Naegleria fowleri Meningoencephalitis Associated with Public Water Supply, Pakistan, 2014.

Najia K Ghanchi,Afia Zafar,Erum Khan,Azam Khan,Wali Muhammad,Faisal Riaz Malik

doi:10.3201/eid2210.151236

Abstract

To the Editor: Naegleria fowleri, a free-living ameba, causes acute, fulminant, fatal primary amebic meningoencephalitis (PAM) in persons with history of recreational activities in warm freshwater (1,2). During 2008–2009, thirteen case-patients with PAM and no history of recreational water activity were reported from Karachi, Pakistan (3). Since then, PAM caused by domestic water exposure, nasal cleansing by using neti pots, and ablution has been reported globally (4–6). During 2014–2015, the Aga Khan University Hospital clinical laboratory in Karachi confirmed 19 PAM case-patients without history of recreational activities in warm freshwater.

Highlights

During 2008–2009, thirteen case-patients with primary amebic meningoencephalitis (PAM) and no history of recreational water activity were reported from Karachi, Pakistan (3)
We investigated for presence of N. fowleri amebae in domestic water and for the patient’s possible exposure
The other 10 samples were from Plant B and its water distribution system, for which the local government had initiated additional chlorine enhancement because of previously occurring PAM cases

Summary

Introduction

During 2008–2009, thirteen case-patients with PAM and no history of recreational water activity were reported from Karachi, Pakistan (3). During 2014–2015, the Aga Khan University Hospital clinical laboratory in Karachi confirmed 19 PAM case-patients without history of recreational activities in warm freshwater. In August 2014, a previously healthy 34-year-old man living in Karachi and having no recreational water exposure was admitted to the Aga Khan University Hospital with multiple episodes of vomiting, severe headache, and fever. We investigated for presence of N. fowleri amebae in domestic water and for the patient’s possible exposure.

Results

Conclusion