A 71-year-old Texas woman died from a rare brain infection after using tap water from an RV to rinse her sinuses, according to a report published May 29 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The woman developed severe neurological symptoms within four days of using a nasal irrigation device filled with tap water from her recreational vehicle’s water system at a campground. She experienced fever, headache and altered mental status before seeking medical treatment for suspected Primary Amebic Meningoencephalitis infection.
Despite receiving medical intervention, the woman began having seizures and died eight days after symptoms first appeared. Laboratory testing confirmed the presence of Naegleria fowleri in her cerebrospinal fluid, the protective fluid that surrounds the brain and spinal cord.
Naegleria fowleri, commonly known as the brain-eating amoeba, is a single-celled organism that lives in warm freshwater environments including lakes, rivers and hot springs. The CDC indicated that “if water containing the ameba goes up the nose and to the brain, it can cause an infection called primary amebic meningoencephalitis.”
The infection is extremely rare but nearly always fatal. Medical records show 164 cases of PAM were reported in the United States between 1962 and 2023, with only four patients surviving. Fewer than 10 people per year in the United States contract PAM, according to federal health officials.
The Texas Department of State Health Services investigated the case and determined the woman had no recreational exposure to fresh water. She reportedly used non-boiled water from the RV’s water system for nasal irrigation on several occasions during her stay at the campground.
Investigators tested water samples from both the RV’s portable water tank and the municipal water system 23 days after the woman’s exposure. Neither source tested positive for the amoeba, though officials noted the environmental conditions may have changed by the time of testing. The RV’s water system showed evidence of inadequate disinfection, with low chlorine levels and cloudiness that can allow dangerous pathogens to grow.
The CDC noted the water tank had likely been filled three months prior to the incident and had poor water quality. Health officials determined the RV water tank’s improper maintenance created conditions that allowed the deadly organism to survive and multiply.
This case represents one of several deaths linked to brain-eating amoeba infections from nasal irrigation with tap water. At least two similar deaths were reported in 2023, including a Florida woman who also died after using tap water to rinse her nose.
The Cleveland Clinic reports that PAM symptoms appear suddenly and are severe from the start, with a fatality rate higher than 97 percent even with treatment. Initial symptoms include high fever, severe headache, nausea and vomiting. The infection progresses rapidly to include symptoms resembling meningitis, such as stiff neck and extreme sensitivity to light, followed by mental confusion, seizures and coma.
Most patients die within five to 18 days after symptoms begin. The amoeba literally feeds on brain tissue and triggers massive inflammation once it reaches the brain through nasal passages.
Health officials emphasize that people cannot become infected by drinking contaminated water. The amoeba only causes infection when contaminated water enters through the nose and travels to the brain.
The CDC has issued specific safety recommendations to prevent brain-eating amoeba infections. When swimming in fresh water, people should hold their nose or wear nose clips when jumping or diving. Swimmers should keep their heads above water in hot springs and avoid digging in shallow water where the amoeba is more likely to survive.
For nasal irrigation, health officials strongly advise using only distilled, sterile or previously boiled and cooled tap water. Regular tap water, even when safe to drink, may harbor bacteria or amoebas and should never be used for sinus rinsing.
Federal and Texas health officials have created educational materials specifically for RV users to help them maintain proper water quality and reduce risks of PAM and other waterborne illnesses.
The brain-eating amoeba grows best in temperatures up to 115 degrees Fahrenheit and can survive in all stages of its life cycle at temperatures up to 149 degrees. The organism has three life stages and remains most dangerous in its active trophozoite form, when it actively feeds and reproduces.