Naegleria fowleri a lethal brain-eating amoeba causes Primary Amoebic Meningoencephalitis (PAM) a fatal brain infection. This review highlights the alarming prevalence of PAM globally with Pakistan ranking second highest particularly in Karachi. Uniquely victims contract PAM through routine ablutions with tap water rather than recreational water exposure. Our study of Karachi's tap water found N. fowleri in 22 of 36 samples via PCR revealing severe water sanitation issues. High microbial loads and low chlorine levels indicate failures in water treatment. Urgent improvements in infrastructure disinfection protocols and public awareness campaigns are crucial to mitigating PAM risks. Further molecular analyses of N. fowleri strains are essential for understanding disease mechanisms and refining treatments.
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