Thursday, June 14, 2012

Religion vs infection control: issue #7

The June 15 issue of Clinical Infectious Disease has a 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


  1. Ablution is a cleaning process practiced 5 times daily before prayers by Muslims and it should include the following areas: Hands, mouth, nose, ears, face, head, arms and legs which collectively include the exposed area of Muslims bodies and such practice keeping him clean all the time, this is in addition to regular showers. There are criteria for the water which can be used, it should not be tasty (checked during mouth wash) should be clean (checked during face wash, should not be smelly (checked during nose cleaning). There is no sinus cleaning by water during this procedure. Cleaning the nose with water might decrease the load of bacteria like staph or MRSA colonization status, and decrease the need for dipping the fingers in the nose to remove crust and throwing it anywhere. The writer of this article might not know that this practice done by billion people daily all over the wards. So if he observed few people has PAM preceded by ablution, he did not tell us how many people has PAM not preceded by ablution, so we can calculated the Odd ratio or Risk ratio or any other statistical analysis to prove for him that this is just came by chance. I might repeat, Ablution does not include sinus irrigation, that is not possible.

    1. I agree with what you've said. :) I don't understand also how performing wadu would lead to sinus infections unless the water was contaminated. You have given a good and valid point here.