Nagleria Fowleri, a microscopic organism, inhabits warm, fresh water and is capable of inflicting primary amoebic meningoencephalitis (PAM), a rare but fatal brain infection. The amoeba enters the nose, perhaps during swimming or ablution, and travels to the brain along the olfactory nerve, causing the infection. The symptoms are usually like meningitis which include headache, fever, nausea, vomiting, and seizures. It is a very deadly infection and has a mortality rate of nearly 98%.

Nagleria fowleri in Pakistan:

After the United States, Pakistan has the second highest cases of Primary Amoebic Meningoencephalitis (PAM) in the occurrence of this disease. Since 2008, more than 150 cases have been reported from Karachi, the largest city and coastal site of Pakistan. Most cases occur in adults aged 26-45 years, which suggests that the strain of Nagleria fowleri in Pakistan may be different from other strains or resistant to saline water. Most cases also occur in Muslims who practice ablution, which involves rinsing the nose with water for religious purposes.

The infection is more common in summer and before the monsoon season. The main reason for it is that the temperature of water is high, which is favorable for amoeba to grow. The amoeba loves such an environment and can multiply faster in such condition.

A suspected case of PAM was also recently reported in the city of Lahore which is the second largest city of Pakistan. A 30-year-old man died after swimming in a pool and developing meningitis-like symptoms. This lead to an alarming concerns among health officials and the public about the rise in spread of Nagleria fowleri in other parts of the country aswell.

Why is it spreading in Pakistan ?

There are several possible causes for the spread of Nagleria fowleri in Pakistan, such as:

Climate change: Extended summers and prolonged humid conditions due to climate change provide an ideal environment for the amoeba to flourish in warm, freshwater bodies.
Water quality: The amoeba may be present in the domestic water supply of Karachi and other cities, especially if the water is not properly chlorinated or disinfected. The amoeba may also have developed resistance to saline water, which is normally found in coastal areas.
Water activity: Most infections occur in Muslims who practice ablution, which involves rinsing the nose with water for religious purposes. Some infections may also occur in people who swim or dive in freshwater lakes or pools.

Nagleria fowleri: A Brain eating Amoeba overview:

What is nagleria fowleri?

Nagleria fowleri is an amoeba usually known as brain eating amoeba. It is found in water bodies containing freshwater such as rivers, lakes and hot springs. It was first identified in the 1899 and belongs to the phylum Percolozoa. Normally, this amoeba poses no threat to humans and cause no diseases. However, it can lead to Primary Amoebic Meningoencephalitis (PAM) in some conditions, which is a severe brain infection.

How Brain eating amoeba enters into the body?

The transmission of Nagleria fowleri primarily occurs through the nasal passage. When individuals comes into the contact with warm freshwater environments, such as swimming or diving, the amoeba can enter the body through the nose. It is commonly transmitted during water-related activities in warm freshwater bodies, including lakes, rivers, hot springs, and poorly maintained swimming pools.

The amoeba enters the body through the nasal passages when individuals come into contact with contaminated water. This can happen when water is forcefully inhaled through the nose or when it enters the nose unintentionally while diving or jumping into water. Once inside the nasal passages, Nagleria fowleri can migrate along the olfactory nerve to reach the brain. It then damages the tissues inside the brain, which leads to the development of severe brain infection,  PAM.

However, the infection doesnot spread through physical contact, respiratory droplets, or from one person to another. Therefore, it is not contagious. And also, there is no evidence stating that the nagleria fowleri infection can occur through the intake of contaminated water. So, the brain eating amoeba’s entry to the body is only specific to nasal passage.

Symptoms of Nagleria fowleri infection:

It takes two to 15 days for symptoms to appear after the entering of amoeba into the body. The average time to death is 5.3 days from the onset of symptoms. Only a few of the patients worldwide have been reported to have survived an infection caused by the brain eating amoeba. The symptoms of the infection caused by brain eating ameoba are:

