Brain-Eating Amoeba Alert in Pakistan

Imama Riaz

Islamabad: A 19-year-old boy from the Gulshan Iqbal area in Karachi has become the latest victim of a Naegleria Fowleri infection, according to a news report released by APP, a private news channel. This brings the total number of fatalities from the brain-eating amoeba in Pakistan to five in 2024.

Naegleria Fowleri, commonly known as the brain-eating amoeba, poses a significant health threat due to its rare but severe infection, Primary Amoebic Meningoencephalitis (PAM). The amoeba thrives in warm, shallow bodies of fresh water such as lakes, rivers, and hot springs, and can also be found in soil. It does not survive in saltwater environments.

Despite its ominous nickname, the brain-eating amoeba does not specifically target the brain as a food source. The term ‘brain-eating’ reflects the unfortunate result of the infection rather than the organism’s feeding habits.

Health authorities and researchers continue to monitor and study the amoeba to better understand its impact and improve prevention strategies.

These amoebas usually eat bacteria. But after entering the human body, the human brain becomes their food source.

What Are Naegleria Symptoms?

The most common way to become infected with Naegleria fowleri is by having infected water enter the nose, which can then travel to the brain. This type of infection is rare but can occur when swimming, diving, or water skiing in contaminated water.

In extremely rare cases, heated tap water or inadequately chlorinated swimming pool water can also be infected. The amoeba does not cause harm if the infected water is swallowed.

Reports indicate that the fatality rate of Naegleria fowleri infection is higher than 97%, even with treatment. The signs and symptoms of primary amoebic meningoencephalitis (PAM) appear suddenly and are severe at onset. These include high fever, severe headache, nausea, vomiting, and tremors.

Symptoms can develop up to 15 days after infection and may also include symptoms similar to meningitis, such as a stiff neck and extreme sensitivity to light (photophobia). Other symptoms may include mental confusion and a decline in brain function. Coma and death typically occur within 10 weeks of symptom onset.

The infection is not contagious or airborne, meaning it is not transmitted through air or physical contact with an infected person. Studies are ongoing to determine if transmission might be possible through tissue or organ donation.

 PAM Diagnosis Challenges

Upon analyzing symptoms, healthcare providers may recommend a spinal tap—also known as a lumbar puncture—to check for the presence of the amoeba in cerebrospinal fluid. They may also suggest a brain biopsy, where a tissue sample is taken and examined under a microscope to confirm the presence of the amoeba.

Diagnosing PAM is challenging, with 75 percent of cases identified only after the amoeba has already caused death. The best outcomes are achieved with early diagnosis and treatment, including the use of specific drugs. Additionally, cooling the body below normal temperature may be employed to prevent brain swelling.

While Naegleria fowleri is considered rare, some cases may go unreported or undiagnosed. For example, a 2021 study in Virginia analyzed over 16,000 autopsy reports from meningitis patients and found five cases that were possibly unreported instances of PAM.

Antifungal Drug Protocol

In a 2009 study, CDC researchers indicated that the common presence of antibodies to the amoeba in humans, along with the frequent detection of Naegleria fowleri in U.S. waters, suggests that exposure to this amoeba is much more widespread than the occurrence of primary amoebic meningoencephalitis (PAM) would suggest.

The treatment of choice for Naegleria fowleri infection is the antifungal amphotericin B. Some survivors from North America were reportedly treated with a combination of drugs, including amphotericin B, rifampin, fluconazole, and miltefosine—a drug approved for treating leishmaniasis, a parasitic disease transmitted by sandflies.

Caution & Prevention

Even though the condition is marked as rare, the outlook is grave and alarming, for which people need to take precautionary actions such as;

1. Avoid swimming, wading, or doing water sports in fresh waters, especially still waters, without nose plugs.
2. Avoid using tap water for nasal cleaning. Boil the water for one minute and let it cool down before using. Prefer the usage of distilled or sterilized water.
3. If you develop symptoms like headaches, fever, or trembling, consult a physician in order to confirm the diagnosis. Early diagnosis is crucial to treating the Naegleria Fowleri.

Additional Input fromAPP.