- Dr Fatima Majeed
Naegleria fowleri, is known for causing a rare but severe brain infection called primary amebic meningoencephalitis (PAM) in humans.
The outbreak of Naegleria fowleri in Pakistan presents a significant public health concern due to its high fatality rate and limited treatment options. This review explores the impact of the outbreak on communities and the challenges faced in combating the disease. It evaluates available treatment options and highlights the need for early diagnosis and intervention According to a study, Pakistan had the second highest prevalence of Naegleria infections around the world (4). The first case of PAM in Pakistan was recorded in Karachi in October 2008. Sources of virus: Warm Lakes and Ponds: Naegleria fowleri is often found in warm bodies of freshwater, especially during hot weather.
Hot Springs: Natural hot springs with warm temperatures can provide a suitable habitat for Naegleria fowleri.
Soil: The amoeba can also be found in soil, and it may become present in warm, stagnant water sources.
Thermally Polluted Water: Naegleria fowleri has been found in water that is heated by industrial processes or power plants.
It’s important to note that while Naegleria fowleri is found in these environments, infections in humans are extremely rare. Most people who come into contact with the amoeba do not develop the infection.
The infection is usually associated with activities that involve the nose being exposed to contaminated water, such as diving or jumping into warm freshwater. Taking precautions, such as avoiding waterrelated activities in warm, stagnant water and using nose clips, can help reduce the risk of infection.
Naegleria fowleri, the amoeba that can cause a rare and severe brain infection in humans called primary amebic meningoencephalitis (PAM), enters the body through the nose.
Water Entry into the Nose: Naegleria fowleri infects humans when water containing the amoeba is forcefully pushed into the nose. This can occur during activities that involve water activities, particularly where water is forced into the nasal passages
Presentation of Naegleria fowleri
The symptoms of PAM typically begin about 5 to 7 days after exposure to the amoeba. Initial symptoms may resemble those of bacterial meningitis, but the progression is usually rapid, and the condition can become severe very quickly. It’s important to note that PAM is a rare but very serious condition, and early diagnosis and treatment are crucial. The symptoms include: - Initial Symptoms (Early Stage):
- Fever
- Sudden onset of severe headache
- Nausea and vomiting
- Stiff neck
- Later Symptoms (Advanced Stage):
- Confusion or altered mental status
- Lack of attention to people and surroundings
- Loss of balance
- Seizures
- Hallucinations
- Coma
The progression of symptoms is rapid, and PAM can lead to death within a very short period, often within a week of the onset of symptoms. It’s important to seek medical attention immediately if someone develops symptoms after exposure to warm freshwater environments.
Pakistan has faced several N. fowleri outbreaks in the past, causing serious public health issues. In several parts of Pakistan, the temperature can rise beyond 50°C, and the monsoon season, which is characterized by increased rainfall and stagnant water,5 also has an impact on the epidemiology of the disease there. A significant number of cases were reported in Karachi which has particularly scorching temperatures (40), most of them being reported between April and September when temperatures are peaking.
Situation in Pakistan:
This amoeba is an emerging problem in Karachi, which is a major metropolitan city and coastal site of 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 (ie, 142 cases between 1968 and 2019).1 The highest number of PAM cases in the USA were reported in children younger than 14 years,1 but in Pakistan, most cases are reported in adults aged 26–45 years,2 which points to the possibility of a genetically unique strain in Pakistan.
Most cases of PAM are reported in the summer and before the monsoon season. The emergence of N fowleri in Pakistan is diverting the attention of scientists towards climate change. Extended summers and prolonged humid conditions due to climate change provide an ideal environment for amoebas to flourish in bodies of water.
Public awareness campaigns and education are vital to inform the population about preventive measures and the significance of early diagnosis and treatment. Collaboration between research institutions and public health organizations is crucial in formulating evidence-based policies and treatments, ensuring the safety and wellbeing of the people.
Main preventive techniques:
1. Avoid using tap water when irrigating, flushing, or rinsing nasal passages. Use sterile, distilled water. After use, rinse the irrigation device, such as a neti pot, with sterile, distilled water and let the device thoroughly dry.
2. Do not let water get up the nose when taking part in water related activities involving bodies of warm, freshwater. This includes water discharged from industrial plants. The nose should be held shut, nose clips used, or the head held above water.
3. When engaged in water-related activities in warm freshwater, avoid stirring up the sediment in shallow areas.
4. Keep swimming pools adequately disinfected before and during use. Chlorine and pH levels should be maintained at proper levels.
5. Avoid any activity where it is difficult to prevent water from being forced up the nose.
