Epidemiology of primary amoebic meningoencephalitis-related deaths due to Naegleria fowleri infections from freshwater in Pakistan: An analysis of 8-year dataset

Objective: This study was aimed at gathering all the data related to Naegleria fowleri resulted primary amoebic meningoencephalitis (PAM) deaths in Pakistan and present it in a dataset, conduct statistical analysis to report any significant finding and present it as a base for future investigations on the subject. Materials and Methods: A retrospective 6-month study was designed which gathered data related to N. fowleri resulted PAM spread in Pakistan from 2008 to 2015. The study adhered to STROBE recommendations for observational cross-sectional studies. Results: The mean (X) age of the patients was 29.47 years (standard deviation [SD]: 13.95), and adults between 26 and 45 years were most affected (n = 24, 24.5%). The mean (X) survival days after onset of symptoms till death was 4.26 (SD: 2.94). Mortality observed from 2008 till 2015 was 98 (n = 98, 100%). The majority of deaths occur in southern city of Karachi (n = 94, 95.9%) in temperature range of between 35°C and 39°C (n = 39, 60.2%). An incidence rate of 4.084e + 92 was calculated for Karachi. The chlorination of the municipality water supply of Karachi city was below the WHO recommended level of 0.5 ppm. All deaths belonged to individuals from Muslim community (n = 98, 100%) and without swimming history. Only one individual was reported to have a swimming history. Conclusion: Apart from contaminated municipal water supply, the use of water for ablution directly from ground source is believed to be a major contributing factor to the increasing number of infections; however, this claim could not be statistically verified. This study suggests that concerted efforts by all stakeholders are required if Pakistan needs to bring down the number of Naegleria infection cases. Further research is also immediately required to uncover the role of environmental factors in the rise of Naegleria infection cases.