Brain Eating Amoeba: Alarming Rise of Naegleriasis in Pakistan
Jinnah Sindh University, Karachi City, Pakistan
- *Corresponding Author:
- Hamza Sohail, Jinnah Sindh
University, Karachi City, Pakistan
Citation: Sohail H, et al. Brain Eating Amoeba: Alarming Rise of Naegleriasis in Pakistan. Ann Med Health Sci Res. 2020;10: 816-817.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Naegleriasis also known as primary amoebic meningoencephalitis (PAM) is a fulminant brain infection is caused by a single-celled, ameboflagellate known as Naegleria fowleri. Naegleria fowleri has been difficult to eradicate since its growth is typically found in bodies of warm freshwater, unchlorinated, piped water, swimming pools and moist soil. This letter focuses on characteristics and route of spread of infection caused by Naegleria Fowleri and preventative measures that can be taken to limit its spread. A thorough literature review was performed to identify different route of spread of Naegleria Fowleri infection and specific measures that should be taken to limit its spread. We found that Naegleria follows a nasal route of infection, migrating along the olfactory nerve, through the cribriform plate into the brain where it evokes a substantial immune response causing a widespread inflammation, hemorrhage and necrosis eventually leading to death. The at-risk population includes individuals associated with swimming, diving and water skiing in freshwater and poorly chlorinated swimming pools and individuals performing ablution. Therefore, specific measures should be taken to limit the spread of Naegleria Fowleri infection which includes education and awareness of the public as well as of the health professionals regarding Naegleriasis and its preventative measures.
Naegleriasis; Brain Eating Amoeba
Naegleriasis also known as primary amoebic meningoencephalitis (PAM) is a fulminant brain infection characterized by headache, high grade fever, neck rigidity, seizures, photophobia, vomiting, altered mental status, positive Kernig’s sign and positive Brudzinski’s sign. CSF analyses show low glucose levels, high protein levels and significant leukocytosis. [1,2]
Naegleriasis is caused by a single-celled, ameboflagellate known as Naegleria fowleri. The brain eating amoeba has been difficult to eradicate since its growth is typically found in bodies of warm freshwater, unchlorinated, piped water, swimming pools and moist soil. It follows a nasal route of infection, typically when water is rushed into nostrils during deep inhalation.  It migrates along the olfactory nerve, through the cribriform plate into the brain where it evokes a substantial immune response causing a widespread inflammation, hemorrhage and necrosis eventually leading to death. [1,2]
Although, Naegleria is seen to have a worldwide distribution, the at-risk population includes individuals associated with swimming, diving and water skiing in freshwater and poorly chlorinated swimming pools. Another important cause is ablution, which involves taking water into the nostrils, performed by Muslims before their prayers at least five times a day and has been increasingly associated with N. fowleri infection. [3,4]
Since 1962, 147 cases of Naegleria fowleri have been reported in the United States with only four survivors.  To date, there have been only seven survivors worldwide. 
In Pakistan deaths related to PAM have been reported from Tertiary care hospitals of Karachi regularly since 2008, especially during the summer. In the last 10 years around 88 cases have been recorded, with a fatality rate of 100%. In 2019, 16 new cases have been reported.[6,7]
In majority of the cases, victims denied any history of recent swimming or other recreational water activities. However, almost all patients were Muslims, so the infection likely occurred through ablution with tap water.
Specific measures should be taken to limit the spread of Naegleria Fowleri infection. These measures include education and awareness of the public as well as of the health professionals. When performing ablution, water that is boiled for one minute and left to cool, or filtered to remove small organisms, or disinfected appropriately should be utilized, together with cautious ablution (not pushing water inside nostrils vehemently), in order to avoid serious consequences for communities living in developing countries. Water disinfected appropriately can minimize the risk for infection. Swimming pools, water tanks and domestic water supplies should be effectively disinfected and chlorinated. Jumping and diving into warm freshwater or swimming pools should be avoided and head should be kept above water.[1,2]
The authors declare that they have no competing interests.
- Siddiqui R, Khan NA. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges. PLoS Negl Trop Dis. 2014;8:e3017-e.
- Nih.org.pk. 2019.
- Grace E, Asbill S, Virga K. Naegleria fowleri: A Review of the Pathogenesis, Diagnosis, and Treatment Options. Antimicrobial agents and chemotherapy. 2015;59.
- Shakoor S, Beg MA, Mahmood SF, Bandea R, Sriram R, Noman F, et al. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis. 2011;17:258-261.
- Woodward A. A 10-year-old Texas girl has been killed by a brain-eating amoeba after a swim in the Brazos river. Insider.
- Pakistan issues advisories for dengue fever, chikungunya and Naegleria fowleri [Internet]. Outbreak News Today. 2019
- Digital S, Ali S, Murtaza S, Amin M. Naegleria death toll reaches 16 in Karachi | Samaa Digital Samaa TV. 2019.