Rare brain-eating amoebas killed woman who rinsed her sinuses with tap water | Hacker News Reader

Rare brain-eating amoebas killed woman who rinsed her sinuses with tap water

seattletimes.com

158 pointslxm198 comments

Sounds like she was using a neti-pot. I thought most of the neti-pot products made it pretty clear that you're supposed to use previously boiled or distilled bottled water. Maybe they need to make it more clear that the consequences of using tap water can be pretty dangerous.

They do, but I am never sure how that is supposed to be practical. You need to use warm water, which is easy with tap water, but hard to do quickly with distilled or boiled water.

I know it has risks, but I still use normal tap water. From what I have read, all of the cases are from people using well water, never from city provided, chlorinated water. It actually says this in the article, too.

Whenever I use a neti pot, I use distilled water and heat it for a brief time in the microwave, adding additional room temp distilled afterward if it comes out too hot.

Exactly this. Putting it in the bottle and microwaving for 38 seconds (experimentally determined, your <microwave> may vary) makes it a nice, comfortable temperature for use.

In practice you don't need to use warm water. I do twice daily saline sinus washes with distilled water and it's pretty low maintenance. Tap would be easier but I've always found the idea of using tap water for this to be gross so it's never been an attractive idea.

Oh man, if the water is room temperature it really hurts my nose.

Do you use the saline packets? That makes it much easier on your nose. I only have to use mine a few times a year but I have a bottle of distilled water that I just use at room temperature and its fine.

Yes, I use the saline packets. It REALLY hurts without those. But even with them, it hurts at room temperature.

It's actually quite practical: boil water then stick a thermometer in it. Go do other stuff and check the temp; as it comes down and matches your body temp, it's perfect.

Can you explain why you use a neti-pot? I don't know anyone who uses one and I don't really understand the reasons behind it.

My wife uses one to clear out her sinuses when they are stuffed due to a cold. Sinus infections cause her pain. Her doctor recommended it. She uses a squeezable bottle.

I made sure she only uses distilled water. She dissolves a saline powder in it.

It relieves the symptoms of sinusitis. Painful pressure can build in your sinuses, and rinsing can help open passages and equalize the pressure as well as soothe the pain a bit.

I also like to think I'm removing bad stuff and helping with the healing process, and maybe killing bad stuff by flushing it with salt water, but this is my own personal myth.

I use a version* of a net-pot to flush out my sinuses after surfing. If I don't, especially if I surf in a red tide, I get a nasty sinus infection (surfers sinusitis or acute sinusitis). I even had sinus surgery to reduce my turbinates and increase my sinus ducts which helps, but still doesn't prevent the problem.

* I use NeilMed's sinus flush which basically is a sealed bottle with a straw I can use to force flush my sinuses, vs. just using gravity.

I had to use one after a sinus surgery (to remove a not-so-tiny bone spur and then put things back where they belong) to flush out dried blood and whatnot.

I've used it a few times after when I have a severe head cold to open things up a bit. Easier and less invasive than going through the background check needed to buy cold medicine.

Reduces incidents of mild sleep apnea in conjunction with nasal strips and sleeping on my side. (I determine occurrence of sleep apnea by checking if waking happens between or during sleep cycles.)

Also helps with voice work (I am a voice coach), makes for clearer mask resonance.

(An in-hospital sleep study confirmed my self-diagnosis of mild sleep apnea.)

What do you mean by mild? I did a study and had an AHI of 28, my doctors put me on CPAP. I'm not overweight and the machine is set to give hardly any pressure but it still seems to eliminate the issue, at least according to the machine's own counts. If I could fix it with just some nose strips and a neti pot, that would be amazing.

"Mild" used by doc prescribing me Modafinil after study. There were insurance cost concerns as well so I pursued other options.

I have to work at keeping my mouth closed, and some nights don't work out well, but most do. I also use alternating combinations of sedatives, and take them in stages (e.g. sometimes a partial pill embedded in a softgel taken after 3 hours of sleep). I'm overweight, and it did start for me after I gained weight

It REALLY clears out your sinuses if you have a lot of mucus (from allergies or a cold). You know how when you blow your nose, you never get everything out? Some of the mucus comes out, but some is driven up into your sinuses because the air is coming from the middle (imagine a tube full of water,and you blow into a hole in the middle... half the water will be blown in each direction)

Neti pot will get all of the mucus out (especially when i do it first thing in the morning, before blowing my nose). It comes back, of course, but having a few minutes of mucus free breathing when you have a bad cold or allergies is amazing.

For me it basically cured a several-years long bout of hay-fever symptoms (constant congestion, could never get it all the mucus out) over a period of just a couple weeks of usage. I use it now just a few times of year whenever I get a cold that causes congestion, because its such a relief to get that crap out of your nasal and sinus passages.

