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Primary amebic meningoencephalitis can ensue when fresh water containing Naegleria fowleri is forcibly introduced into the nose. Such introduction most commonly occurs when individuals jump or dive into water containing the amebae. The organisms make their way through the cribriform plate and into the brain, often with fatal results.
In a recent case, a 47-year-old man living in the U.S. Virgin Islands was exposed to amebae-containing fresh water through his household water system, which delivered both untreated rainwater from a cistern and untreated groundwater from a well. The man practiced ritual ablution — including nasal rinsing — several times daily in preparation for Islamic prayer.
On the day before admission, the man presented to an …