KARACHI: As the authorities have finally confirmed two more deaths caused by the deadly ‘brain-eating amoeba’ or naegleria fowleri, one each belonging to Karachi and Hyderabad, what is more worrisome for them is the evidence of the amoeba’s presence outside Karachi where chlorination level in water is much more pathetic, it emerged on Friday.

Chlorination is considered to be the only cure against the spread of the deadly disease, which has so far claimed a total of five lives.

Irfan, a young resident of Gulberg, had died at a private hospital on June 1. The authorities have confirmed that the death was caused by naegleria. Similarly, Shakeel Ahmed of Damin-i-Kohisar Society of Hyderabad had been shifted to Karachi early this month where he died last weekend.

Officials said that he too was a victim of the same disease. However, he was the first naegleria victim from outside Karachi, a fact the authorities feared would have grave implications.

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Out of a total of five naegleria caused deaths, four have been reported from Karachi with two from Gulistan-i-Jauhar alone.

The first death was reported on May 27.

“We have just officially received reports today that both the victims died of naegleria fowleri,” said Dr Zafar Ijaz, executive district officer, health in Karachi, while speaking to Dawn.

He said that since the department had no exclusive network to instantly learn about such deaths, the official confirmation took a lot of time to confirm and make public.

“All the five victims have no history of swimming,” he said.

Swimming is considered to be one of key factors that cause the primary amoebic meningoencephalitis (PAM) or naegleria fowleri.

As recent reports suggested that chlorination levels in more than 40 per cent of Karachi’s water were found to be unsatisfactorily, the level of threat by PAM has attained grave proportions.

“This amoeba can only be eliminated by use of properly chlorinated water,” said a provincial health department official, who admitted that the water being supplied elsewhere in Sindh was pathetically more dangerous as far as chlorination was concerned.

“The first death in Hyderabad could be confirmed only when the victim was shifted to a Karachi hospital. We might not have known about him if he had been admitted to a hospital in Hyderabad where he might have been considered to be a victim of meningitis,” said Dr Ijaz.

He said that he had asked all the hospitals in Karachi to carry out examinations for naegleria as well of the patients whom they admitted for suspected meningitis.

“There could be some more such cases which might have been mistaken for meningitis. We are making efforts to gauge the exact level of threat through such realistic measures,” he added.

Officials in the provincial government said similar orders had been sent to the hospitals in the rest of the province.

Similarly, sources said, the provincial health department was contemplating establishing a system to document the disease on scientific lines.

Related: Naegleria threat looms as water lacks chlorine

But at the same time, however, no efforts are in sight to improve the performance of Karachi Water and Sewerage Board and its counterparts in other parts of the province.

Maintaining required chlorination levels in water supplied to the city is part of the KWSB’s responsibilities, which it requires to improve greatly.

Last year, the disease claimed three lives — a 14-year-old boy from Korangi, a 20-year-old man from New Karachi’s Godhra Colony and a 40-year-old man from Lines Area.

The deadly disease had resurrected in the city with extreme lethality in 2012 when it claimed 10 lives.

PAM 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.

According to a research, only three cases have been reported so far in the medical literature of the world where patients suffering from this infection survived.

Swimming in public pools with improper arrangements for chlorination was believed to be the only cause of contracting the dreaded amoeba infection.

These germs travel through the nasal cavity and only affect the brain. The illness attacks a healthy person, three to seven days after exposure to contaminated water with symptoms of headache and slight fever, in some cases associated with sore throat and rhinitis (commonly called stuffy nose).

The ages of the naegleria victims so far ranged from about four years to 49 years.

Published in Dawn, July 12th, 2014