Brain Eating Amoeba invades Pakistan

It is with a very heavy heart that I share this medical alert, my Father-in-Law Mr. Ghulam Mustafa Khalid passed away on Friday 22nd October 2010 after having been infected with a very rare form of fungal meningitis known as Naegleria Fowleri. He was admitted into the hospital with symptoms of meningitis, but over the next few days suffered from Primary Amoebic Meningoencephalitis which is widespread destruction of the brain tissues caused by the bacteria to have finally having succumbed within the week.

Naegleria Fowleri, also known as the “brain-eating amoeba” is a bacteria typically found in warm water, such as ponds, lakes, rivers and hot springs. It is also found in soil, near warm water discharges of industrial plants, and also can exist in under-maintained or minimally chlorinated swimming pools, though there is no evidence of this amoeba found in ocean water. It is most potent in warm water anywhere above 42°C, at this temperature where it actively reproduces transmits and thrives on brain tissue, while it is known to go in a state of hibernation in cooler temperatures awaiting better conditions.

In humans, Naegleria fowleri invades the nervous system via the nose, when contaminated water is deeply inhaled into the nose, the bacteria initially damages the nerves of smell and slowly creeps up into the brain tissue where it then causes severe hemorrhaging and inflammation. Only a particular set of anti-fungal medications are known to work, needs to be administered for at least 14 days, but in the case of Naegleria the stipulated 14 days is a far cry as it causes massive destruction resulting in death within a 48-72 hours. In June Discovery Health made a mini-documentary explaining this horrid disease Monsters Inside Me: Brain Eating Amoeba

The Wikipedia article on Naeglaria is perhaps the only concise list of patients to have suffered from this disease, unfortunately this bacteria has an exponentially high morbidity rate, to have infected and killed all of the 200+ people across the world in US, New Zealand, Czech Republic and now even in Pakistan, in most cases death occurring within 48-72 hours of its onset.

CASE

Mr. Ghulam Mustafa Khalid was admitted to a hospital in Karachi suffering from neck stiffness, fever and delirium indicating sign of meningitis, CT scans revealed thickening of the linings of the brain forcing the doctors to perform a lumber puncture in an effort to withdraw CSF fluid for lab pathology. Pathological results revealed that he was suffering from the ill-fated bacteria Naegleria Fowler and the doctors immediately began IV and intrathecal administration of Amphotericin B, which is the only drug available to fight this bacteria, unfortunately even the CDC has doubts on its efficacy as there is no concrete clinical evidence that this treatment will affect the outcome quite possibly since there are no survivors of this bacteria.

The continued increase in cranial pressure in Mr. Mustafa’s case indicated the infection was going at a very rampant pace from the start, forcing the neurosurgeon to perform a drastic procedure called decompressive crainectomy which is the removal of the skull bones, to prevent possible brain herniation, in an effort to buy time, allowing the anti-fungal drugs to do their work. On 22nd October the doctors had to proclaim the death of Mr. Ghulam Mustafa Khalid after having gone through a total collapse of all body functions. He was a healthy man of 54-yrs, the only possibility was that he probably inhaled this bacteria while doing aggressive nasal cleansing [a regular daily habit] during his routine wudu,

Pakistan unfortunately has seen an increase in its incidence, possibly attributed to poor water quality but interestingly neurologists and pathologists have seen a considerable rise in the occurrence of this bacteria in Pakistan possibly crossing over 20 or more deaths over the past year. The two documented reports appearing from Pakistan, only on wikipedia, appear after July 2010 have occurred in the post flood-era, could the possibility of an outbreak of such a ruthless disease making its way in Pakistan sent shudders down the medical community.

I was personally shocked to note the unprofessional response by a team of inspectors from Sindh Department of Health who showed up at the hospital during Mr. Ghulam Mustafa’s illness, they were totally ignorant of any previous incidents, and during their short ten-minute inspection took no concrete measures to better document or investigate this case in detail, they hovered around the ICU and disappeared shortly thereafter with absolutely no follow-up since. Even if this were the only case in to appear in Pakistan, it should have brought the government machinery to its feet in instigating efforts to prevent further spread of this bacteria, they never bothered to take water samples or any other measures, seemingly one got the feeling they were more eager to shove this under the carpet than to worry about it any longer

Public Health Prevention Strategy

There is no sure shot way to avoid this brain eating bacteria as it will naturally exist in water, it is mere precautions that need to be take to prevent exposure

  • The only way to prevent contamination is to avoid taking water deep into your nose
  • Avoid swimming in stagnant warm water bodies, it is the risk of inhaling contaminated water though the nose
  • Avoid swimming in less chlorinated swimming pools
  • Owners of Swimming pools must ensure proper levels of chlorination are maintained to prevent the growth of this bacteria
  • Use a nose plug while swimming
  • Avoid deep nasal inhalation of water during Wudu
  • This bacteria is not contagious from person to person
  • Close family members have prophylactically taken Ciprofloxacin, but there is no evidence to suggest that it may help prevent the infection

This write up is not an attempt to create a medical panic, but more to document the case in an effort to raise awareness helping prevent any more such incidents, we as the family of Mr. Ghulam Mustafa Khalid in his memory hope to work towards solving this mystery in times to come possibly finding a cure for this life threatening disease with the vision of helping save lives in his loving memory.

