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**Ronan Kelly** · July 20, 2012, 05:53 AM

Re: Pakistan: Naegleria kills four in Karachi

Waterborne amoeba blamed for three recent deaths
From the Newspaper | Mukhtar Alam | 15 hours ago 0

KARACHI, July 19: Three young men between 22 and 27 years of age admitted to a private hospital in the city during the past two weeks have died due to what doctors described as a ?free-living amoeba capable of causing human disease?, it emerged on Thursday.

The doctors, who treated the three patients at the Liaquat National Hospital, named the pathogenic amoeba as Naegleria fowleri, which causes an acute and usually lethal central nervous system (CNS) disease called primary amebic meningoencephalitis (PAM).

Initially, it was assumed that the deceased persons had contracted the Naegleria fowleri amoeba through water sources, including swimming pools. However, Dawn?s investigation revealed that only one of the three amoeba victims had swum in a recreational place swimming pool along the Superhighway.
...

Waterborne amoeba blamed for three recent deaths

http://dawn.com/2012/07/20/waterborne-amoeba-blamed-for-three-recent-deaths/

KARACHI, July 19: Three young men between 22 and 27 years of age admitted to a private hospital in the city during the past two weeks have died due to what doctors described as a “free-living amoeba capable of causing human disease”, it emerged on Thursda

**alert** · July 20, 2012, 06:44 AM

Re: Pakistan: Naegleria kills four in Karachi

Over an 18 month period from 2008 to 2010, 13 fatalities from that ameoba were reported from Karachi:

Primary Amebic Meningoencephalitis Caused by Naegleria fowleri, Karachi, Pakistan (13 cases - washing with tap water suspected as cause) - FluTrackers News and Information

http://www.flutrackers.com/forum/showthread.php?t=172169

The suspected method of infection involved washing with contaminated tap water. I hope this is not a repeat of that situation, especially as four cases in a short period of time appear to be a higer frequency than that outbreak.

**alert** · July 20, 2012, 06:48 AM

Re: Pakistan: Naegleria kills four in Karachi

Well, this is certainly unusual now, if this report is accurate....

http://www.thenewstribe.com/2012/07/19/naegleria-spread-in-karachi-causes-symptoms-and-prevention/

Eight die in Karachi due to Naegleria
By Shahid Abbasi - Jul 19th, 2012 (1 Comment)

11Karachi: 8 people were killed at Southern Part of Pakistan in last one week by amoebic disease identified as ‘Naegleria’.
According to TheNewsTribe’s correspondent from Pakistani metropolitan Karachi that all dies hospitals were admitted in Agha Khan University Hospital and Liaquat National Hospital.

[snip]

**Ronan Kelly** · July 21, 2012, 06:18 AM

Re: Pakistan: Naegleria kills eight in Karachi

Microscopic death: More cases of Naegleria confirmed
By Samia Malik
Published: July 21, 2012

KARACHI:
More cases of the rare infection caused by Naegleria, a waterborne parasite, have emerged, taking the total number of patients to nine this year.
Since July 3, three Naegleria cases were received at Liaquat National Hospital and one at Aga Khan University Hospital. All of them died within a few days.
Dr Naseem Salahuddin, the head of the Indus Hospital?s Infectious Diseases Department, confirmed on Friday that her hospital had received two patients infected by Naegleria fowleri.
Sources at the Aga Khan University Hospital also revised their total number of patients dying of the rare disease from one to four this year.
...

Microscopic death: More cases of Naegleria confirmed | The Express Tribune

http://tribune.com.pk/story/411168/microscopic-death-more-cases-of-naegleria-confirmed/

Parasite penetrates human body through nose when a person dives into infected swimming pool, pond or river.

**alert** · July 21, 2012, 04:52 PM

Re: Pakistan: Naegleria kills 9

Read the full article. Apparently there is suspicion the tap water may have gotten contaminated again, as most of the cases have no obvious exposure.

Waterborne infection claimed seven lives this year

http://dawn.com/2012/07/21/waterborne-infection-claimed-seven-lives-this-year/

KARACHI, July 20: A fatal waterborne infection that recently caused death of four young men in the city had also claimed the life of a high-level official of the armed forces over a month ago and so far this year seven patients have died of the disease, i

Waterborne infection claimed seven lives this yearFrom the Newspaper | Faiza Ilyas | 24 hours ago 0 KARACHI, July 20: A fatal waterborne infection that recently caused death of four young men in the city had also claimed the life of a high-level official of the armed forces over a month ago and so far this year seven patients have died of the disease, investigations carried out by Dawn show.

According to sources, the official of the armed forces died of primary amoebic meningoencephalitis (PAM) at the PNS Shifa Hospital.

He was brought with initial symptoms of severe headache, mild fever and vomiting and later developed signs of irritation, agitation and loss of orientation finally leading to coma and a fatal heart attack. At least four cases of the infection, with one patient having a history of swimming have been reported at the PNS Shifa Hospital over the past 12 months or so. All patients, under 45 years of age, died.

