Brain-Eating Amoeba: Naegleria fowleri Case in Kerala

Recent Incident

• A child aged, nine years old was killed and two other children infected (including a three-months old baby child) in the Kozhikode district of Kerala by a deadly brain-eating amoeba.
• The causative agent of the infection (Primary Amoebic Meningoencephalitis or PAM) is a pathogen, Naegleria fowleri.
• Globally, fewer than 500 cases of PAM have been reported since 1965, but it has been found in every continent except Antarctica.

History of PAM in India

• It was reported in 1971 that the first case occurred in India, followed in 2016 by a report from Kerala.
• Kerala in 2024 reported 36 cases of which 9 died between 2024 with 97 percent mortality level.
• This year, Kerala has reported eight confirmed cases and two deaths so far, while three children are still under treatment.

The Pathogen: Naegleria fowleri

•   An amoeba is a single-celled organism found in warm, fresh and moist soil.
• Can survive in aquatic environments with temperatures reaching 46°C.
• It can be present in natural water bodies like rivers, lakes, and ponds, as well as in hot springs, neglected swimming pools, and water parks.
• The infection results when the nose comes in contact with contaminated water (not through drinking water).

Symptoms of PAM

• • Severe headache
  • Fever, nausea, and vomiting

• Neck stiffness

• Seizures, hallucinations, and confusion
• The illness can advance quickly, often proving fatal within 1 to 18 days after symptoms appear.

Treatment of PAM

No standard effective treatment is available.

Treatment involves using a combination of medications, such as:

• Amphotericin B
• Fluconazole
• Azithromycin
• Rifampin
• Miltefosine
• Dexamethasone

Infection in Kerala

• It was initially detected in Alappuzha in 2016, associated with extensive freshwater sources.
• The rise in PAM cases is linked to Kerala’s high incidence of Acute Encephalitis Syndrome (AES).

Risk Factors

• Children face higher risks because they spend more time involved in water-related activities.
• Poorly maintained water sources contribute to risk.
• Global climate change and rising water temperatures may increase cases.

Preventive Measures

• Refrain from swimming or diving in warm, still freshwater areas.
• Use nose clips when swimming.
• Ensure proper chlorination of swimming pools.