Fatal amoebas: Up your nose and into your brain

Published: November 22, 2014
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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.