Sinus pain can be excruciating. In my mid-20s, pretty much any cold or flu I got started being followed by a sinus infection. Most of them are relatively mild, but a couple of them have been truly debilitating. Pseudoephedrine brings some relief, but has side effects. Neti pot brings additional relief, and is free of side effects. (And is much cheaper than PSE.)

You shouldn't be using water from the hot tap even just for drinking or cooking, let alone putting in a neti pot. Water from a hot water tank can contain high levels of dissolved contaminants since it sits in your plumbing system for extended periods at high temperatures.

No cooking? Even, say, boiling potatoes? I always use filtered water if I'm planning to consume it, but I thought I could get away with the sink if I was throwing it out.

That's news to me, I'll have to boil cold water from now on.

I wouldn't worry as much about boiled potatoes as I would something like soaking/cooking grains. It's a matter of your level of concern. I rinse dry goods and and vegetables with tap water, and steam with tap water, but I use expensive water for anything else. Mostly because I don't discard the water. Either the food absorbs all the water, or I accept a mushy, stewy, or soupy consistency.

Steaming is better if you're going to use tap water and discard it. With the food out of the water there's less contamination as well as less nutrient loss.

Filters are not perfect. Reverse osmosis or distillation is better (in theory). Anyone using a filter should pay attention to what it filters. Some filters don't even claim to filter lead. I think Brita and Pur still have multiple filter types that filter different things, and one type isn't a strict subset of the other.

After some googling, I concluded that filters in good-tap-water neighborhoods do more harm than good -- they filter out nutrients that we do need from water.

What nutrients does tap water have in it? Fluoride?

Various minerals and electrolytes such as calcium, magnesium, potassium. I don’t count fluoride as a nutrient.

All kinds of minerals and such. In fact totally clean water, without them, is harmful and poisonous:

"Drinking absolutely pure water can kill you. All the water we normally drink – from taps, from bottles, from the garden hose – contains impurities which affect a property of water called tonicity. This is the ability of a solution to draw or repel water from ajacent solutions when separated by a membrane. Solutions that are hypertonic gain water, while hypotonic solutions lose water. Drinking water, which we usually think of as pure, really contains a whole mess of salts and sugars which make it slightly hypertonic. They also give water its taste. The cytoplasm in the cells of your body also have a tonicity. So, when they are exposed to hypertonic solutions, the cells themselves lose water and shrivel up. When they are in hypotonic solutions, they gain water, swelling up and bursting like a balloon. Absolutely pure water -with no impurities at all – is the most hypotonic solution. So, if you drink enough of it, your cells will start absorbing water. This disturbs the balance of electrolytes (electrically conductive ions) in your body. This is most seriously a problem in the brain, where water poisoning can lead to brain damage, coma and even death."

> I rinse dry goods and and vegetables with tap water, and steam with tap water, but I use expensive water for anything else. Mostly because I don't discard the water. Either the food absorbs all the water, or I accept a mushy, stewy, or soupy consistency.

I use roughly the same rule of thumb, but I've never been confident about applying it to beans. I often rinse and soak dry beans in bulk. I portion them out and freeze them after cooking, and don't really want to be freezing bean mush. They do absorb a lot of water, but between the rinsing/soaking/cooking process, it's also a lot of expensive water to be pouring out.

The lady in the article got the infection after using a water filter.

This leaves 2 possibilities that I can see.

1. The filter didn't do it's job. I thought that a good filter would filter all organisms (or like 99.9%). I'm told by people that you can drink out of a swamp or mud puddle with a good filter.

2. The filter does work, but she didn't maintain her filter. Maybe the dirty filter actually was a nice place to cultivate the amoebas? I would be curious if an unchanged filter can actually increase your chance of infection. At best though, the dirty filter wasn't able to filter this organism.

>I'm told by people that you can drink out of a swamp or mud puddle with a good filter.

"Good filter" is a relative term. Maybe you could do it if you "filtered" the water with a $10M reverse osmosis membrane? The filters I buy all say "do not use with unsafe water" or some similar phrase.

Filters for camping/outdoor usage are less than $100 and most of them are explicitly sold as suitable for use with dirty water. You get a disclaimer that they'll be slower and need to be replaced more often when used on dirty/cloudy water, and sometimes they also advise a chemical or UV treatment be used post-filtering if there are concerns about viruses. Eg. https://www.katadyn.com/us/us/428-8019160-katadyn-gravity-ca...

There’s a big difference between those and, say, a Britta filter.

Huh? If tap water is contaminated (by, say, metals or salts from plumbing system pipes), then boiling won't decontaminate it either.

The hot water in your water tank may contain an excess of salt deposits, leeched metals, and rusts that you don't want to consume.

Cold water has less solubility of most substances than hot water and it spends less time sitting in a hot container of those substances.

Therefore, use the cold water to make hot water on your stove and regularly clean the kettle: https://www.reddit.com/r/ThingsCutInHalfPorn/comments/7uu0jz...

