Residents of Terrebonne Parish in Louisiana are being warned once again: Independent testing of the water supply returned positive results for Naegleria fowleri – also known as the “brain-eating amoeba” –  which causes fatal brain swelling and tissue destruction.

The Terrebonne Consolidated Waterworks District issued the notification Sunday and has temporarily switched from using chloramine to free chlorine, which should kill off the amoebas, reports

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Officials say they are doing what they can, but residents are understandably afraid:

Residents, once again, are ignoring their swimming pools and the nearby bayous, terrified of something they can’t see but officials warn is there. This is the third time since 2015 the deadly amoeba has been detected in the water, impacting all fresh water sources in the parish. That includes drinking water, the water in the bayous and pools and the water used for showers and baths.

“It kinda freaks me out because this is my home, I can’t do what I usually do,” Lindsey Dupre said. “I want to know I’m secure rather than freak out over an amoeba.”

“Normally we see this amoeba in surface water when people go swimming and they get it way up in their sinuses and they’ll get an infection. They’ll start getting symptoms that are similar to meningitis,” Jimmy Guidry, Louisiana Department of Health’s medical director, told CBS News.

Naegleria fowleri infections are rare, according to the CDC. From 2007 to 2016, 40 infections were reported in the U.S. Of those cases, 36 people were infected by recreational water, 3 people were infected after performing nasal irrigation (with Neti Pots and similar devices) using contaminated tap water, and 1 person was infected by contaminated tap water used on a backyard slip-n-slide.

Infections occur mainly during the months of July, August, and September. They are more likely to occur in southern states, but can also occur northern states. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.

The amoeba causes Primary Amebic Meningoencephalitis (PAM), which is a severe brain infection that destroys brain tissue, causing brain swelling and death.

The fatality rate is over 97%. Only 4 people out of 143 known infected individuals in the United States from 1962 to 2016 have survived.

Several drugs are effective against the amoeba in a lab setting, but their effectiveness in people isn’t clear because almost all cases have been fatal, even when a similar drug combination is used. Two people who were treated with a new drug called miltefosine that was given along with other drugs and aggressive management of brain swelling survived.

The CDC says people should seek medical care immediately whenever they develop a sudden onset of fever, headache, stiff neck, and vomiting, particularly if they have been in warm freshwater recently.

To reduce the risk of infection, the CDC recommends the following:

Naegleria fowleri infects people when water containing the amoeba enters the body through the nose. Infection is rare and typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. Very rarely, infections have been reported when people submerge their heads or get water up their nose, cleanse their noses during religious practices, or irrigate their sinuses (nose) using contaminated tap or faucet water. Naegleria fowleri can grow in pipes, hot water heaters, and water systems, including treated public drinking water systems.

Personal actions to reduce the risk of Naegleria fowleriinfection should focus on limiting the amount of water going up the nose and lowering the chances that Naegleria fowlerimay be in the water.

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These nasal rinse devices — which include bulb syringes, squeeze bottles, and battery-operated pulsed water devices — are usually safe and effective products when used and cleaned properly, says Eric A. Mann, MD, PhD, a doctor at FDA.

But using the wrong type of water for irrigation and/or improper cleaning of the devices can lead to serious infections, including Naegleria fowleri.

Researchers believe that two deaths in 2011 in Louisiana were caused by brain-eating amoebae that made its way into the victims’ tap water:

Normally, people get the infection after swimming in warm freshwater lakes and rivers because the amoeba flourishes in those warm conditions.

However, the two victims, a 28-year-old male and 51-year-old woman from Louisiana, had not been around freshwater. The man and woman used tap water in their neti pots.

The victims’ home plumbing systems were tested and came back positive for the amoeba, but the city water distribution systems tested negative. Naegleria fowleri was found in the woman’s bathroom sink and faucet tub, and it was in a tankless water heater in the man’s home.

Tap water isn’t safe for use as a nasal rinse because it’s not adequately filtered or treated. Some tap water contains low levels of organisms — such as bacteria and protozoa, including amoebas — that may be safe to swallow because stomach acid kills them. But these organisms can stay alive in nasal passages and cause potentially serious infections.

The FDA offers the following tips for safe neti pot use.

What Types of Water Are Safe to Use?

  • Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
  • Boiled and cooled tap water. Boiled water for 3 to 5 minutes, then cool until it is lukewarm. Previously boiled water can be stored in a clean, closed container, but use it within 24 hours.
  • Water passed through a filter designed to trap potentially infectious organisms. CDC has information on selecting these filters.

Naegleria fowleri symptoms typically start 1-9 days (median 5 days) after exposure, and can mirror bacterial meningitis, which can make diagnosis tricky. This is unfortunate, because the disease progresses rapidly – so rapidly, in fact, that diagnosis is usually made after death.

Death occurs within 1 – 18 days (median 5 days) after symptoms begin.

Signs and symptoms of infection include:

  • Stage 1
    • Severe frontal headache
    • Fever
    • Nausea
    • Loss of appetite
    • Vomiting
  • Stage 2
    • Stiff neck
    • Seizures
    • Altered mental status
    • Hallucinations
    • Coma

For more on Naegleria fowleri, please read Deadly Brain-Eating Amoeba Strikes Again: What You Need to Know.

Lily Dane is a staff writer for The Daily Sheeple. Her goal is to help people to “Wake the Flock Up!”