• Severe Headache: Intense and persistent headaches are one of the initial symptoms of Nagleria fowleri infection. The headache may worsen over time and become unbearable.
• Fever: A high-grade fever is often present in individuals infected with Nagleria fowleri. The body temperature may rise rapidly, accompanied by chills and sweating.
• Nausea and Vomiting: The common symptoms of the infection includes nausea and vomiting. These symptoms may be severe and lead to dehydration.
• Stiff Neck: Neck stiffness and pain are typical signs of Nagleria fowleri infection. The neck may become difficult to move due to inflammation of the meninges (protective membranes around the brain).
• Altered Mental State: The person infected by the brain eating amoeba infection may experience confusion, disorientation, and changes in mental status. They may have difficulty concentrating or understanding their surroundings.
• Seizures: Seizures can occur as a result of the brain inflammation caused by Nagleria fowleri. These seizures may be generalized or focal, causing abnormal movements or loss of consciousness.
• Hallucinations: Some infected individuals may experience hallucinations, seeing or hearing things that are not actually present. These hallucinations can be distressing and contribute to altered mental state.
• Coma:  In severe cases, Nagleria fowleri infection can progress to a coma. The individual may be unresponsive and show no signs of wakefulness.

The symptoms of the Nagleria infection are usually similar to that of meningitis. Therefore, seek immediate medical assistance if you experience any above symptoms especially after water-activities.

Prevention of Nagleria fowleri infection:

Currently, there is no vaccine or specific treatment for PAM in the whole world. So, prevention is the best strategy to avoid this deadly infection. Here are some tips to reduce the risk of exposure to Nagleria fowleri:

1. Avoid swimming or diving in the fresh water bodies such as lakes, rivers, ponds and hot springs. If you do swim, wear a nose clip or hold your nose shut to prevent water from entering your nose.
2. Avoid using tap water or unchlorinated water for nasal irrigation or ablution. Use boiled, distilled or sterile water instead. You can also add salt to the water to make it saline.
3. Avoid putting your head under water when using hot tubs or spas. Make sure they are well maintained and disinfected regularly.
4. Keep your swimming pools clean and chlorinated. Check the water quality and temperature frequently.
5. Seek medical attention immediately if you develop symptoms of PAM after being exposed to warm, fresh water. The chances of survivial are only when the infection is diagnosed early and treated properly.
6. Nagleria fowleri is a serious threat to the people living in Pakistan and other countries with warm climates and poor water quality.
   So, by following these preventive tips, you can protect yourselves from this rare, deadly brain-eating bacteria.

Possible treatment options:

Early diagnosis and prompt treatment are crucial in improving the chances of survival for individuals with Nagleria fowleri infection. Antifungal medications are primarily being used for the treatment of the infection. The most used is amphotericin B . Supportive care, including management of intracranial pressure and control of seizures, is also essential. Despite these efforts, the mortality rate associated with Nagleria fowleri infection remains high.

FAQs:

1. Can Nagleria fowleri be transmitted through drinking contaminated water?
No, Nagleria fowleri infection cannot be transmitted through drinking contaminated water. The amoeba enters the body through the nose, primarily during water-related activities.

2. Is there a vaccine available to prevent Nagleria fowleri infection?
Currently, there is no vaccine available for Nagleria fowleri infection. Preventive measures, such as avoiding high-risk water environments and using nose clips when swimming, are recommended.

3.  How common is Nagleria fowleri infection?
Nagleria fowleri infection is extremely rare. Only a few cases are reported globally each year. But it’s an extremely fatal disease.

4. Can Nagleria fowleri be transmitted from person to person?
No, Nagleria fowleri cannot be transmitted from person to person. It is not a contagious infection.
5. Are there any ongoing research efforts to combat Nagleria fowleri?
Yes, researchers and public health agencies continue to study Nagleria fowleri to better understand its biology, transmission, and potential treatment options. Ongoing research aims to develop effective preventive strategies and improve the management of this rare infection.

6. Is Nagleria fowleri infection curable?

No, it is not curable and the mortality rate of the infection is extremely high.

Conclusion:

Nagleria fowleri is a dangerous brain-eating amoeba that can cause a severe and fatal brain infection known as PAM (Primary Amoebic Meningoencephalitis). Although, the cases of this infection are rare but it is important to be aware of the potential risks associated with warm freshwater environments. By following preventive measures and taking precautions when engaging in water-related activities, individuals can significantly reduce the risk of Nagleria fowleri infection. It is crucial to stay informed, prioritize safety, and enjoy water activities responsibly.

Affan Lateef

Hi, I’m Affan lateef , a pharmacist by profession. I have a degree in pharmacy and over 5 years of experience helping people achieve their health goals. I write about various topics like health, artificial intelligence in health, mental health, diet and weight loss. Follow me here on these platforms given below.