55 thoughts on “Brain Eating Amoeba invades Pakistan”

  1. accept my condolences on this great loss to the family and thankyou for sharing the details .I am sure this information will help the common individual and who knows the health dept might look into it as well.

  2. my deep condolences to the family and thank you for sharing this with all. I, however, have a question to ask of you. not everybody has a pool personally and most people end up using the ones at sports centers or clubs. How is it then that we ensure that chlorine levels in the water are adequate and that proper measures have been taken by those responsible for maintainence?

    1. Tania – you point to a very genuine issue, considering winter has already befallen us, it might be best to avoid swimming in public pools for now, that itself does not mean the fungus will go away – this is a very potent fungus, in adverse conditions (below 32 degrees) it goes into a protective cyst awaiting better conditions and is known to survive in very cold water temperatures even 10 degrees and below

      Swimming pool management must be forced to ensure proper cholrination, generally there is a tinge of chlorine smell, which I believe is the right qty to prevent this fungus. If you still have doubts, then invest in nose plugs, the issue is deep inhalation, akin to the sudden rush of water (like in drowning) into the nose which causes the contamination. Regular water into the nose makes no effect.

      No need to panic, just play it safe

  3. Condolances with the aggrieved family.

    Thanks for sharing this. I'll retweet, share on facebook and email this to all my contacts.

  4. Awab, my deepest condolences to Sadiqa and to the rest of the family. Thank you for sharing what must have been a very painful, traumatic and shocking personal experience for you. This is certainly quite frightening but I hope that more people will help you spread an awareness of this problem so that other lives can be saved.

  5. my deepest condolences to your family,may Allah grant him the best in heaven and rest his soul in peace.

    thankyou for sharing this.

  6. Awab, certainly a tragic loss! My heartfelt condolences for the family.

    But, above all, truly appreciate ur contribution to the society regarding awareness of this unique & fatal infectious disease.

    May Allah bless you for this noble cause! Jazak'Allah.

  7. I'm really sorry to hear about your loss. Thank you Awab bhai for this information. I have already shared it on Facebook, will further spread it to my contacts so that everyone that I know has a chance of safety and prevention from this infection.

  8. So sorry dear Awab, I remember we met at the hospital on 16th and you told me about your father-in-law is admitted. Thanks for writing this blog its very important read it.

  9. Deep condolence to the aggrieved family.Indeed,its a great loss for the family.

    while water contamination is a leading and alarming issue that must be dealt with,I would like to add more to relief anguish regarding amoebic brain infections.

    It is virtually impossible to have a sterile environment free from each & every microorganism anywhere in the world (except hospital ICU,s mayb,though I doubt!).

    Their r numerous such extremely rare infections and diseases which honestly merely serve as case-studies for hospital clinicopathological conferences & serve as laurels for the doctors for having it diagnosed and sometimes treated. I m happy to know that it got diagnosed in Pakistan,though treatment is limited as mentioned in the post & survival rate only 3%.

    N.Fowleri and other free-living aomeaba r ubiquitous,it isnt something that has invaded Pak like dengue.It rarely infects and than CNS infiltration is exceptionally rare all over the world.(Other than that most commonly amoeba (E.Histolytica)causes fairly treatable dysentery,liver abscess)

    we donot have control over time of death.So no worries. Roads are most lethal, but we dont stop driving.

    1. Fatima, I think you do point to relevant argument – it is noted that 70% of all US Lakes are contaminated by this amoba, why hasnt it surfaced, I can only guess that the only time one inhales water in a lake so deep enough is when one might accidentally plunge in a drowning incident.

      In Pakistan there is another strange twist, My father in Law got this disease as he usually deep cleansed wile doing Wudu, I suspect a lot many people do this exercise and that is where I feel lies the problem, not general swimming or dunking in flood water

    1. Vaqas – it has most definitely surfaced in Pakistan – previously it was found only in US, New Zealand and Czech Republic – the occurrence even of one particular new country should be alarming. But I am told that many more cases have been appearing in AKU. So Id rather pay caution to the wind then merely shrug it aside.

  10. Doc, it was a bit unusual to see you absent from the cyberspace for a long time. I had thought that you may have been traveling. That is why i wrote you that message. Didn't know about this loss till that time.

    Please accept our heartfelt condolence. Our prayers for the departed soul and also for Sabr to the family.

    Few years ago, I also have had suffered a personal loss due to meningitis but that was then turned into encephalitis. We could not do much except seeing him going out of our hands. Allah's will.

    All the best my friend…and keep up all the great work that you continue to do…now all the more important in his sweet memories.

    Prayers!

  11. my deepest condolances with the family.May Allah Pak grant him Jannah , forgive his sins and spare him in the grave and hereafter and give patience and strength to his family.

    this is a scary scenario ! because we all do wudhu !! :

  12. Please accept our heartfelt condolence, prayers for the departed soul and family..

    Meningitis came into my knowledge when Salman suffered from it, I really don't know which meningitis was it.. but doctor said fungal and yet I can't get from where he catches it..