> The hot water in your water tank may contain an excess of salt deposits

This is clearly impossible due to conservation of mass, unless you're claiming that the water heater is so hot that it causes nuclear reactions in the water.

Convervation of mass? What do that has to do with it.

Hot water tanks accumilate mineral sediment which might tear of as particles and follow the stream.

? I'm not quite a physicist, but I'm pretty sure this is wrong. The closed system under consideration here consists of both the solute (from the parts of the plumbing system the water has passed through) and the water. If hotter water dissolves more solute, then less solute remains in those parts. What part of this violates conservation of mass?

I would have had your perspective except that a few months ago I came back from vacation to find that my hot water smelled like windex. The apartment complex flushed my hot water tank, a whole lot of black sludge came out, and my water has been fine since. I assume that not using the hot water for a few weeks caused everything to collect in a concentration high enough to notice, but it makes me cringe to think of how much low level of windex-smelling stuff I drank previously. (Fortunately my hot water takes a minute or two to arrive, so I probably didn’t consume that much just because I didn’t want to wait long enough.)

This is what is in your hot water tank right now.

https://www.youtube.com/watch?v=kAzKts6Wp1Q&t=55s

If your water heater is malfunctioning and not heating up all the way to 140 degrees but it's still heating up to e.g. 100 degrees then it's a breeding ground for listeria. The temperature difference changes the solubility of minerals and salts dissolved in it as well as changing how quickly everything even slightly volatile leaches into the water.

Paradoxically if that is in the tank it means the water coming out must be purer than cold since the contaminats are left in the tank - on average.

In terms of dissolved minerals sure, but there's two important distinctions to make. The tank isn't just accumulating deposits, there's an anode rod inside that's designed as a sacrificial element to protect the tank itself from corrosion. That anode rod gets consumed over the course of a decade so while it's not much, it is being introduced into the water. Also those deposits provide a porous substrate for bacteria to grow on and the heat will help things along.

>> This is what is in your hot water tank right now

Does anyone think the inside of a ~20 year-old cold water feed pipe is going to look shiny and "clean"?

Go take an electron micrograph of the bacteria on your skin, or use a microscope to look closely at the living things inside your bed, in your sofa, or on your pet.

Then take a deep breath, check the causes of death tables if you really have to, and remember that - given we're all intelligent humans - none of these "eww, gross!" things really matter in the overall scheme of things.

Yeah the cold water side will look dramatically better. It certainly will have deposits accumulating but it's not going to be anything close to the amount of deposits that form inside of a water heater. Heating up hard water will chemically alter the water going through it. It's not that those calcium carbonate molecules were in solution before, it's pretty insoluble in water, it's that they were chemically formed when the water was heated.

I'm not suggesting that those deposits are going to kill you or anything, but if things go wrong and the water isn't heated enough those deposits make a great substrate for harmful bacteria to grow.

Ideally you shouldn't use hot water for consumption even though normally it's safe. It also tastes different than cold water because of the change.

Isn't that pretty dependent on where you live? If you are in a newer house I doubt it would be an issue, since you have a personal water heater that gets cycled through pretty regularly.

If the water heater uses copper pipes, the copper still gets into the water. And even with plastic pipes the trace amount of plastic may still end in the water and nobody knows if drinking such water for, say, 40 years is safe.

So do not use hot water for cooking/drinking.

Pex is thermo stable.

You can buy food supplements containing copper explicitly, so I wonder how bad that could be.

Copper containers are actually great at killing bacteria.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312355/

But high levels can cause health problems, including kidney damage and possibly cancer.

https://www.canada.ca/en/health-canada/programs/consultation...

Between dying of dysentery and risking long term health issues it's a simple choice.

But unless your doctor specifically tells you to add more copper, you shouldn't be going out of your way to get it.

Yup. In houses that are not connected to the central heating, hot water travels through many more systems in your house than the cold water. Some of those systems can be pretty nasty e.g. when I disassembled my circulation pump, the water-immersed rotor assembly was leaking black goo.

Naegleria Fowleri were found in public water systems in Louisiana last year. I don't know of anyone dying because of it though.

https://www.ajc.com/news/national/brain-eating-amoeba-found-...

>They do, but I am never sure how that is supposed to be practical. You need to use warm water, which is easy with tap water,

Uh, 30-45 seconds in the microwave in a microwave-safe container.

I have a motorized unit, distilled water goes into a glass in the microwave for 45 seconds. Salt packet goes into the reservoir and a maybe 5 ounces of room temp distilled then the microwaved water.

We've got a neti-pot-like thing that comes with a built-in filter. I don't worry about it past that.

Going by this article, it seems like you should.

A filter is not good enough to remove microbes.

In the case of Neil-Med, the documentation I have retained says to use previously boiled or properly filtered water (they provide some examples) when mixing. And they say not to use tap water. But they don't inform the user of the potential hazard of using otherwise safe-to-consume tap water.