Officials at the hospital, however, refused to provide any details about the cases and said that they could only be shared with the permission of the director general of the medical services (DGMS), naval headquarters, based in Islamabad. The DGMS was not available for comments despite repeated attempts to contact the officer through phone and email.

PAM is defined in medical literature as a rare but typically fatal infection caused by Naegleria fowleri, a free-living amoeba found in freshwater environments like rivers, lakes, springs, drinking water networks and poorly chlorinated swimming pools.

It needs to be recalled that four patients, all between 20 and 27 years of age, died of PAM over the past two weeks. Three patients were admitted to the Liaquat National Hospital (LNH) whereas one to the Aga Khan University Hospital (AKUH). Earlier, three cases were reported at the AKUH.

[snip]

To date, less than 300 cases of PAM have been reported worldwide from 1965 to 2008 and attributed to N. fowleri. Patients survived only in three cases.

**alert** · July 21, 2012, 04:55 PM

Re: Pakistan: Naegleria kills 9

There are not many survivors of this disease, but here is a report of one whose treatment might suggest options:

Neurology India

http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2002;volume=50;issue=4;spage=470;epage=2;aulast=Jain

Naegleria meningitis : a rare survival.

Jain R, Prabhakar S, Modi M, Bhatia R, Sehgal R
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.

Correspondence Address:
Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.

Acute amebic meningoencephalitis caused by free-living amebae naegleria fowleri is extremely rare and uniformly fatal with only seven survivals reported till date. An interesting case of naegleria meningitis diagnosed by wet mount cytology of cerebrospinal fluid (CSF) and treated with amphoterecin B, rifampicin and ornidazole with complete recovery is presented. In cases of suspected pyogenic meningitis, if CSF staining, antigen detection or culture is negative for bacteria, a wet mount cytology of CSF for naegleria is suggested. Early treatment with amphoterecin B and rifampicin may improve survival.

**Ronan Kelly** · July 25, 2012, 06:38 AM

Re: Pakistan: Naegleria kills 9

Disease warning: Another death confirmed from naegleria
By Our Correspondent
Published: July 25, 2012

KARACHI: The Disease Early Warning System (DEWS) of WHO, working in coordination with the provincial health department, has detected yet another case of naegleria meningitis admitted to a private hospital in the Bahadurabad area, said a source in the health department on Tuesday. According to DEWS, a 27-year-old man living in Baldia Town, was admitted to a private hospital on July 11. His cerebrospinal fluid (CSF) sample tested positive for naegleria fowleri also known as ?brain-eating amoeba? on July 12 and due treatment was started on the same day, but he expired on July 13. Like previous cases, the deceased had no history of swimming.
...

Disease warning: Another death confirmed from naegleria | The Express Tribune

http://tribune.com.pk/story/412749/disease-warning-another-death-confirmed-from-naegleria/

The latest death brought the tally of primary amoebic meningoencephalitis deathsto five in the city for 2012.

**Ronan Kelly** · July 26, 2012, 06:06 AM

Re: Pakistan: Naegleria kills 9

Another death confirmed by DEWS Waterborne amoeba brings KWSB into focus
From the Newspaper | Mukhtar Alam | 8 hours ago 0

KARACHI, July 25: The rising number of deaths due to waterborne Naegleria meningitis in the city has brought the performance of the Karachi Water and Sewerage Board ? the main government agency responsible for the provision of water to the entire population and industries in Karachi ? into focus.
...
Since five of the six people died of primary amoebic meningoencephalitis (PAM) had no history of swimming in a public pool or a recreational farm settings in days before their deaths, a DEWS team in collaboration with another international agency has been considering measures to contain the outbreak of the disease and to assist the health department and the KWSB in controlling the emergency-like situation due to the disease caused by an amoeba ? Naegleria fowleri.
...
According to DEWS, the patient who died at the armed forces hospital was a 49-year-old man admitted to the hospital on July 8, while the cerebrospinal fluid (CSF) culture was found positive for Naegleria fowleri on July 10.
...
Four of the patients who died on July 6, 11, 13 and 14 were between 22 and 27 years of age, while two deceased were between 44 and 49 years of age and only one of them had a history of swimming, the relevant data suggested
...

Another death confirmed by DEWS Waterborne amoeba brings KWSB into focus

http://dawn.com/2012/07/26/another-death-confirmed-by-dews-waterborne-amoeba-brings-kwsb-into-focus/

KARACHI, July 25: The rising number of deaths due to waterborne Naegleria meningitis in the city has brought the performance of the Karachi Water and Sewerage Board — the main government agency

**Ronan Kelly** · October 8, 2012, 06:00 AM

Re: Pakistan: Naegleria kills 9

Brain-eating amoeba claims two more lives
From the Newspaper | Mukhtar Alam | 11 hours ago 0

KARACHI, Oct 7: While senior physicians are still clueless about the spread of much-dreaded ?brain-eating amoeba?, or Naegleria fowleri, two more deaths from the infection in as many private hospitals have been confirmed by health officials.

