Kerala is on high alert as its northern region has reported four cases, including three casualties of the rare but deadly primary amoebic meningoencephalitis (PAM) in the last two months.
Children have been the victims in all four cases reported from the state.
In the latest incident, a 14-year-old boy hailing from Thikkodi village in Kozhikode district tested positive for the infection on July 5 and is now undergoing medical treatment.
His status is believed to be stable now.
The pestilence first came to light on May 20. That is when doctors established the reason for the death of five-year-old Fadva from Munniyur in Malappuram district. She had breathed her last while undergoing treatment at Government Medical College Hospital in Kozhikode.
On June 12, 13-year-old V Dakshina from Kannur succumbed to the infection in a local private hospital.
On July 3, 12-year-old EP Mridul from Feroke, on the outskirts of Kozhikode city, died at a local private hospital following the infection of the organism.
Health officials said the infection was first detected in the Alappuzha municipality in 2016. It later surfaced in Malappuram in 2019 and 2020, Kozhikode in 2020, Thrissur in 2022, and Alappuzha again in 2023.
Naegleria fowleri, an amoeba that lives in warm freshwater environments like lakes, ponds, and rivers, causes PAM, according to a state health department notification. In rare situations, it can also live in poorly maintained swimming pools.
The communication states that this one-celled organism, the ‘brain-eating amoeba’, can infect the brain and destroy its tissues.
Though rare, these infections are fatal, and survival is difficult for 97 per cent of the people affected by them. The infection typically occurs when people go for a swim in lakes, ponds, or rivers during the summer.
Experts say the infection could occur if the atmospheric temperature is high and water levels are low. The amoeba enters the body through the nose and reaches the brain, where it destroys brain tissue and causes swelling.
Fortunately, the infection is not contagious. Swallowing water containing the amoeba does not lead to it either.
The Centers for Disease Control and Prevention (CDC) in the United States reports that early symptoms of PAM include headache, fever, nausea, and vomiting. The condition can progress quickly, resulting in later symptoms such as stiff neck, confusion, loss of focus and balance, as well as hallucinations. According to the CDC, PAM usually causes a coma and death within five days, with the majority of victims dying between one and 18 days.
The infection can be diagnosed through PCR tests of cerebrospinal fluid. However, because PAM is rare, detection can sometimes be challenging. In Kozhikode, doctors at the Government Medical College Hospital suspected its possibility in Fadva, the five-year-old girl from Malappuram, after she exhibited symptoms similar to those of bacterial meningitis. Instances of bacterial meningitis have reduced in recent times, mainly due to vaccination.
Currently, no standard treatment techniques are available. Thus, doctors follow CDC guidelines. Sources have told this reporter that the state health department has purchased miltefosine, a broad-spectrum antibiotic medication, from Germany for treating infected people. Azithromycin and Amphotericin B, among other recommended medications, are available, according to paediatricians.
Children with ear infections have been advised against bathing or diving in ponds or stagnant water. This is because the amoeba can enter the brain through openings in the membrane that separates the nose and the brain or through potential holes in the eardrum.
Operators of water theme parks and swimming pools have been instructed to chlorinate the water regularly.
To avoid infection, one must hold the nose or wear a nose clip when jumping or diving into freshwater. When entering warm water, the head must be held high. Distilled or boiled water is recommended to clear nasal passages.
Experts said the recent unusual rise in cases of PAM may be due to unhygienic and stagnant water sources and high temperatures.
“There has been a rise in such cases worldwide. The warming of the atmosphere and stagnant, unhygienic water resources could be some of the conditions leading to it. This particular amoeba is found to be more active in warm water,” MP Jayakrishnan, additional professor of paediatrics at Government Medical College Hospital, Kozhikode, told this reporter.
Jayakrishnan was among those who had treated Fadva, the five-year-old girl from Malappuram.
“She had showed symptoms similar to those of bacterial meningitis. But that disease has declined of late due to vaccination. That is when we considered the possibility of PAM,” he added.
KK Purushothaman, a professor of paediatrics at MES Medical College Hospital in Perinthalmanna, Malappuram, said further research was needed to identify the variables causing the rise in infection cases.
He questioned whether lifestyle modifications in vulnerable individuals, environmental alterations, or an escalation in the organism’s virulence were accountable. In addition, he raised doubts about whether the disposal of garbage or pollution in natural water bodies was creating a conducive environment for the proliferation of these species.
Both doctors recommended refraining from swimming and bathing in unsanitary and stagnant water sources as a beneficial precaution.
Meanwhile, medical practitioners around Kerala have been instructed to remain vigilant for potential cases of the infection, using the patient’s medical background and symptoms as indicators.
According to Health Minister Veena George, it is necessary to direct suspicious cases to specialised facilities for treatment.
Kozhikode has been a public health hotspot in Kerala for the last few years because of the repeated reporting of Nipah and West Nile virus outbreaks. Kyasannnur forest disease is also being reported repeatedly from different parts of the region.
George urged people across the state to be extremely cautious about consuming water and exposing themselves to water stored for recreation until the situation improves.