Worse, the bottle (mine is a squeeze bottle) doesn't have any reminder not to use tap water, at all. It would seem this would be worth a large placard on the back of the bottle. The likelihood is low but the danger high; this is the worst kind of risk because it doesn't happen often enough to serve as a reminder.

Doesn't this company direct you to use their salt packets as well?

Does the salt kill amoebas?

Using a normal saline solution of 0.9% NaCl is much more comfortable, doesn't sting the sinus membranes at all. I wouldn't count on it to kill anything

If the amoebas thrive inside the body, they certainly won't be harmed by a saline solution.

> But they don't inform the user of the potential hazard of using otherwise safe-to-consume tap water.

Devil's advocate: if they did, odds are consumers would consider it as if the company is peddling conspiracy theories rather than actual science. Or "maybe it's true for tap water where the pots are made, but I trust my tap water and I know it's safe". If such explanations are more likely to harm a company's perception than to protect consumers, then what value do they have?

The good that that does is saving lives, even if it harms the companies reputation. It sounds like you're suggesting that a companies reputation is worth more than the potential death of unknowing, innocent people.

Of course the company has a moral obligation to protect their consumers, which is why the company warns against using tap water in the first place. The question isn't whether or not it's worth it for the company to try and save lives, it's whether an additional explanation will actually save more lives. The fact that there's a real potential image hit to the company makes the case that much more difficult to make to decision makers.

This person may have had a poor immune system. I mean, people do put plenty of unsterilized compounds up their noses regularly, without drying from brain-eating amoebas... Though I suppose brain-eating amoebas don't typically thrive in powdered chemicals, making the users more safe from this one potential risk.

How is a neti pot worse than steam in the shower? I’m surprised at this.

By definition, steam has been heated to a high temperature and exists as stray molecules before condensing back to water droplets. I guess microbes can't easily survive or be carried along in this process.

That said, it seems it's possible that this kind of thing can happen [1], but it's rare (and though that article is confusingly written, it seems that the bacteria in that case came from the air, after the steam had re-formed as water droplets).

Anyway, the OP says this amoeba in a neti-pot scenario is rare too, so it seems we're always talking about fringe cases with this kind of stuff.

[1] http://www.cleveland19.com/story/33829012/doctors-warn-about...

How's this for a disclaimer:

"There's almost no potential upside and a massive potential downside."

RTFM... When is the last time you’ve actually did it?

It’s a problem with user not understanding its own anatomy rather than product itself.

Not to mention, hot water tanks are a prime facility for some of these pests to grow while most people have no idea they should avoid their home hot water for anything other than washing. It should not be consumed in any way... this is why coffee makers specifically tell you to use cold water.

Pretty sure that is because of metals. Living things die when boiling anyway

The temperature of a typical hot water tank is 120-140 degrees Fahrenheit, which is significantly less than the boiling point of water, 212 degrees Fahrenheit. If the water tank temperature is just a little lower, at 115 degrees, it's the prime temperature for these buggers.

Also, this might be a fun read for you: https://en.m.wikipedia.org/wiki/Thermophile

Hot water tanks aren't hot enough to sterilize. In fact, they're a perfect temperature to grow many things.

Lead dissolving in hot water is the primary reason that one should not consume hot tap water. Nor should one wash their hands with hot water after lead exposure. Some gun ranges go so far as to remove the hot water tap from the bathrooms.

what's the difference from washing your face? Doesn't some water go inside the nose /sinuses when you blow it, breathe as you wash? (I guess even 1mm3 would contain plenty of microbes.)

Since these types of incidents are so rare I would not suddenly be afraid of using such a device.

I also wonder if she applied salt to the water (you should use saline) which also may help keep this stuff away if the concentration is right. But I don't know about that.

If you don’t use saline solution, it becomes very uncomfortable. Even accidentally using the wrong concentration is immediately noticeable.

I’d highly doubt many people would do that regularly.

When I used neti pot long long ago, our instructor made it explicit that you should only use boiled and cooled lukewarm water mixed with salt, if you cannot find a readily available saline solution. She even gave the salt:water ratio which I've forgotten. The general consensus in the yoga community is to better be safe than sorry.

> The general consensus in the yoga community is to better be safe than sorry

The safe thing would be to avoid netting pots, which have no known benefit and several known risks.

Pain relief is a pretty nice benefit.

I don't get the scare mongering in this discussion. People are saying to always boil the water, to not cook with hot tap water, etc. Don't these people bathe in hot tap water? Don't they drink cold tap water? Do they all live in areas with super unsafe tap water?

Or is there a specific danger that comes from the water going up your nostrils? (Which can easily happen while bathing)

What am I missing here?

109 cases in a little over 40 years.. yeah, this is more of a freak occurrence. also, the article says they never tested the water, so this idea of the neti pot is just a guess to begin with.

There must have been something else involved. Should we not swim in pools, rivers or lakes, or submerge ourselves in hot tubs?

