KARACHI, June 3: The deadly waterborne infection (primary amoebic meningoencephalitis) claimed at least two lives last month, health officials disclosed here on Monday.

The latest death was of 20-year-old Mohsin, a resident of New Karachi’s Godhra Colony.

“The patient died at the Aga Khan University Hospital on May 27. He was apparently admitted to the hospital the same day,” said the executive district officer for health, Imdadullah Siddiqui, adding that it was the second death from the same infection in May in the city.

Hospital sources also confirmed the death and said that the patient died the following day after admission and had no history of swimming.

PAM (primary amoebic meningoencephalitis) is defined in medical literature as a rare but typically fatal infection caused by Naegleria fowleri, an amoeba found in rivers, lakes, springs, drinking water networks and poorly chlorinated swimming pools.

“Two deaths in a short period of time is worrisome. The health department is doing its bit but the responsibility to provide safe and clean water to the city lies with the Karachi Water and Sewerage Board (KWSB),” said Mr Siddiqui when asked about government efforts to properly chlorinate the water which, according to experts, was the most effective way at the state level to check the spread of the infection.

The KWSB, he said, in collaboration with other government departments was carrying out joint sampling and testing of water samples that had so far shown satisfactory results.

Earlier, a 14-year-old boy died of the disease after remaining under treatment for a week at the Liaquat National Hospital on May 17.

Speaking to Dawn, Misbahuddin Farid, managing director of the KWSB, expressed sorrow over the deaths and said that there was no negligence on part of his department.

“We have absolutely no problem in properly chlorinating the city’s water which is being done at all stations. It’s difficult to say that the victims died of the fatal waterborne infection as we are still waiting for the exact details of the victims’ medical history and the sources of water they were exposed to,” he explained.

“I think everyone including the citizens needs to participate in order to comprehensively address the issue. People are just not used to cleaning their water storage tanks regularly.”

Apart from the city’s water agency, there is also a need for proper chlorination and filtration of water in the interior of Sindh.

“Our job is only limited to the city but we have no idea as to what is happening in Hyderabad, Jamshoro and other areas of Sindh. The health department should look into this issue,” he said.

Naegleria fowleri had emerged in the city in May last year and claimed 10 lives till October, according to official records.

While swimming in public pools with improper arrangements for chlorination was believed to be a major cause of contracting the dreaded amoeba infection, there was no history of swimming in most cases.

The disease represents clinically in a fashion that may be indistinguishable from bacterial and viral meningitis resulting in delayed appropriate diagnosis and treatment.

High index of suspicion is required from treating physicians and clinical laboratories, especially in summer, when the frequency of this parasitic disease increases due to two reasons: higher temperature of water facilitates the germ’s propagation while it’s also the time when recreational activities associated with water increase.

The germ is believed to enter the central nervous system (CNS) via the nasal passages. When a person jumps into the water without closing their nostrils, water forcefully enters the nose and hits the mucosal surface of nasal cavity roof. This damage facilitates penetration of organisms in the CNS. The illness attacked a healthy person three to seven days after exposure to contaminated water with symptoms of headache and slight fever and in some cases associated with sore throat and rhinitis [common symptom is a stuffy nose].

The disease progresses fast with rising fever and increasing headache, vomiting and stiff neck. Deep coma is followed by cardio-respiratory failure.

The microorganism is wrongly referred to as a ‘brain-eating amoeba’ since it doe not eat the brain, but infects the brain tissues and its covering membrane, according to experts.

Preventive measuresAt the individual level, experts suggest people clean their underground and overhead tanks on a regular basis, clean nose softly with tap water and try to use boiled water to irrigate sinuses, neti pots should be kept and stored dry, swimming be avoided in ponds, freshwater pools and private swimming pools not chlorinated as per international standards.

At the public health level, the government, they say, should ensure supply of chlorinated water supply for domestic use, monitor and ensure quality checks of water supply and swimming pools and make water filter plants functional.