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.