Fatal amoebas: Up your nose and into your brain

Published: November 22, 2014

We should use bottled water instead of tap water for ablution, especially in Karachi, where the infection is primarily located. PHOTO: REUTERS

We should use bottled water instead of tap water for ablution, especially in Karachi, where the infection is primarily located. PHOTO: FILE We should use bottled water instead of tap water for ablution, especially in Karachi, where the infection is primarily located. PHOTO: REUTERS

Just reading the title makes one assume that this is a story out of some cheap sci-fi movie: a unicellular organism killing mankind, one brain at a time. When, in reality, this amoeba does exist and it’s called Naegleria Fowleri. This organism is thermophilic and lives in fresh water like lakes, ponds as well as polluted water systems such as sewage and dirty canals.

All the amoeba needs is a passage to enter the brain, and that usually happens when people swim in such waters, when the possibility of water entering the nose is high. Since the nose is the quickest route to the brain, wuzu (ablution) is a sure fire way for the amoeba to gain entry. Once it’s inside, it begins by first feeding on the nerve tissue and from there it migrates towards the cranium. It starts eating the cells of the brain and through its pathogenicity causes Primary Amoebic Meningoencephalitis (PAM), a disease that attacks the central nervous system of our body.

The symptoms from the infection usually start appearing five to seven days after exposure, which include changes in senses of taste and smell, headaches, nausea and vomiting. The problem that comes with such vague initial symptoms is with its diagnostics, since people who do suffer from this disease assume it’s nothing more than a common cold or a flu bug, rather than assuming something far scarier.

After the initial symptoms, the amoeba multiplies rapidly and attacks more parts of the brain leading to secondary symptoms such as confusion, hallucinations, stiff neck, seizures and even a coma, amongst others. By this time, the disease shifts into high gear in terms of progression where death becomes imminent by seventh to 14th day since the symptoms first appeared.

This is a rare and a near fatal disease that has a 99% fatality rate. According to the Centers for Disease and Control (CDC), only three out of 132 people in the US have survived from this disease from 1962 to 2013. The odds aren’t stacked great for even those who do survive either. Since the focus of the infection is to infect and eat away at the brain, those who do survive can have problems in brain functionality.

The problem with Naegleria Fowleri is three fold: prevention, diagnosis and treatment. Prevention for such a disease is mainly alerting the public about the disease, informing them of the risks and making sure that the various bodies of water such as ponds, lakes and even the water systems are properly chlorinated. Chlorination has been determined as one possibility of stopping the growth of the organism.

The diagnosis is a bit tricky since the disease is uncommon and its symptoms are vague enough to be related to other infections, including the common cold. Furthermore, since the progression rate is very high for this disease, catching it in a timely manner is crucial to the patient’s survival. If it is not detected earlier, then the patient would eventually die from the symptoms.

The treatment is still unclear with different drugs being developed to attack the infection. Amphotericin B is the most common drug used to treat this disease. Amphotericin B, an antifungal disease, acts like a double edged sword.  While it can act as a somewhat effective treatment, if PAM is detected early, the drug can also have severe side effects. The high dosage required to halt the progress of the amoeba can also permanently destroy the kidneys. Rifamicin has also been used along with Amphotericin B as a cocktail drug but it still doesn’t inhibit the organism’s growth.

Recently, a breast cancer and anti-leishmania drug, miltefosine, has shown to be a promising treatment. It is an ameobicidal drug and using it along with a cocktail of other drugs has proven to be an effective treatment for this disease. There have been many drugs that are still being experimented on and determined for their efficacy, thus research on its treatment is still ongoing.

While the disease itself is rare and only a handful out of hundreds survived in the US, Naegleria Fowleri has seemingly arrived and viciously attacked many in Pakistan. A report showed that from July to October 2012, 44 people in the southern part of Pakistan died within a week from the Naegleria infection. With 13 reported cases in Karachi, Naegleria Fowleri is now a disease that the public needs to be made aware of.

We cannot let Pakistan become just another statistical data in a long list of diseases that has run rampant in our land. We need to learn how to protect ourselves and be aware of diseases that seem to be popping up left, right and center. While treatments are still underway and many experimental options are being considered, we at least need to learn how to prevent such a disease and be educated enough to detect it early on.

In the summer of 2013, my family and I went to Karachi to visit my mamoo (maternal uncle). With the suitcases propped in our rooms and the pleasantries completed upon arrival, he immediately took us in to the washroom and gave us very strict instructions. He had a Nestlé water bottled kept next to the sink and told us to never use the tap water when washing our face and especially when putting the water up our nose. I was so confused and remembered thinking that,

“Why was he being so weird and finicky about water? I mean it’s just water, right?”

Back then, I had no idea that such a disease even existed outside the realm of science fiction. Then a few weeks later, I heard that one of my uncle’s close friends had died from bacterial meningitis in Karachi. That incident really affected me and I started doing thorough research on what happened and was able to connect the dots, which led to me learning about the disease, a gruesome and unforgiving disease that robs a person of everything that they are in a matter of days.

It should be understood that drinking water does not cause this disease. Only water going up the nose can lead to a person being infected with the disease, so efforts need to be made to avoid water contact with the nose. For example, we can use bottled water instead of tap water for wuzu, especially in Karachi, where the infection is primarily located. Furthermore, work needs to be done in chlorinating such bodies of water and improving the water and drinking systems.

If we work on these two aspects, then we can lower the rate of fatality of PAM because if we make it hard for the amoeba to enter our bodies, then the lack of treatment is not a great concern. And on the off chance that it does infect us, we need to be vigilant of the side effects and connect the dots early on so that the drugs can be administered quickly.

With scientists working on promising new treatments and more preventive measures implemented, this deadly amoeba can be on its way to becoming more fiction than fact.

