Three children have so far died in Kerala due to infection with Naegleria fowleri, the brain-eating amoeba.

According to Dr Drishya Pillai, consultant physician at Meditrina Hospital, Palakkad, Kerala, four cases of primary amebic meningoencephalitis (PAM) have been reported in the last two months, three of which were fatal.

“These deaths are due to its rapid spread, high mortality rate (about 90-95%) and lack of established or effective treatments. Raising awareness is important,” Dr Pillai said.

A 14-year-old boy from Payyoli was diagnosed with the disease and is currently undergoing treatment at a private hospital.

Earlier, another 14-year-old boy had died of the infection. On May 21, a five-year-old girl from Malappuram died and on June 25, a 13-year-old girl from Kannur also died of the disease.

All about the brain-eating amoeba

PAM, or primary amoebic meningoencephalitis, is a rare but serious infection caused by Naegleria fowleri. This is a free-living amoeba that thrives in warm freshwater environments such as lakes, ponds, and poorly maintained swimming pools.

The amoeba enters the body through the nose, usually when people swim or dive in contaminated water. Once inside, it travels to the brain, causing severe damage.

“Naegleria was named the ‘brain-eating amoeba’ because of its extreme affinity for the brain and the rapid damage it causes,” Dr. Pillai said. Initial symptoms often include fever, nausea, vomiting, headache and a stiff neck.

As the infection progresses, patients may experience confusion, behavioral changes, seizures, and eventually coma and death.

Diagnosis of brain-eating amoeba

Diagnosing PAM can be challenging because it is rare and its symptoms resemble other conditions, such as bacterial meningitis.

“Apart from routine tests, timely diagnosis can be ensured by high clinical suspicion and spinal fluid or CSF PCR, CSF analysis for motile trophozoites,” said Dr Pillai.

Although there is no established treatment for PAM, azithromycin, miltefosine, and dexamethasone, as well as amphotericin B administered intravenously and intracranially, have shown some success.

However, the efficacy of the treatment remains uncertain.

Prevention

Given the high mortality rate and lack of a definitive treatment, prevention is of utmost importance.

Dr. Pramila Radhakrishnan of Neuberg Diagnostics emphasises the importance of awareness among parents: “Children eagerly look forward to swimming in lakes, rivers and ponds, so it is important for parents to be aware of the rare but potentially fatal threat of the brain-eating amoeba.”

Parents are advised to take the following preventive measures:

• Don’t allow children to swim in warm freshwater such as lakes, ponds, and poorly maintained pools.
• Make sure children wear nose clips to prevent water from entering their nose.
• Clean children’s nose with warm water after swimming.
• Keep a close eye on water activities.

“If you suspect that your child is showing symptoms of PAM, consult a doctor immediately,” advises Dr. Radhakrishnan. “Tell the doctor about your child’s recent water activities, as this information may be helpful in early diagnosis and treatment.”

Dr CS Narayanan, Chairman, Manipal Institute of Neuro Sciences, Manipal Hospitals Dwarka, highlighted the preventive measures.

“Preventing infection with Naegleria fowleri primarily involves avoiding activities that allow water to enter the nose. Public health recommendations include avoiding swimming in warm freshwater during peak temperatures, wearing nose clips or holding the nose closed when underwater, and avoiding touching sediment in warm freshwater.”

Although the risk of infection with Naegleria fowleri is low, the potential consequences are devastating.

Awareness and preventive measures are essential to safeguard against this rare but deadly threat.

By understanding the risks and taking the proper precautions, families can enjoy water activities safely while minimizing the risk of encountering this deadly amoeba.