‘Naegleria Floweri’ In Pakistan – OpEd


Naegleria fowleri is a single-celled, free-living amoeba commonly found in warm freshwater environments such as lakes, hot springs, and poorly maintained swimming pools. It is known to cause a rare but severe infection called primary amebic meningoencephalitis (PAM). Naegleria fowleri is also called a “brain-eating amoeba” because it can cause a brain infection when water goes up the nose. 

PAM is a devastating brain infection that occurs when Naegleria fowleri amoebas enter the body through the nose, usually when individuals swim or dive in warm freshwater. Once the amoeba enters the nasal passage, it travels through the olfactory nerve to the brain, causing inflammation and destruction of brain tissue. While the number of reported cases is relatively low, they are often severe and have a high fatality rate. PAM is a rapidly progressive and usually fatal infection, with very few reported cases of survival.

Symptoms start 1 to 12 days (median five days) after swimming or having another nasal exposure to water containing Naegleria. People die 1 to 18 days (median five days) after symptoms begin. PAM is difficult to detect because the disease progresses rapidly, so diagnosis sometimes occurs after the patient dies. Signs and symptoms of the infection include: Initial stages include Severe frontal headache, Fever, Nausea, and Vomiting, which further leads to a Stiff neck, seizures, altered mental status, hallucinations, and ultimately coma. Infections are treated with a combination of drugs. It is still unclear how well these drugs work.

The disease is generally fatal; among well-documented cases, there are only five known survivors in North America: one from the United States in 1978, one from Mexico in 2003, two from the United States in 2013, and one from the United States in 2016. The first U.S. survivor’s condition gradually improved during a one-month hospitalization. The only reported side effect of treatment was a reduction in leg sensation for two months after discharge, which gradually improved. There was also no detection of Naegleria fowleri three days post-treatment. It has been suggested that the first survivor’s strain of Naegleria fowleri may have been less virulent, contributing to the patient’s recovery. In laboratory experiments, a California survivor’s strain did not cause damage to cells as quickly as other strains, suggesting that it is less virulent than strains recovered from other fatal cases.

The first reported case of Naegleria fowleri infection occurred in Australia in 1965. It involved a young boy swimming in a warm freshwater lake. The boy developed symptoms of meningitis, and subsequent laboratory testing identified Naegleria fowleri as the causative agent. This case marked the first recognized occurrence of a Naegleria fowleri infection and led to further research and understanding of the amoeba and its potential to cause severe illness. Since then, additional cases have been reported in various parts of the world, primarily associated with warm freshwater environments. Here are some notable instances of Naegleria fowleri-related infections and deaths in different countries;

Australia: In 2007, an outbreak of Naegleria fowleri infections occurred in New South Wales, Australia. This outbreak was associated with warm freshwater bodies and boiling springs. Several cases were reported, and unfortunately, they resulted in multiple deaths.

United States: Most reported PAM cases have occurred in the United States, primarily in southern states with warm climates. Outbreaks and individual cases have been reported over the years, mostly associated with warm freshwater recreational activities. In 2011, there was an outbreak of Naegleria fowleri infections associated with warm freshwater lakes in the southern United States, particularly in Florida. Several cases were reported, leading to multiple deaths.In 2013, two cases of Naegleria fowleri infection were reported in Arkansas, resulting in two fatalities.Individual cases have been reported in other states over the years, although they remain relatively rare.

Pakistan: Currently 2023, Karachi is facing this brain-eating amoebic disease, and till now, more than three patients have died. In Pakistan, 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 (i.e., 142 points between 1968 and 2019). Pakistan has experienced several cases of Naegleria fowleri infections, particularly in the southern province of Sindh. These cases have been associated with contaminated water sources, including poorly maintained water supply systems and swimming pools. The number of issues and fatalities has varied over the years.

It is important to emphasize that while Naegleria fowleri infections are severe, they are infrequent. The disease risk can be minimized by avoiding activities involving warm freshwater exposure, such as swimming in warm freshwater bodies or using inadequately chlorinated swimming pools. Additionally, following proper water hygiene practices, such as using nose clips or holding the nose shut when engaging in water-related activities, can reduce the risk of infection.

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