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

It was a great effort by the authors that will urge researchers to investigate the factors involved in the occurrence of primary amebic meningoencephalitis(PAM) from different dimensions. We ought to take this public health issue on broader context instead of focusing merely on chlorination and ablution. Although authors also mentioned some other possible factors but an emphasis was mostly on the levels of chlorine and ablution. A study conducted in Australia demonstrated for the first time that drinking water pipes are the source of Naegleria fowleri infection. This study found that N. fowleri can persist in a field drinking water distribution biofilm and exerts resistance despite chlorination. The presence of N. fowleri in biofilms of drinking water pipes needs thirty times the standard chlorine dose to kill this thermophilic organism. Another study recommended the physical removal of these free-living amebae from the drinking water distribution systems which act as a reservoir for human pathogens.. We need to conduct studies, especially in Karachi on biofilms of water pipelines that may provide valuable findings in future. A recently published study also highlighted the common practice of the residents of Karachi to store water in overhead tanks which is then utilized on a daily need basis, and during extreme hot weather, it promotes an excystation of free-living ameba into its pathogenic form.