Netis are part of Ayurvedic medicine in India since long before people dreamed of personal immortality.

Remember when people worked outside all summer without worrying about excess UV? Maybe we're overthinking this stuff, we Chicken Little emulators.

Spending a large part of the day under direct sunlight (e.g., working in a farm), is known to paradoxically reduce the risk of skin cancer; whereas occasional exposure (e.g., working at a desk job and then sunbathing in Cancun) greatly increases the risk.

Perhaps we're not overthinking it. Maybe there are complex processes that we don't yet understand.

This phenomenon has been well known for almost all of history.

https://en.wikipedia.org/wiki/Mithridatism https://www.ncbi.nlm.nih.gov/books/NBK349158/

This is interesting - do you have a source for this?

You absolutely should not get river or lake water in your sinuses if you can help it. The lake I used to swim in as a kid would regularly get warm enough to have amoeba in it that could cause amoebic meningitis and we were always told to keep our heads above water.

> Netis are part of Ayurvedic medicine in India since long before people dreamed of personal immortality.

Yes. And in that time period, average life expectancy was somewhere in the neighborhood of 30 years. The risk of death from neti pot use was hardly significant compared to all the other health risks anyone living at the time would be exposed to.

The same goes for skin cancer. It's a meaningful risk to us today because we can live long enough for the cumulative damage from solar radiation to be a meaningful cause of mortality.

30 is the mean between infants and 60-year-olds. There has never been a society in which dying at 30 was typical.

Infant mortality was the biggest contributor, but there was also higher mortality across all age groups.

IMO most of 'average life expectancy' can be attributed to human ignorance and savagery. Like the savagery of pouring dyes into rivers until too many people die of bladder cancer, then moving the factories to another continent. Repeatedly. Or the savagery of using scientific knowledge to create nukes ... and use them.

One example of ignorance is knee-jerk, gainsaying, scientism about alternatives to Western medicine. My use of Neti was recommended by a well-trained physician, and it was very beneficial. There was indeed practical wisdom in the world before the rise of materialist rationalism.

Oh yeah... and western medicine couldn't save the lady's ass. I'm sure the bill was VERY healthy though.

There is a specific danger associated with the water going up your nose. Things that go up your nose have better access to the blood brain barrier. Don't snort unboiled water kids.

Source? 'access to the blood brain barrier' sounds odd. You make it sound like the BBB magically starts in the nostrils and is somehow weak there. That's not how the BBB works. Sure, your nostrils are closer to your brain than, say, your teeth, but not by much.

I’m fairly sure that different body parts do provide easier access to the blood brain barrier. In this case, I would guess that it’s because of the mucous membranes in the nasal cavity. There must be a reason people snort cocaine rather then just rub it on their hands.

Great comment. They don’t dissolve it into water and gargle either.

https://www.futurity.org/nasal-spray-brain-cancer-1859772/

My wording was a bit off. The nerves in your nasal passageways apparently bypass the bbb altogether.

> I don't get the scare mongering in this discussion. People are saying to always boil the water, to not cook with hot tap water, etc. Don't these people bathe in hot tap water? Don't they drink cold tap water? Do they all live in areas with super unsafe tap water?

My understanding is that you can generally drink water with this amoeba in it and be fine. This makes sense intuitively - our digestive systems evolved to handle "adversarial inputs".

> Or is there a specific danger that comes from the water going up your nostrils? (Which can easily happen while bathing)

It seems that this particular amoeba only enters the body through the nose, so yes. Also, a significant amount of water doesn't usually go up your nostrils when bathing or swimming unless something goes wrong. And if it does, you experience a painful sensation that will immediately compel you to clear your airway.

But, looking it up, it appears that swimming in amoeba-infected water can lead to infection. Still, I imagine a neti pot is a great way to increase chance of infection because you're pouring lots of water through your nasal cavity, which is not something that happens while bathing or swimming.

What you are missing is that there is a particular organism that is not killed by normal safe water treatment and has been found in many city water supplies. When you drink it or get it on your body it doesn't matter, your digestive system handles it, that's why they don't have a concern with normal use. You can eat it, put it on your skin, it's okay.

But this particular organism can hurt you if it goes into your nostrils. It is found in many city water supplies, and I suppose the reason is there's something about typical water treatment that doesn't kill it. In both cities I have lived in it was there. My wife use's neti pots and knew about this. The first time I heard you couldn't use tap water for your nose, I thought it must be wrong, because "of course tap water is safe and treated". I have also swam in fresh water pools, usually a natural hot springs, that has a warning about this same organism. If you swim and water gets in your nose in those pools there is a chance it could get into your brain and kill you.

The source of the tap water matters. The article doesn't appear to mention this important detail.

I'm stunned at how many people are commenting that they will continue using untreated water. You can end up having your brain eaten and die, I can't think of a PSA any more convincing.

