some testing, doctors finally determined that her brain has been infected by amoebas. Despite aggressive treatment, the woman died.

The woman was infected by the Balamuthia mandrillaris amoeba

 amoeba brain infection Balamuthia mandrillarisCDCBalamuthia mandrillaris is an amoeba that can cause fatal infections.

It wasn’t until after her death that testing revealed the precise amoeba responsible for the infection: Balamuthia mandrillaris. It’s an organism that can cause serious brain and spinal cord infection, according to the Centres for Disease Control and Prevention (CDC). It’s been found in dust and soil around the world and may also exist in water. It was first discovered by scientists in 1986 and since then, about 200 cases of Balamuthia infection have been diagnosed worldwide.

Right now, little is known about how people contract Balamuthia infections, the CDC website adds. But if someone does get one, the outlook is grim: “Due to the difficulty of diagnosis and severity of this infection, the fatality rate for Balamuthia infection is near 100%,” the authors wrote in the case report.

The authors suspected that the woman’s nasal irrigation provided a “route of entry” for the amoeba to get into her body. They can’t be 100% certain of this, the report added, because the water at the woman’s home was not tested for evidence of Balamuthia.

But there is past evidence to support this idea.

Other people have died after using neti pots with contaminated tap water

Some tap water can contain low levels of organisms like bacteria and amoebas but may still be safe to drink because stomach acid kills them, according to the Food and Drug Administration (FDA). But if an individual uses tap water for nasal irrigation, these organisms may stay alive in the nasal passages and cause infections.

In fact, in 2011, two people in Louisiana died after their brains became infected with the rare amoeba Naegleria fowleri. Both people had used tap water in neti pots to clean out their sinuses, and Naegleria fowleri was found in water samples from both homes, a group of researchers found. Very rarely, cases of Naegleria fowleri infection have also been reported in people who cleaned their sinuses for religious reasons and happened to use contaminated water, the CDC website adds.

In the new case report, the authors described Naegleria fowleri as “comparably insidious” to Balamuthia.

Experts say you should always use sterile water in a neti pot

Neti potMandriaPix/ShutterstockThis is what a neti pot typically looks like.

Nasal irrigation isn’t new. The neti pot comes from Ayurveda, the traditional Indian medical system developed more than 3,000 years ago. When modern-day scientists have put it to the test, however, the results have been murky. Some research has shown that nasal irrigation can improve symptoms of sinus infections, cold and flu, and allergies, and possibly reduce the need for decongestant medications. A 2015 review concluded that, in general, neti pot use may be beneficial, but the evidence we have comes from studies that are small and poorly designed.

Still, according to the National Institutes of Health,nasal irrigation is generally safe – as long as you use the right type of water.

Given the potential risk of infections caused by amoebas, the FDA says there are only three types of water that are safe to use with neti pots:

  • Tap water that has been boiled for three to five minutes and then cooled until lukewarm
  • Distilled or sterile water you buy in a store (look for those words on the label)
  • Water that’s been passed through a filter that a designed to trap infectious organisms (The CDC has more information on these filters)

Neurosurgeon Dr. Charles Cobbs, an author of the case report, echoed this message in an interview with LiveScience.

Because Balamuthia infection is rare, “people should just go about their normal lives” without panicking, he told LiveScience. But if they do use a neti pot, he added, they should “definitely use sterile water or saline.”


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