letter which attempts to link the Islamic practice of ritual ablution with the development of primary amoebic meningoencephalitis (PAM). In this ritual there is repeated irrigation of the mouth, ears, nostrils, arms and feet; some also irrigate the sinuses. The authors note 20 deaths from Naegleria fowleri infection at a small Pakistani hospital in 2010. All were males who performed the ritual regularly and had no history of swimming. The link between ritual ablution and PAM seem plausible, particularly when the sinuses are irrigated. Last year, there were two fatal cases of PAM in Louisiana which were preceded by the use of Neti pots for sinus irrigation.
Photo: Laurie Skrivan, St. Louis Post-Dispatch, National Press Photographers Association