Tanveer Hussain, aged 25, a student at Karachi University, was brought to the emergency at a leading university hospital with complains of fever, vomiting and neck stiffness. The doctors on duty suspected meningitis, infection of the coverings of brain (meninges). All laboratory tests required to establish the condition were performed. All came back negative. The symptoms, on the other hand, worsened. There was drooping of an eyelid in addition to fixed pupils. The tests revealed the involvement of an amoeba named Naegleria Fowleri. Treatment was started as soon as the results came back. Fourteen days after the patient initially presented, after all the laboratory tests and treatment, he passed away. It was September, 2008. Two months prior to this incident, another patient had presented with similar symptoms. He passed away four days after stay at the hospital.

According to Medscape Reference, Naegleria fowleri, a free-living ameba, is the causal agent of Primary Amebic Meningo-encephalitis (PAM), which is an acute and rapidly fatal Central Nervous System infection. PAM develops within several days of exposure to the contaminated water source and typically causes death within one to two weeks after admittance to the hospital. Few individuals survive the infection, partly because of its rapid onset and partly because of delayed diagnosis. Only about 10 patients who have survived PAM due to N fowleri have been reported in medical literature.

It has been called the ‘Brain Eating Bacteria’ in the media, which has raised unnecessary alarm. Scientific data about this disease, and its mode of spread, needs to be understood to avoid panic. It is a rare disease and till date only about 200 cases of PAM have been reported worldwide.

In July 2011, Dr. Sadia Shakoor, Dr. Farheen Ali, Dr. Afia Zafar and Dr. Syed Faisal Mahmood from Aga Khan University presented a case study of 13 cases in a period of 17 months in Karachi, Pakistan in the Journal of Emerging Infectious Diseases. They reported that “PAM is usually associated with freshwater swimming, and outbreaks have also been associated with poorly chlorinated swimming pools. However, all but 1 of the patients in this case series denied recent freshwater swimming or recreational water activities. Nevertheless, because all patients were Muslim, they routinely performed ritual ablution, which involves taking water into the nostrils. Infection acquired through this route has been reported”.

In the last three years, there have been more than 35 reported cases of Naegleria infection in Pakistan (WHO figures mention only 10 reported cases till date). It should be noted that Naegleria is water borne infection and due to lack of planning and interest by the State, access to fresh, clean water (a universal human right) is not available to a wide array of our population. As a result, according to one estimate, 1.2 million people die of waterborne diseases in Pakistan every year, of them 250,000 are children under the age of five years.

In the public health domain, there are five steps to combating a disease. The first step is to identify risk factors and educate the general public. The second and most important step is prevention. Then comes the stage of “Early Diagnosis and Prompt treatment”.

All patients who have died last year were males between the ages of four and 49. This year, an 18 year old girl passed away in Karachi due to PAM infection. There was no particular predilection towards any area or community.

The good news is that we know how Naegleria enters the body and that can be prevented easily. The bad news is that if someone gets the infection, there is very little that can be done, as medication has not proven beneficial. Prevention is always better than cure, especially in cases of such deadly infections. Infectious disease specialists advise caution while swimming and especially while performing ablution before Prayers. They also advise increased chlorination of water so that the bacteria can be kept in check. It is worth mentioning that the bacteria Naegleria Fowleri is abundant in our environment and usually does not cause any trouble. Its notoriety starts when it enters nose and from there to the brain through a covering known as Cribrifom plate. If we don’t give it a chance to reach the nostrils, we can prevent the bacteria from causing infection.

A meeting was convened last year involving Karachi’s lawmakers, health officials, medical experts, town administrators and representatives of the civil administration, civic agencies and the water board, to discuss the outbreak of Naegleria. It was stressed that chlorination of water needs to be increased to prevent further loss of lives. However, fresh cases of Naegleria infection have surfaced again. The Sindh Health Department sent a series of letters last week to its officers and the Karachi Water and Sewerage Board (KWSB) asking them to put their house in order and save lives under immense risk from Naegleria Fowleri.

We have observed the efficacy of health education and prevention in case of another deadly disease—Dengue fever—which wreaked havoc in Lahore few years ago. In the last couple of years, there have been very few reported cases of Dengue fever and that was possible due to concerted efforts of the local government. Similar efforts are required by the Sindh government to halt the spread of Naeglaria infection.