Outbreak of ‘Brain-eating Amoeba’ in Karachi
What is Naegleria?
Naegleria is an amoeba (single-celled living organism) commonly found in warm freshwater (for example, lakes, rivers, and hot springs) and soil. Only one species (type) of Naegleria infects people: Naegleria fowleri.
How does infection with Naegleria fowleri occur?
Naegleria fowleri infects people when water containing the amoeba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri amoeba then travels up the nose to the brain where it destroys the brain tissue. You cannot be infected with Naegleria fowleri by drinking contaminated water.
Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water and contaminated tap water) enters the nose, for example when people submerge their heads or cleanse during religious practices (wuzu), and when people irrigate their sinuses (nose) using contaminated tap water.
In what water temperature does Naegleria fowleri cause infection?
Naegleria fowleri is a heat-loving (thermophilic) microbe. It grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.
Can I get a Naegleria fowleri infection from a disinfected swimming pool?
No. You cannot get a Naegleria fowleri infection from a properly cleaned, maintained, and disinfected swimming pool.
When do Naegleria fowleri infections most commonly occur?
While infections with Naegleria fowleri are very rare, they occur mainly during the summer months of July, August, and September.
Can infection be spread from one person to another?
No. Naegleria fowleri infection cannot be spread from one person to another.
What are the symptoms of Naegleria fowleri infection?
Naegleria fowleri causes the disease primary amebic meningoencephalitis (PAM), a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to symptoms of bacterial meningitis.
Initial symptoms of PAM start about 5 days (range 1 to 7 days) after infection. The initial symptoms may include headache, fever, nausea, or vomiting. Later symptoms can include stiff neck, confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly and usually causes death within about 5 days (range 1 to 12 days).
What is the actual mechanism of death from Naegleria fowleri infection?
The infection destroys brain tissue causing brain swelling and death.
What is the fatality rate for an infected person who begins to show signs and symptoms?
The fatality rate is over 99%.
Is there effective treatment for infection with Naegleria fowleri?
It is not clear. Several drugs are effective against Naegleria fowleri in the laboratory. However, their effectiveness is unclear since almost all infections have been fatal, even when people were treated with similar drug combinations.
What should I do if I have been swimming or playing in freshwater and now think I have symptoms associated with Naegleria fowleri?
People should seek medical care immediately whenever they develop a sudden onset of fever, headache, stiff neck, and vomiting, particularly if they have been in warm freshwater recently.
What swimming behaviors have been associated with Naegleria fowleri infection?
Behaviors associated with the infection include diving or jumping into the water, submerging the head under water or engaging in other water-related activities that cause water to go up the nose.
How can I reduce the risk of infection with Naegleria fowleri?
- Use chlorinated and boiled water.
- Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater.
- Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
- Avoid swimming in waters where you suspect poor hygiene and insufficient chlorination.
If you are irrigating, flushing, or rinsing your sinuses (for example, Wuzu), use water that has been:
- previously boiled for 1 minute and left to cool or
- filtered, using a filter with an absolute pore size of 1 micron or smaller or
- purchased with a label specifying that it contains distilled or sterile water.
Dr. Kamran Dawood
Consultant Microbiologist and
Head of Microbiology and Infection Control Department
Further Reference: http://www.cdc.gov/parasites/naegleria/general.html
Medical Disclaimer: This is general information provided for educational and awareness purposes. This information is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.
- Brain Eating Amoeba invades Pakistan | Teeth Maestro (Teeth.com.pk)
- Brain-eating amoeba kills at least 10 in Karachi (guardian.co.uk)
- Fatal parasite strikes in Karachi (bbc.co.uk)
- What is the “brain-eating” amoeba found in Pakistan? (cbsnews.com)
- Pakistan: No risk of Naegleria if water boiled or chlorinated, say experts (crofsblogs.typepad.com)
- Naegleria Fowleri: ‘Brain-Eating Amoeba’ Kills 10 In Pakistan (huffingtonpost.com)
- Deadly Amoeba in Tap Water (foxnews.com)
February 10, 2012
To: All Member Companies of PPMA
LETTER FOR THE EMBASSIES
As you may already know regarding the unfortunate deaths reported at the Punjab Institute of Cardiology in the past few weeks. We, the Pakistan Pharmaceutical Manufacturers’ Association (PPMA), the representative body of the Pakistan pharma industry have been shocked by this tragedy and have full sympathies with the affected families. We have been having contacts and meetings with the authorities and also with the technical personnel in our member companies all over Pakistan. The main purpose of the contacts and meetings was to
