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Volume 30, Number 4—April 2024
Dispatch

Acanthamoeba Infection and Nasal Rinsing, United States, 1994–2022

Julia C. HastonComments to Author , Chelsea Serra, Erin Imada, Emalee Martin, Ibne Karim M. Ali, and Jennifer R. Cope
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.C. Haston, C. Serra, E. Imada, E. Martin, I.K.M. Ali, J.R. Cope); Public Health Institute and CDC Global Health Fellowship Program, Oakland, California, USA (C. Serra)

Main Article

Table 2

Nasal rinsing practices, medical histories, and disease presentations of 10 patients with Acanthamoeba infections who performed nasal rinsing, United States1994–2022*

Year and reference Age, y/ sex State Reason for and type of nasal rinsing Relevant medical history Initial symptom(s) Signs and symptoms Disease manifestations Outcome
1994, Murakawa et al. (10)
45/M
CA
Chronic sinusitis; electric nasal irrigator with tap water
HIV/AIDS (CD4: 26 cells/mm3); co-infections: PCP, Candida esophagitis, perianal herpes simplex
Skin lesions
Pruritic, painful, erythematous papulonodular, ulcerative lesions on the extremities, face, and genitalia; seizures; pansinusitis on MRI; osteolytic lesions
Cutaneous, rhinosinusitis, osteomyelitis, suspected GAE
Died
2015, Brondfield et al. (11)
60/F
CA
Chronic sinusitis; nasal irrigation using tap water for several months before symptom onset
Heart transplant (nonischemic cardiomyopathy); chronic kidney disease
Rhinorrhea, sinus pressure, epistaxis
Acute sinusitis and development of septal mass; subcutaneous nodules of left flank and extremities; pathologic fracture of right metatarsal bone underlying a nodule
Cutaneous, rhinosinusitis, osteomyelitis
Survived
2015, Breland et al. (12), Winsett et al. (13)
36/F
TX
Chronic sinusitis; neti pot with tap water for 2 wks before symptom onset
Kidney transplant (ESRD due to diabetes mellitus)
Skin lesions
Painful nodules on bilateral upper extremities, face, and back, spreading to lower extremities and trunk; later, fever, dyspnea, nausea, vomiting, and knee pain with cortical destruction in the proximal fibula; abnormal lung imaging
Cutaneous, osteomyelitis, suspected rhinosinusitis, suspected pulmonary
Survived
2016, CDC, unpub. data†
59/F
MD
Ritual ablution; no further information available
HIV/AIDS (CD4: 97 cells/mm3); co-infections: Salmonella bacteremia
Headache and blurred vision
Headache, blurred vision, multiple brain lesions; later, fever, disorientation/altered mental status, ataxia, weakness, cranial nerve deficits
GAE
Died
2017, Voshtina et al. (14)
73/M
WI
Unknown reason; neti pot using sterile water 1×/wk (submerged filled neti pot in warm tap water to heat)
Cancer: CLL
Focal seizure
Focal seizure and headache; later, fever, lethargy, altered mental status, cranial nerve deficits, cerebral herniation
GAE, suspected rhinosinusitis
Died
2017, CDC, unpub. data†
64/M
OH
Chronic sinusitis; nasal irrigation with undistilled tap water
Cancer: CLL
Sinusitis, skin lesions
Sinusitis and tender, erythematous skin lesions on lower extremities; later, altered mental status, headaches, photophobia, phonophobia, hallucinations, cranial nerve deficits, declining mental status
GAE, cutaneous, suspected rhinosinusitis
Survived
2018, CDC, unpub. data†
32/M
TX
Chronic sinusitis and epistaxis for 2 y; squeeze bottle with saline nasal spray
Microscopic polyangiitis; pauci-immune glomerulonephritis; renal failure
Seizure
Seizure; weakness, paresthesias, fatigue; later, meningismus, altered mental status, fever, aphasia, dysphagia, facial numbness, hemiparesis, cranial nerve deficits, acute respiratory failure
GAE, suspected rhinosinusitis
Survived
2020, CDC, unpub. data†
46/M
TX
Ritual ablution 5×/d
Cancer: AML; stem cell transplant ×2
Neutropenic fever
Fever; later, facial pain, papular and nodular erythematous skin lesions on lower extremities, sinusitis, endophthalmitis, brain lesions on MRI
Cutaneous, suspected GAE, suspected rhinosinusitis, suspected endophthalmitis
Survived
2021, CDC, unpub. data†
66/M
MD
Chronic sinusitis after multiple surgeries for orbital fracture and deviated septum; squeeze bottle 4×/d for years
Cancer: CLL; chronic kidney disease; multiple reconstructive surgeries following orbital fracture
Sinusitis; skin lesion
Sinusitis; progressive, necrotizing facial lesion
Cutaneous, rhinosinusitis
Survived
2022, CDC, unpub. data† 80/M FL Chronic sinusitis and nasal surgery; squeeze bottle daily for 3 y (water source unknown) Cancer: CLL; chronic kidney disease Headaches related to sinus disease Chronic headaches; nasal congestion, postnasal drip; occasional nausea and vomiting Rhinosinusitis Survived