Mariam Sajid

Mariam Sajid

The writer is currently doing her BS(Hons) in biotechnology from Forman Christian College and has an interest in human genetics and diseases. She likes to read novels and write stories in her blog.

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Malti Chaturvedi

    so after polio another disease ….. recently congo fever also….. who cares in pakistan anyway……they planning to buy china junk with AID money…kewlRecommend

  • Maximus Decimus Meridius

    For those who cannot afford a bottle of bottled water five times a day for each family member there is a cheap alternative. You can keep chlorine tablets at hand and use them in a bucket of water to perform ablution.Recommend

  • Lt Col Imtiaz Alam(retd)

    A job well done . Govt should take notice & educate the Public to take Prevention measures. All water supplies must be Chlorinated. People storing water in under ground/overhead tanks must be facilitated to chlorinate the water. Chlorination has been determined as one possibility of stopping the growth of the organism.Recommend

  • Furqan

    We need to be ware of these because reliable treatment post-infection is not available: dengue, congo, rabies, amoeba meningitis. I am sure the list is short, but cant recall the rest.Recommend

  • abreez

    Sometime I wonder what will happen when two or three
    inhabited lands will be there in outer space at a distance of 500 light year
    away or 700 light year away. More
    knowledge and more worries, instead we make knowledge an enjoyable
    thing we’re making it a horrible thing.
    Someone very powerful and very knowledgeable is controlling everyday life
    of every creature and He has the ability and power to do so.

    He manages (every) matter from the sky to the earth, then it
    (every matter) will ascend to Him in a day the measure of which is one thousand
    years according to the way you count.[32:5]

    They ask you to bring the punishment sooner, while Allah
    will never go back on His promise. In fact, one day with your Lord
    is like one thousand years according to your calculation.[22:47]Recommend

  • Parvez

    To be honest I enjoyed reading this because it was different.
    After reading it, with a broad grin on my face, the first thing that came to mind was some years back there was a campaign accusing Benazir Bhutto of importing Evian bottled water for drinking……..and now we have you touting Nestle water for wuzu. Isn’t this a bit paranoid ? In Karachi the chances of getting hit by a vehicle coming up the wrong side of the road is greater than an a bug going up ones nose.Recommend

  • Qbosal

    what would be the condition of brain of the affected person…is there nay burst in the veins or something else??
    use full and good research…..Recommend

  • UtkarshSinghNain

    Oh, no, something to do with religion has been kind of mentioned as having to do with something bad! must be a Jewish heathen who wants to lead people to Satan.

    Hope people understand the argument first, which is basically about using clean water. Recommend

  • Mihir shah


  • Swapnil N.

    The authorities at the mosques should make arrangements to ensure that people dont get contaminated water up their noses.Recommend

  • Baba Ji

    Thanks for a good piece to educate general masses … I lost one of my closest friends to this in Karachi in 2012.Recommend

  • Asher

    my one colleague has died earlier this year due to this diseaseRecommend

  • Great article to write on part of the writer; truly a service.Recommend

  • Malik Abdul Rehman

    for a disease that has infected probably less then a 1000 people around the globe till date and with it’s pathogenicity not fully understood you are advocating major life style changes and advertising a bottled water brand……….the real thing to be emphasized here is proper chlorination of water………… which according to you affects Muslims only since according to your article people not in a need to practice ablution are no likely to clean their nose with water every once in a while and ablution seems to be the only likely way people would pour water in their nose……..beside that let me assure you that using ordinary water to clean your nose in 99.99 % of cases will not give you bacterial meningitis and that swimming in unchlorinated water is the most debated cause of aforementioned disease that too probably happening in one in a billion cases or less.Recommend

  • saqib

    Excellent piece of work. A very useful article and I applaud you for spreading the word about this disease.Recommend

  • Farooq khan

    Thankyou for sharing the knowledge.Many of us are lacking awarness of such.

    Sometimes i feel these diseases are imposed on us,because as i see it medicine is a multi billion dollar industry and i am very sure someone is responsible for introduction of dengue to us,as it came out of no where and within an year dissapeared with the wind rises questions of its roots.it surely had filled the pockets of the government and the companies providing the medicines.Now Godforbid if this desease goes viral it will add to our miseries and to already book of precautions already been taken.Recommend

  • Ruqaiyyah Siddiqui
  • Ashar Bazeb Saeed

    Please present all these reasons when Allah forbid you or your close relative or friend falls victim to this or any other “obscure” disease!Recommend

  • http://kashifmd.com/ Kashif Chaudhry

    Thank you for writing this piece. Very helpful.Recommend

  • Too early with your prejudice, weren’t you? How do you live with the personal disappointment of being just another Indian troll?Recommend

  • Dante

    This looks like an inspirational essay I would have written back in junior school, to rid the world of amoeba that is eating away humankind one brain at a time.

    Reminds me once I was young too. Actually I wouldn’t mind it.

    I have a feeling that you wrote this article as a sarcasm, in which case it’s a brilliant effort. I can guarantee you that all the scientists in the world have other more common things to worry about than Naegleria Fowleri. Can you care to elaborate if the new drugs that you mentioned are being developed specifically for this amoeba or PAM in general?Recommend

  • Khurram Shahid

    Avoid the fatal step. Don’t clean your nose. Recommend

  • abubakar

    Oh you elitists, i wish you could step out of your elite bubble for once and see things in Pakistan for what they are in reality Recommend

  • Abidktk

    Nice article it will really help all those people having no awareness about this silent killer disease.Recommend

  • UtkarshSinghNain

    Why am I a troll?
    I said people shouldn’t get ahead of themselves when religion is mentioned and should actually go through the article first. I fail to see how this is trolling.Recommend