There's been ~100 cases in 40 years. That's less than 3 people per year, so it's very rare.

There's about 10 shark attacks per year in the U.S. Now that you know that, will you stay out of the ocean forever? Or will you maybe take the risk and go for a dip if you go on a beach vacation?

edit Plus, of those 40 cases the vast majority are from swimming in lakes. So there's only a handful of cases where the infection was due to neti-pot usage. I could only find 3 confirmed cases. That's extremely rare.

>Now that you know that, will you stay out of the ocean forever?

No but I might avoid areas known to host sharks.

This is exactly the point. It's just a curiosity, nothing more. There's no reason to believe that you should change your behaviour in any way.

Crossing the street once is more dangerous.

And yet, how little effort is it to use saline or boiled water? Boil the kettle, leave to cool. Warm water is more comfortable anyway.

Also, it might be incredibly rare because most people follow the instructions, and/or the people who follow instructions poorly live in areas with highly treated water (essentially the entire urban population). In warmer rural areas, using rainwater or borewater, it is likely to have significant growth of Naegleria fowleri. Children are particularly susceptible.

https://healthywa.wa.gov.au/Articles/A_E/Amoebic-meningitis https://www.cdc.gov/parasites/naegleria/pathogen.html https://www.abc.net.au/news/2018-03-20/professor-encouraging...

There is a similar problem where cleaning contact lenses with untreated water leaks to Acanthamoeba infection, leading to possible blindness of loss of an eye.

Are you going to stop bathing or showering in untreated water because it might get inside you that way?

We all weigh risk against convenience. This is very low risk.

It's more likely to die from an infected burn caused by an accident while handling boiling water to prepare your water for rinsing - I suppose.

I wash my nose in such a way frequently because I have an extreme sensitivity to airborne chemicals and fragrances. It’s so uncomfortable to be doused with air freshener, diesel exhaust, cleaner fumes, laundry fragrance, plastic odor or perfume that I rinse my nose out with whatever water is available, which includes taps and drinking fountains. I’ve worried about such an illness happening to me, evidently with good reason.

Yea, you need to stop that. Start carrying distilled water with you.

How do you warm it?

In my experience using saline nasal flushes, having the water at room temperature hasn't really bothered me, as long as I've added the salt.

Someone else responded to my question saying the same thing. I tried using distilled water at room temperature (with the salt) and it REALLY hurt my nose. Feels great when the water is luke-warm. Maybe I am the only one.

I'm sure you're not. For me it's uncomfortable but bearable at room temperature. Much more comfortable after 12s or so in the microwave.

Could try microwaving it or using a chemical reaction to heat it, like an MRE meal.

I would recommend placing the bottle in a hot/warm water bath. Like how baby bottles are warmed.

If microwaving, make sure to mix well!

The temperature doesn’t make any difference to me.

I generally have RO water in my car, and use the cleanest water available wherever I am, but can’t carry a bottle at all times.

You can safely use bottled water, that would probably be a easy alternative :)

I usually do, but I don’t have a bottle at all times.

Just so you know: "In a new report entitled "Take Back the Tap," Food & Water Watch explains that 64 percent of bottled water comes from municipal tap water sources" https://www.foodandwaterwatch.org/sites/default/files/rpt_18...

how is bottle water better? where I live the tap water is usually of higher quality than the bottled water, just a bit harder.

Your symptoms are the same of people with untreated nasal polyps. Ask your doctor about nasal corticosteroid spray treatment.

I see that listed as causing a decreased sense of smell - can it also cause a hypersensitivity to odors? My sense of smell is very precise, to the point that I can do things like smell which friends my girlfriend visiting on the way home from work. It could be in part because I maintain such a pristine, scent free environment where as other people have environments flooded with fragrances. This started it about the same time as my autoimmune disease and has steadily gotten worse at the same rate.

Upon exposure to an odor like Pantene or Gain, my upper lip feels numb and I start salivating. It makes me feel slightly dizzy and gives me a headache. The odor lingers in my nose and mouth until I rinse it out or 10-30 minutes. I was diagnosed with an esophageal hypersensitivity and dozens of allergies, but nasal polyps didn’t come up. I’ll ask.

Yes, it distorts the sense of smell and taste - my mother-in-law would smell an annoying floral aroma everywhere, can’t smell certain foods or she would get immediate heartburn, and couldn’t taste salt or taste it too much in certain hours of the day. It’s weird! But we tend to not take our sense of smell and taste so seriously so I think it should be very important to the brain to have a healthy sense of smell and taste or else you would get these “hallucinations” because it cannot be a real allergy.

My issue seems to be with amplification and lingering of odors more than distortion. I guess another issue is scents interfering with my taste during and after eating.

Yeah, I think a distorted sense implies amplification or narrow signals as well.

I still don't quite understand how tap water in a neti-pot is significantly more dangerous than swimming in local lakes, swimming pool or the ocean. Certainly, you get water in your sinuses from that, right?

