Naegleria fowleri strikes again, exposes Karachi's water woes

By Mukhtar Alam

KARACHI: A 36-year-old housewife living in District East Karachi became the first victim of Naegleria fowleri in 2025, succumbing to the brain-eating amoeba at a private hospital on February 23. The case has raised concerns over the deteriorated drinking water quality in the megapolis, particularly during the moderately cold temperatures.

According to health authorities, the woman, a resident of Gulshan-i-Iqbal, developed primary amebic meningoencephalitis (PAM) after using tap water for ablution (wuzu) five times a day. She suffered from fever, headache, vomiting, and altered consciousness for six days before passing away. A preliminary inspection report revealed that the woman was pregnant. Initially, she developed a fever and took paracetamol. Her hospital declared her a lab-confirmed Naegleria fowleri case a day after her death.

The initial investigators found that the patient had not participated in any water-related activities, which are typically considered the main reason for PAM infection. "Her only exposure was the regular use of water to perform ablution (wuzu) five times a day at home," they noted.

The last Naegleria fowleri victim of 2024 in Sindh was a 19-year-old man, also a resident of Gulshan-i-Iqbal, who suffered the infection through the amoeba.

The incident has sparked concerns about the presence of Naegleria fowleri in the city's water supply. Experts believe that the amoeba thrives in inadequately chlorinated water, particularly during high temperatures. However, the latest case suggests that the amoeba can survive in stagnant water, including water tanks and poorly maintained water distribution systems.

Dr Syed Zafar Mehdi, former officer-in-charge of the Naegleria cell at the Sindh Health department, emphasised the need for educating people about the risks of using unboiled or unchlorinated tap water for nasal rinsing. "Regular water testing, proper chlorination, and preventive actions should be emphasized even in cooler months," he said.

Dr Mehdi agreed that the presence of the amoeba in late February, which is not peak summer, suggests that the water source might have been contaminated even in cooler temperatures. "If the victim used tap water for nasal irrigation – during ablution for prayers – or had contact with contaminated water, it suggests a year-round risk, not just a summer concern."

The case has highlighted the importance of urgent water quality checks, especially in areas where ablution with tap water is common. Authorities have been urged to assess chlorination levels and take preventive measures to prevent further cases.

Since its emergence 16 years ago, PAM has claimed around 100 cases in Karachi and other parts of Sindh. In 2023, Sindh reported nine fatalities due to Naegleria fowleri, followed by four cases in Karachi and one in Hyderabad in 2024.