Over two weeks since the death of a patient, ‘possibly’ from a deadly brain-eating amoeba, called naegleria fowleri, the medical authorities in the city are still struggling to ascertain the cause of death. But the incident has sparked serious concerns among healthcare professionals as well as general public.

The man in question, 30-year-old Mustafa Shafique, was admitted to Services Hospital, Lahore, in the last week of June, with complaint of severe headache. Initially dismissed as an ordinary headache, Shafique drew the doctors’ attention when his pain continued to aggravate despite treatment.

Sources at the hospital claim that Shafique was advised to have diagnostic tests at a private laboratory where it was confirmed that he had been infected with naegleria. He was immediately transferred to the intensive care unit (ICU), where a dedicated medical team tried to save his life.

Some of the doctors still dispute the authenticity of the lab report. “We’re waiting for the autopsy report of the patient,” said a spokesperson for Medical Superintendent Dr Ehtesham-ul Haq. “The report shall be released by the director general of health.”

He also said that definitive diagnosis of naegleria fowleri infection could only be made by a microscopic examination of fresh, unfrozen, and unrefrigerated cerebrospinal fluid (CSF).

When contacted, the Director-General of Health Services Punjab, Dr Ilyas Gondal, told TNS that his office had nothing to do with the autopsy procedure, which he said was to be done by the hospital.

Shafique’s was the first identified case of naegleria infection in Lahore, but the infection is not new to many other parts of the country. It took several lives in Sindh last year. Recent weeks saw two recorded cases of the infection in Karachi.

Naegleria fowleri is a pathogen commonly found in freshwater environments such as lakes, rivers, hot springs, ponds and soil. In humans, an acute infection occurs when water containing the organism forcefully enters the upper nasal passages during activities like bathing, swimming, or other recreational water-based pursuits. The amoeba then migrates to the brain through the olfactory nerve, resulting in extensive inflammation, hemorrhage and necrosis, frequently leading to death in three to seven days.

Caretaker Minister for Health Dr Javed Akram said that the Health Department had prepared Standard Operating Procedures (SOPs) to prevent future occurrences of the infection. Protocols have been shared with the district governments.

Besides, the Health Department has urged the relevant authorities including the WASA, the Cantonment Board, the Defence Housing Authority (DHA) and the government, semi-government and private organisations to ensure effective chlorination of all water reservoirs, swimming pools, spas, water recreational sites, and reticulated water supplies seriously. Implementation of these instructions is crucial to preventing and controlling the infection.

Recommendations

Chlorination: Water supplies at risk of N fowleri should implement adequate primary disinfection and maintain a chlorine residual of at least 0.5 mg/L throughout the distribution system. Regular monitoring of water temperature and chlorine residual is essential for effective chlorine disinfection.

Swimming and Water Activities: While swimming, it is advisable to avoid diving and to prevent water from entering the nose. It is also recommended that water-related activities be refrained from, especially where the water is not chlorinated.

Maintenance and Cleaning: Regularly empty and clean the collapsible bathing pools. Ensure that swimming pools and spas are adequately chlorinated and well-maintained.

Nasal Irrigation and Lavage: Do not use potentially contaminated water for any form of nasal irrigation or nasal lavage.

Periodic Testing: Consider carrying out periodic testing for N fowleri in high-risk systems.

Awareness and Education: Educate people in affected areas about necessary preventive measures.

Enhanced surveillance, notification and dissemination of case definitions, diagnostic options, transmission risks, and areas at risk are also necessary for effective management of this infection.

— A M

The writer is a media veteran interested in politics, consumer rights and entrepreneurship