NAEGLERIA FOWLERI

“Brain-eating amoeba”

Naegleria Fowleri can cause a rare and deadly infection of the brain called Primary Amoebic Meningoencephalitis (PAM).

https://www.cdc.gov/parasites/naegleria/general.html

How can Naegleria infect people?

It usually infects people when contaminated water enters the body through the nose. After entering the nose, it travels to the brain where it causes PAM, which is usually fatal.

Naegleria can be found in fresh water lakes, rivers, insufficiently chlorinated swimming pools and even contaminated tap water.

Naegleria infection CANNOT be spread from one person to another.

You CANNOT get infected from drinking water contaminated with Naegleria

Symptoms:

The initial symptoms start approximately 5days (range 1 to 9 days) after infection.

Initial Symptoms:

  1. Headache
  2. Fever
  3. Nausea
  4. Vomiting
  6. Late symptoms:
  7. Stiff neck
  8. Confusion
  9. Loss of balance
  10.  Seizures
  11.  Hallucinations

After the start of symptoms, the disease progresses rapidly and usually causes death within about 5 days! (range 1 to 12 days). The fatality rate is over 97%.

If there is a sudden onset of any of the symptoms mentioned above, immediately visit a hospital or consult a doctor.

What is the peak season for Naegleria?

Since it is a thermophilic organism, it thrives in high temperatures during summers.

From April to October, the average temperature in Karachi remains above 30°C and almost all N. fowleri positive cases have been diagnosed during this period. 1

‘The first case of PAM was reported in 2008, and up until October, 2019, 146 cases had been reported from Karachi. In only a decade, the number of PAM cases in Pakistan exceeded those reported in the USA in half a century (ie, 142 cases between 1968 and 2019)’

Why are there such an alarming number of cases in Pakistan?

  1. Hot and Humid Climate – Climate Change
  2. Ablution through tap water in Muslim Community
  3. Water from fresh water lakes is not treated or chlorinated properly
  4. Broken pipelines and leakages of the sewage and water lines
  5. Obtaining water through boring (water is accessed through a deep hole ‘bored’ in the earth). N. Fowleri lives in such habitat.

Prevention and Control:

  1. All concerned authorities should make a collective effort in ensuring that the water supply is adequately chlorinated
  2. Use sterilized and filtered water for ablution
  3. When bathing or washing face do not allow water to enter the nose
  4. Ensure that swimming pools are properly chlorinated
  5. Increase public awareness regarding the cause of infection and prevention methods.
  6. Improve facilities for diagnosis and testing of N. Fowleri
https://www.cdc.gov/parasites/naegleria/pdf/naegleria-ritual-ablution-factsheet.pdf
https://www.dawn.com/news/1690803/naegleria-threat-alert-issued

References:

  1. Ghanchi NK, Jamil B, Khan E, Ansar Z, Samreen A, Zafar A, Hasan Z. Case Series of Naegleria fowleri Primary Ameobic Meningoencephalitis from Karachi, Pakistan. Am J Trop Med Hyg. 2017 Nov;97(5):1600-1602. doi: 10.4269/ajtmh.17-0110. Epub 2017 Oct 10. PMID: 29016297; PMCID: PMC5817751.
  2. Naqvi, Atta & Yazdani, Nida & Ahmad, Rizwan & Zehra, Fatima & Ahmad, Niyaz. (2016). Epidemiology of primary amoebic meningoencephalitis-related deaths due to Naegleria fowleri infections from freshwater in Pakistan: An analysis of 8-year dataset. Archives of Pharmacy Practice. 7. 119-129. 10.4103/2045-080X.191924.
  3. The Lancet  Infectious Disease – Naegleria fowleri in Pakistan
  4. Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F, Ali F, Visvesvara GS, Zafar A. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011 Feb;17(2):258-61. doi: 10.3201/eid1702.100442. PMID: 21291600; PMCID: PMC3204751.
  5. https://www.dawn.com/news/1690803/naegleria-threat-alert-issued
  6. https://www.cdc.gov/parasites/naegleria/index.html

Written by
Dr. Alvina Farhat