    Its still a mystery for me..

    I don't know enough about it.. but he was suffering from high fever, unconsciousness.. etc.

    It is said meningitis is rare and very rarely people get cure from it.

    Anyways..

    Nice and informative piece doctor :) thank you!

  13. Sad, but truly everyones fate is written. What concerns me now is the NeliMed (sinus rinse) people do, how can we prevent these things…precaution to what extent??

  14. continued: It is therefore recommended to use distilled water, incase anyone uses tap water for it. I guess one shud use distilled water for nose rinses during wudu too.

  15. I'm truly sorry, Awab. Please accept my deep condolences.

    And thank you very much for sharing this with us. I'm putting this on my Wall. People should be alerted to the danger, especially those performing ablution.

  16. Really sorry to hear about your father in-law Awab.May his soul rest in peace. Thanks for updating us about this deadly amoeba. Hoping and praying it doesn't spread further specially in flood-affected areas.

  17. It is a freighting Amoebic dysentery is quite common in our country. Ablution areas of the mosques definitely need attention as due to lack of good water people store water in mosques un-hygienic tanks for months and without choline and irony is many people in their quest of being strong believers take water way deep in the nose for Ablution.

  18. Inna lillahi wa inaa ilaha rajioon…

    Dr. Sahib, May Allah have mercy on your father in law and on you and your family and forgive all the muslimeen and all the muslimaat.

  19. Deep condolence from me as well; it's sad and shocking at the same time.

    However, please change the title of this post. Nowhere in your post you have any strong arguments to use the work "invade" in the post title. So, this post could also be titled, "My father-in-law dies from brain invading amoeba" which would create the same level of awareness without any panic.

  20. Sorry to hear of the sad demise with such a big disease well Allah's will we should accept but of course may Allah give you'll His Mercy and May his soul rest in peace and Magfirat be granted we pray for our Muslim brothers be Patient Allah will reward you for the same and incase there was negligence in the treatment they shouldn't be spared.

  21. inna lillah e wa inna ilaih e rajioon.

    May Allah bless the departed sould.

    Indeed a very informative article and its good to see that you decided to share that.

  22. This is indeed a dilemma that we are facing today as naegleria meningitis is a very serious issue and calls for urgent measures to improve potable water supply. we have seen atleaset 20 cases in karachi this year and most of them were young males. and the mortality is greater than 95%, despite all the possible treatment measures. this is a parasitic "amebic" infection and not a fungal infection.

    very sad about the loss in your family. but this article will enlighten people alot. thanks for sharing it.

  23. We offer our most heartfelt condolences to you and to the other family and friends of Mr Ghulam Mustafa Khalid. Also we thank you with gratitude for posting the article. I have already shared the information with many of my friends and will keep doing so. Thank you.

  24. Very sorry at your loss and my deepest condolences to your wife May Allah allows her strength to cope with this.
    Thank you for posting such an informative piece prevention is the best measure .
    I hate chlorine in the water but it can be life saving I had no idea

  25. Just to clear things up, the organism appears to be an amoeba, rather than a bacterium or a fungus.

    Thanks for sharing this information with us and spreading awareness. Incidentally, perhaps it would be wise to alter the title – the implication that the amoeba is on a wild rampage in the country could lead to panic!

  26. Hello assalamvalium ,Yesterday my friend zain kamran died just because of this syndrome,he is from karachi federal b area and he died within 5 days in agha khan hospital.May Allah rest his and your father soul in peace.

  27. Can u tell me that the water use to come in ur tap was that khara pani or meetha one of well??????? which water should we use?

  28. Referring to your comment on the article, "Brain-eating amoeba claims two more lives" (http://dawn.com/2012/10/08/brain-eating-amoeba-claims-two-more-lives/), everything you've stated I agree with except for one thing: N. folweri is not a bacteria. It is an amoebic-parasite. N. fowleri is an amoeba, which makes it a protozoan which ultimately categorizes it as a eukaryote organism while bacteria are prokaryote organisms. Lastly, it is a parasite because it benefits at the expense of its host.

  29. first of all I am very sorry for your lose. However, I have a question…it is understood now that we should avoid taking water deep into our nose…but to be more safe….i heard that we should use chlorinated water right? well, to be honest i dont believe our water supply board to do that…so..is there any way to do it on our own? Like chlorinate the water in our tanks etc by own…is there any specific method? and how should it be done and the quanitity? If you have any idea, please do share.
    Thanks.

  30. Was this article written for medical purposes? Because if so, I find it hard to trust this article. The first line of the second paragraph is a medical blunder itself "Naegleria Fowleri, also known as the “brain-eating amoeba” is a bacteria ", an amoeba cannot be a bacteria.

    Furthermore , the article describes it as a fungal amoeba. So now we have an amoeba that is also a fungus AND a bacterium? If thats true then all I can say is: Watch out we have a BADASS over here.

    This article contradicts itself in such hilarious ways that I laughed several times.

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