1. To ascertain the facts
2. To review the Quality Assurance/ Quality Control and cGMP guidelines and SOPs for validation.
These measures would be vital to prevent any further mishap of this nature.
Coming now to the facts; the samples were sent to the government labs as well as independent labs in the UK and Belgium. So far we have seen reports of one batch from a particular company being contaminated. However, we are unable to share the details as the matter is subjudice as the Supreme Court of Pakistan has taken Suo Moto notice of the entire matter.
We would like to mention here that due to lot of hype created by the media, panic has been created in the public’s mind that all locally produced medicines are spurious and sub-standard. We started getting enquiries from the foreign buyers of our medicines, asking our manufacturers to clarify the matter. In at least two cases, the orders have been cancelled by the foreign buyers. We held press conference in Karachi, Lahore, and Islamabad where we stated the facts of the matter with a view of restraining the media not to spread the misinformation campaign as it would shatter the trust that the National pharma industry has built in the public over several decades, and would lead to its collapse, paving way for counterfeits to fill the vacuum that would be created in the market. The National pharma industry is exporting to over 60 countries and the total exports are around USD 170 million. 40% of the leading brands of medicines marketed by MNCs in Pakistan are manufactured by National companies under contract manufacturing. This is reflective of the quality manufacturing of the National industry and the trust reposed in it. We would like to mention that the exported drugs also undergo stringent quality control checks in their respective importing countries (case in point, Afghanistan where all batches are quarantined for 15 days by their Ministry of Health and then released for marketing after QC clearance), suggesting additional safeguards for the patients.
Incidence like this one, though unfortunate, happens even in developed markets and big MNCs have recalled contaminated batches, after deaths were reported. We strongly feel that the entire industry’s image should not be damaged because of once in a lifetime incident like this one.
We hope that we have been able to give our viewpoint, and would like to assure you that the PPMA is doing whatever it can to prevent such an occurrence in the future. Our members have already started the process of re-validation in their manufacturing process. We seek your understanding and support in the matter.
Thanks and regards
Executive Director/ Secretary General PPMA
c.c. Mr. Tariq Ikram, Acting Chairman PPMA
Mr. Muhammad Asad, Chairman PPMA (on leave)
PIC case gets a new twist | Efroze Chemicals ISOTAB was not prescribed to most of the victims – Mubashir Luqman
Free medicine at Punjab Institute of Cardiology (PIC) becomes a death sentence. 130 plus deaths. Political mud-slinging. Conspiracy theories. Spurious accusations. Pakistan’s pharmaceutical industry in trouble. Catch up on the news first then read on.
Now that you are up-to-date on this bizarre story here’s a new twist! (Forward to around the 27 second mark)
What’s that now? Mubashir Luqman is on Dunya TV saying Efroze Chemical’s ISOTAB, the alleged killer drug, was not even prescribed to most of the PIC patients who died? Yes read that again. ISOTAB may not have been prescribed to those who died. Wait wasn’t the anti-malarial inadvertently added to ISOTAB conclusively responsible as the cause of death? Talha bin Ayub wrote a few days back in a guest blog on Teeth Maestro that things don’t add up medically and that a overdose from the anti-malarial can be reversed also.
We need to step back and really investigate this whole incident properly without political circuses or lynch mobs baying for blood. For the sake of the 130 plus who passed away. For the sake of the thousands that may die in the future if this entire episode is not used to structure the pharmaceutical industry, to build in safeguards, to strengthen our institutions, and to protect our people.
What do you think of this entire episode and these new developments?