Lake swimming is the primary way people are infected with brain-eating amoeba. It is a fresh-water amoeba that is killed by chlorine.

https://en.wikipedia.org/wiki/Naegleria_fowleri

Can this happen to anybody, or only to people with a weakened immune system?

Infection is universally fatal even with treatment, and your immune system actually makes it worse.

https://www.iflscience.com/brain/brain-eating-amoeba-kicks-f...

The swimming pool is at least chlorinated, but AFAIK, it can happen in any fresh water.

https://www.kolotv.com/content/news/Child-dies-from-brain-ea...

When you swim in lakes & rivers, you typically don't get water way up your sinuses. Maybe a bit in the nose but not far back. So the odds are lower. Not impossible as there have been case of triathletes dying from the same thing after a lake race, but definitely lower odds.

As for the ocean, its salinity prevents that kind of amœba from even being present.

Yes, and people get from it from swimming [0] [1] [2]. That's typically how people get infected. It doesn't affect that many people because people typically don't intend to fill their nose while swimming.

The issue is that a neti pot is that you're intentionally putting water deep into the sinus cavities. This amoeba is exactly why they tell you to only use sterilized water in a neti pot and to clean and sterilize your neti pot regularly.

[0]: https://www.theepochtimes.com/surfer-dies-from-brain-eating-...

[1]: https://www.dailymail.co.uk/news/article-2392917/Hope-Kali-H...

[2]: https://www.nbcnews.com/health/health-news/brain-eating-amoe...

Beyond just that, I have to question how many non-lethal non-brain-eating infections come from injecting untreated water into your face that don't make the news.

Thanks for the references. Skimming through them it seems it's only the case for warm freshwater. Citing from your 1st reference:

> Naegleria fowleri infects people when water containing the ameba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers.

Does it mean sea water is safe or at least safer?

This stuff lives in old water heaters right? It could've happened any time, but if you're using a neti pot you probably have a cold and are already susceptible to infection.

You certainly also can get amoeba infections from swimming.

https://www.allaboutvision.com/contacts/acanthamoeba-keratit...

If you're a contact lens wearer, you should be careful using them while swimming or rinsing them with tap water. A hydrogen peroxide cleaner like Clear Care will help kill amoebas.

I can't find it now, but there was a news story recently where a contact lens wearer contracted something from tap water because she did not dry her hands troughly after washing them and handling the lenses.

https://www.bbc.com/news/magazine-39568781

FDA: “Is Rinsing Your Sinuses With Neti Pots Safe?” https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm316375.h...

Highlights:

* “...usually safe and effective products when used and cleaned properly”

* “Tap water isn’t safe for use as a nasal rinse because it’s not adequately filtered or treated.”

* Neti Pots are FDA regulated medical devices

I'm a little confused. Was the tap-water untreated (that is, well water)? Can these damn things survive chlorination? They're a known danger swimming in southern (US)- meaning warm- fresh-water lakes and ponds. But- damn, this is scary. Probably because I also use a neti-pot.

Neti-pots are often used to help alleviate the symptoms of sinusitis. My neti-pot came with packets of salts that you dissolve in the water, which I use. But I didn't think that was required to kill stuff in treated water. I thought it was to reduce irritation when using it- and maybe help kill the bacteria you are trying to rinse away.

The salts are to reduce irritation. Plain water is extremely uncomfortable in your sinuses, but saline is fine. As far as I know they do nothing to reduce contaminants in your water or harm bacteria.

And yet the article mentions distilled OR saline, which definitely raises the question.

If I wake up feeling like crap, it is far easier to use a salt packet than to go to the store for distilled water. The article implies that is fine (but the article may be misleading)

Perhaps they meant premixed , sterile saline solutions ?

Yes, the salt mainly is meant to reduce irritation.

Amoeba aren't bacteria, though. Both, however should be adversely affected by saline solutions because osmosis will draw water out of the cells, effectively killing these organisms.

Salt can be as effective a disinfectant as chlorine if dissolved in water. There are public swimming pools that make use of this because chlorine can have adverse effects on your health, such as causing irritation on both the skin and the respiratory system.

Yes, it was well water. According to the article:

> Amoebas may be found in fresh-water sources around Puget Sound such as wells, but aren’t present in city-treated water, according to Liz Coleman, a spokeswoman for the Environmental Public Health division of the state’s Department of Health.

Right. I wasn't sure if Coleman was saying "it couldn't have happened from her tap water, because it's treated" or if the implication was that the victim had a well. I like your interpretation- the latter.

Yeah, people get confused by the idea of well water sometimes. Many people think of well water as the old fashioned, bucket on a rope, kind. In reality, many people get their tap water from a local well.

The main difference between well water and non-well water is that well water is not centrally treated by the water department. There will be filters and stuff, but it is not treated the same way.

