Brain-Eating Amoeba Claims Another Life in Karachi

Health officials tested water of different areas of Karachi which concluded only half of the city is provided with chlorinated water while 90% of pumping houses undergo no chlorination . Chlorinated is the only trusted process to kill this organism, proper sanitation should be practiced. Water chlorination level of city was still below than 0.5 ppm, the standard chlorination level recommended by WHO. Deteriorating water line conditions of Karachi hinder in chlorination of water.

A young woman residing in Malir district died of Naegleria fowleri on Thursday, taking the death toll blamed on the ‘brain-eating amoeba’ to 12 in the province, officials said.

She was the second female to die of Naegleria fowleri this year. Officials said Humaira Bano, 25, was a resident of Taiser Town in Malir district. She had been admitted to a private hospital a day before she died.

“We have taken water samples supplied to the area where she lived and sent them for examination,” said Dr Zafar Ijaz, director health, Karachi division.

Doctors and health experts say Naegleria usually enters the brain and attacks the nervous system when infected water is ingested through the nasal cavity while bathing, swimming or performing ablution.

“The victim was initially treated at a private hospital before being brought to the JPMC on Sunday morning with a history of headache, fever and mental confusion. This was followed by vomiting and seizures,” he explained, adding that the patient’s condition further deteriorated and he was put on a ventilator.

All citizens were advised to add chlorine tablets to the water tanks that supply water to their homes which are used for washing and bathing.

The symptoms of the disease are high-grade fever, vomiting, headache and altered consciousness

Life cycle

Naegleria fowleri, a thermophilic and free-living amoeba, is primarily found in warm and hot freshwater environments such as ponds, lakes, rivers, and hot springs.^[14] As temperatures rise, its population tends to increase. Although the amoeba was initially identified in Australia in the 1960s, it is believed to have evolved in the United States.^[15] N. fowleri exists in three forms: cyst, trophozoite (ameboid), and biflagellate. While it does not form cysts in solid human tissue, where only the amoeboid trophozoite stage is present, the flagellate form has been discovered in cerebrospinal fluid.

Treatment

A combination of medications, such as amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone, is frequently used to treat primary amebic meningoencephalitis (PAM). Since these medications have been used to treat people who have survived, it is believed that they are efficacious against Naegleria fowleri. The most recent of these medications, miltefosine, has been demonstrated in lab settings to eradicate free-living amebae, including Naegleria fowleri1, 2, 3. Additionally, patients with disseminated Acanthamoeba infection5 and Balamuthia infection4 have responded well to treatment with miltefosine.

Five confirmed survivors of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri infection have been reported in North America, despite the fact that the majority of cases of PAM caused by this virus have been fatal (153/157 in the US)6, 7.