*AML, acute myeloid leukemia; CDC, Centers for Disease Control and Prevention; CLL, chronic lymphocytic leukemia; ESRD, end-stage renal disease; GAE, granulomatous amebic encephalitis; MRI, magnetic resonance imaging; PCP, Pneumocystis jirovecii pneumonia; †Cases from the CDC free-living amebae database.

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References
  1. Centers for Disease Control and Prevention. Free living amebic infections [cited 2023 Jun 5]. https://www.cdc.gov/dpdx/freeLivingAmebic
  2. Carnt  NA, Subedi  D, Lim  AW, Lee  R, Mistry  P, Badenoch  PR, et al. Prevalence and seasonal variation of Acanthamoeba in domestic tap water in greater Sydney, Australia. Clin Exp Optom. 2020;103:782–6. DOIPubMedGoogle Scholar
  3. Stockman  LJ, Wright  CJ, Visvesvara  GS, Fields  BS, Beach  MJ. Prevalence of Acanthamoeba spp. and other free-living amoebae in household water, Ohio, USA—1990-1992. Parasitol Res. 2011;108:621–7. DOIPubMedGoogle Scholar
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  5. Haston  JC, O’Laughlin  K, Matteson  K, Roy  S, Qvarnstrom  Y, Ali  IKM, Cope  JR. The epidemiology and clinical features of non-keratitis Acanthamoeba infections in the United States, 1956–2020. Open Forum Infect Dis. 2023 Jan;10(1):ofac682.
  6. Centers for Disease Control and Prevention. Sinus rinsing for health or religious practice [cited 2023 Mar 11]. https://www.cdc.gov/parasites/naegleria/sinus-rinsing.html
  7. Miko  S, Collier  SA, Burns-Lynch  CE, Andújar  AA, Benedict  KM, Haston  JC, et al. (Mis)perception and use of unsterile water in home medical devices, PN View 360+ Survey, United States, August 2021. Emerg Infect Dis. 2023;29:397–401. DOIPubMedGoogle Scholar
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  10. Murakawa  GJ, McCalmont  T, Altman  J, Telang  GH, Hoffman  MD, Kantor  GR, et al. Disseminated acanthamebiasis in patients with AIDS. A report of five cases and a review of the literature. Arch Dermatol. 1995;131:1291–6. DOIPubMedGoogle Scholar
  11. Brondfield  MN, Reid  MJ, Rutishauser  RL, Cope  JR, Tang  J, Ritter  JM, et al. Disseminated Acanthamoeba infection in a heart transplant recipient treated successfully with a miltefosine-containing regimen: Case report and review of the literature. Transpl Infect Dis. 2017;19:e12661. DOIPubMedGoogle Scholar
  12. Breland  M, Beckmann  N. Amebic osteomyelitis in an immunocompromised patient. Radiol Case Rep. 2016;11:207–11. DOIPubMedGoogle Scholar
  13. Winsett  F, Dietert  J, Tschen  J, Swaby  M, Bangert  CA. A rare case of cutaneous acanthamoebiasis in a renal transplant patient. Dermatol Online J. 2017;23:13030/qt88s2t7wp.
  14. Voshtina  E, Huang  H, Raj  R, Atallah  E. Amebic encephalitis in a patient with chronic lymphocytic leukemia on ibrutinib therapy. Case Rep Hematol. 2018;2018:6514604. DOIPubMedGoogle Scholar

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Page created: March 01, 2024
Page updated: March 20, 2024
Page reviewed: March 20, 2024
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