From WebMD on Naegleria Fowleri (the brain eating amoeba)

> Naegleria can't live in salt water. It can't survive in properly treated swimming pools or in properly treated municipal water.

> Most cases of N. fowleri disease occur in Southern or Southwestern states. Over half of all infections have been in Florida and Texas.

Here's the paper: https://www.ijidonline.com/article/S1201-9712(18)34525-9/pdf.

Ouch. I've taken to using the Arm&Hammer spray cans, even though they're quite a bit more expensive.

A more common problem is eye infection. This is an issue for contact lens wearers, and amoebas can also get in your eyes when you go swimming.

https://www.allaboutvision.com/contacts/acanthamoeba-keratit...

Distilled water certainly is the safest way but tap water mixed with salt in countries where it's safe to drink tap water in most cases should cause no harm either.

Salt works as a disinfectant when dissolved in water. When rinsing your sinuses you'll want to use saline water anyway because fresh water will hurt the mucous membranes in your nose.

That's bad advice. Common saline solutions are around 9g/L and won't kill most protozoa.

http://www1.nencki.gov.pl/pdf/ap/ap574.pdf

Even at seawater-like concentrations of over 30g/L, it can take over 72 hours to sterilize water containing fresh-water protozoa.

Boiling is the only practical way to sterilize water.

I wonder if it’s things like this that make people feel like their tap water isn’t safe and then they buy bottled water or “natural” or “raw” water, instead of understanding that tap water is pretty safe. By historical standards we have superior water, compared to most of history.

So, these medical people did not consult House? https://house.fandom.com/wiki/Henry_(patient)

Well great, I just did this last night. Goodbye HN.

I use a product like this, and I'm paranoid enough to buy distilled water, boil it, and then add a saline mixture before doing the deed.

How hard would it be to design a microwave water still? I steam things in my microwave all the time. It's not really my area of expertise, but I imagine it wouldn't be super difficult to design a glass (or similar) vessel that would collect condensate after the microwave shuts off.

It's not clear after reading this article the source of the victim's tap water. Was it from a well? I suspect the tap wasn't using filtered, and possibly chemically treated water.

This happens every ten years.

And millions of people every day suck in tap water through their noses to clean them - and still this infection happens virtually never.

But it seems that even the rational and sophisticated HN crowd isn't immune to overresponding towards news that is basically just gross on a visual level while completely irrelevant from a statistical perspective.

Having said that I once while tripping immersed my head in water and got some of it quite far up my head through the nose. That water was in a warm, lenitic and rather dirty pond - the optimal breeding conditions for this terrible little creature. I was worried for at least a week about having my brain eaten :D

But that was in middle Germany and it seems these amoebas don't really like it here so much.

Does UV-C irradiation work to kill these little buggers?

Don't swim with contacts either.

I’m seriously shocked by how much push back rational thought is getting in this thread.

Rough.

I think this is one of the most on spot and reasonable comments in this thread. The rest is writing about how worried they are or convincing others how unlikely it is.

Some folks here down vote faster than they can think it seems.

Person dies under unusual, rare circumstances. Happens every day, there are nearly 8 billion of us. Why is this news?

It news because more and more people are starting to rinse their sinuses and may not be aware that they should be following certain guidelines.

I wish all articles like this had stats. But stats can be hard to create :(

Neti pots and nasal rinse methods in general have become fairly popular. If reporting on this could save other people from becoming victims, it's worth covering.

Sounds like the easiest way to avoid becoming a victim is not to use the product.

Yes, except then you would be forgoing the benefits, which are significant for situations like sinus infections or colds. Instead, you could simply avoid using it with untreated well water.

If an article is about a "Brain-eating" danger, it captivates a host of emotional responses, mainly as a result of works of fiction. It's even more powerful if it's from something we can't see with the naked eye.

From a health perspective, it's also a way to remind ourselves that there are simple precautions to prevent that. We learn from others' mistakes.

True, but, if I took every simple precaution I know of to prevent all of the unlikely but known conditions, I doubt I'd get anything done in a day. Or have much fun.

* Avoid cars.

* Wash hands after exposure to public transit and before touching one's face.

* Always wear sunscreen when exposed to the sun.

* Don't wear contact lenses.

* Wash hands after exposure to dust of any kind.

* Wear mask during moderately poor air condition (almost every day in SF Bay!)

* Don't swim in the south (killer amoebas)

* Don't breathe in the north-west (killer fungi)

* Don't walk in the north-east (insanity causing ticks).

* Drink out of only glass or stainless steel.

* Eat only fresh unprocessed foods.

* Never eat bacon or BBQ.

* Never drink alcohol.

* And definitely, never, ever, go to a hospital.

> Don't walk in the north-east (insanity causing ticks).

More recently: insanity and meat allergy causing ticks.

Well, you should have "avoid eating meat" on that safety list anyway, so that is almost helpful.

I found it quite an interesting article to read.

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