Another adult, a 51 year old woman from Desoto Parish in Louisiana, has been confirmed to have died from Naegleria fowleri meningoencephalitis associated with use of a neti pot and tap water. Early this month, Louisiana Department of Health issued a warning to residents not to use water that has not been boiled or otherwise purified prior to using it in a neti pot or sinus wash bottle. Dr. Raoult Ratard, State Epidemiologist, went further, recommending that neti pots and bottles be cleaned, scrubbed, and allowed to dry before use.
This situation highlights, yet again, that:
1. Awareness is VITAL to diagnosis, research, and treatment.
Naegleria fowleri infection is reported to be rare, but it may only be so because we so often fail to see it. This latest case could easily have been signed off on a death certificate as just another unfortunate death from a generic bacterial “meningitis” without further ado. As is typical for most deaths in America today, an autopsy would not have been performed, & the final assumed diagnosis of the patient’s attending physician would have been taken at its word on the death certificate, case closed, by the local medical examiner. It takes unusual conditions, such as unexpected death within 24 hours of hospitalization, to get the case to the medical examiner’s autopsy suite. We might not have known, for years in fact, about either of these two cases of neti-pot-associated-Naegleria if not for serendipity and doctors who were willing to see the unbelievable.
This patient’s astute clinician recollected Dr. Ratard’s earlier warning. Maybe it was as brief as a report overheard in the car on the drive to work this past summer. But awareness led the doctor to ask about neti pot use or swimming in fresh warm waters, and the diagnostic hunt turned up the truth. The truth, in turn, confirmed Dr. Ratard’s conjecture last summer: That a neti pot, as unlikely as it seemed, could have caused a young man to die before his time. That Naegleria fowleri, as preposterous as it seemed to some of my colleagues, could indeed be living in our homes, quite literally, right under our noses.
Awareness. It’s a brutal and beautiful thing. Once you know, you can save lives.
2. Great, we’re aware. NOW WHAT?
For those infected, who suffer unspeakably, and die horribly, and for those who watch it happen to them in our very arms, awareness is not enough. We NEED rapid diagnostic tools for Naegleria fowleri meningoencephalitis. We NEED effective, rapidly available treatments for Naegleria fowleri meningoencephalitis. We need them NOW.
It’s not terribly difficult or costly science. It’s just not as lucrative as anti-depressants, erectile dysfunction pills, or the next me-too anti-cholesterol drug.
Now, please, please, in the name of those who have died and who are going to die, won’t SOMEBODY fund the research??
Become aware & spread the word on preventing amoebic meningoencephalitis. Patients, ask your doctor next time. Students, ask your attending, what she or he knows about it. Why isn’t there a diagnostic test? Why isn’t there a cure?
A pebble dropped into the ocean ripples farther than you see.