With the two newly reported deaths, the total number of patients died due to the brain-eating amoeba reached 10 since May.

The latest known victims of the naegleria fowleri causing primary amoebic meningoencephalitis (PAM) included a three-year-and-nine-month-old boy, who lived in Gulberg Town and died on Sept 30.
...

Brain-eating amoeba claims two more lives

http://dawn.com/2012/10/08/brain-eating-amoeba-claims-two-more-lives/

With the two newly reported deaths, the total number of patients died due to the brain-eating amoeba reached 10 since May.

**Ronan Kelly** · October 8, 2012, 06:03 AM

Re: Pakistan: Naegleria kills 10

Naegleria fowleri: Deadly organism resurfaces after a hiatus of two months
By Our Correspondent
Published: October 8, 2012

KARACHI: After a brief respite for two months, the attention of health officials and doctors has once again turned to the deadly amoeba, naegleria fowleri. The waterborne organism, which causes Primary Amoebic Meiningoencephalitis, has killed three more people over the last week.
Doctors were initially left scratching their heads, unable to glean a pattern in data on the disease and pin it down to a particular factor. But now, there is a growing consensus among them that the life-threatening amoeba is probably breeding in the water supply lines, infecting people when they rinse their noses.
...
Three new cases
A four-year-old boy from Gulberg Town was taken to the Habib Medical Hospital on September 27 died of the disease on September 30. A 24-year-old man, who was being treated for the disease at the Liaquat National Hospital died on October 2. The last person to die of the disease was a 21-year-old resident of FB Area who was taken to Aga Khan Hospital. He was admitted on September 29 and passed away on October 3.
Published in The Express Tribune, October 8th, 2012.

Naegleria fowleri: Deadly organism resurfaces after a hiatus of two months | The Express Tribune

http://tribune.com.pk/story/448507/naegleria-fowleri-deadly-organism-resurfaces-after-a-hiatus-of-two-months/

Doctors say that an epidemic is not imminent and there is no need to panic.

**Ronan Kelly** · October 9, 2012, 05:38 AM

Re: Pakistan: Naegleria kills 10

Despite low chlorine level, KWSB insists there?s nothing fowl(eri)
By Saad Hasan / Samia Malik
Published: October 9, 2012

KARACHI:
As more cases of the deadly illness caused by the amoeba Naegleria fowleri continue to surface, officials have started wrangling with one another over the quality of water that runs through the city?s pipelines.
Since July, the organism has killed nine people in Karachi and one in Hyderabad. The latest cases include four patients living in Federal B Area. This fact sent the Karachi Water and Sewerage Board (KWSB) scrambling to test samples of water from supply lines in the locality. The utility supplies Karachi with over 500 million gallons of water per day after cleaning it and adding chlorine at its filtration plants.
The managing director of KWSB, Misbahuddin Fareed, said on Monday that the results showed that the level of chlorine was indeed low ? it was 0.15 (parts per million) ppm when it should have been at least 0.5 ppm.
Despite this, the manager refused to believe that the water was contaminated and asked Aga Khan University to conduct research to determine whether the water did indeed carry the organism. ?Our water is running water anyway. It does not stagnate and allow germs to multiply.? He said that the organisation checks the quantity of water every three hours.
...

Despite low chlorine level, KWSB insists there’s nothing fowl(eri) | The Express Tribune

http://tribune.com.pk/story/448878/despite-low-chlorine-level-kwsb-insists-theres-nothing-fowleri/

Most recent cases of Naegleria fowleri infection include four residents of FB Area.

**Ronan Kelly** · September 3, 2013, 05:32 AM

Re: Pakistan 2012: Naegleria kills 10

Deaths from rare protozoan encephalitis in Karachi blamed on unchlorinated water
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3580 (Published 31 May 2013)
Cite this as: BMJ 2013;346:f3580

Abdul Nafey Kazi, Talha Riaz

The re-emergence of the deadly water borne Naegleria fowleri in the city of Karachi in Pakistan has been blamed on failure to chlorinate the city?s water supply.

There were 10 deaths from the amoebic disease in the city in 2012, and one reported death so far in 2013.1 In 2012, Karachi was the only city in Pakistan to report cases of the disease.

N fowleri, commonly known as ?brain-eating amoeba,? is a free living ?

Deaths from rare protozoan encephalitis in Karachi blamed on unchlorinated water

http://www.bmj.com/content/346/bmj.f3580

The re-emergence of the deadly water borne Naegleria fowleri in the city of Karachi in Pakistan has been blamed on failure to chlorinate the city’s water supply. There were 10 deaths from the amoebic disease in the city in 2012, and one reported death so far in 2013.1 In 2012, Karachi was the only city in Pakistan to report cases of the disease. N fowleri , commonly known as “brain-eating amoeba,” is a free living …

FluTrackers 2013 Pakistan N. fowleri thread is here; Pakistan primary amoebic meningoencephalitis 2013 - 3 fatalities