Brain-eating amoeba in Kerala: Health officials try to ally fears of more strikes, call it ‘very rare’

An epidemiologist with the health department opined that cases of meningoencephalitis infections are likely to go up due to global warming.

ByDileep V Kumar

Published Jun 30, 2024 | 2:00 PM Updated Jun 30, 2024 | 2:00 PM

Brain-eating amoeba Naegleria fowleri

Recent cases of primary amoebic meningoencephalitis (PAM) infection in Kerala have triggered a wave of fear among the public, despite health officials’ efforts to allay the fears.

However, an epidemiologist said instances of PAM infections are likely to increase due to global warming.

This rare yet deadly brain infection, caused by the microscopic amoeba, Naegleria fowleri — or brain-eating amoeba — has caused multiple fatalities recently.

The situation has raised urgent questions about the safety of freshwater sources in the region, prompting swift action and heightened vigilance.

Also Read: Another case reported in Kozhikode, third in Kerala

Rare, but fatal

While there wasn’t a full-blown outbreak, the recent PAM cases in the state have spread panic among the public.

Discussions on the infection are mainly based on its rarity and severity, a lack of awareness, and concerns over water contamination.

It has been pointed out that PAM is a very uncommon infection, but rapidly progressive and often fatal. The sudden and serious nature of the disease can be frightening, especially for parents with young children, who are most susceptible.

Also, many people might not have been aware of PAM or how it is contracted. This lack of knowledge can lead to fear and a sense of vulnerability.

It is also being pointed out that the link between PAM and contaminated freshwater sources can create a worrying ripple effect. People might be hesitant to use ponds, canals, or even tap water if they’re unsure about its safety.

Also Read: This rare brain infection caused the death of a Kerala teenager

Safety concerns

Aarya S, who practices swimming at Jimmy George Sports Hub Swimming Pool, Thiruvananthapuram, expressed her concerns to South First.

“It’s terrifying to think that something as simple as swimming in a lake or swimming pool could be so dangerous. We need more information and assurance that our water sources are safe,” she said.

Meanwhile, calls for a comprehensive study into these cases are growing louder.

Talking to South First, an assistant professor of the Community Medicine Department of a government medical college highlighted the need for thorough research.

“We need to understand why these cases are happening consistently. Are there specific environmental factors at play? Is there a lack of proper chlorination in swimming pools or tap water? A detailed study is essential to provide clear answers and prevent future occurrences,” he said.

A proposal has already been made to the health department, after a 13-year-old girl died of a suspected PAM infection at a private hospital in Kozhikode on 12 June. She had gone for a swim on 28 January.

What makes this case curious is that death usually occurs within five days (range one to 12 days) of visible symptoms.

The private hospital that treated the girl had demanded a study into the cause of her death.

Also Read: Rare brain infection claims one more life in Kerala

Isolated cases

Health officials, however, are trying to dispel the public’s concerns.

They emphasised that these are just a few isolated cases, reiterating the extreme rarity of the disease.

The department states that though they understand the fear of the people as well as the fact that its severity is undeniable, people should realize that PAM is rare.

“While the occurrence of PAM is indeed alarming, it’s important to note that such cases are extremely rare. There is no need for widespread panic,” Dr Aravind R, Head of Infectious Diseases at the Government Medical College in Thiruvananthapuram, commented.

He said a strategy to prevent this sporadic phenomenon is nearly impossible.

“Lakhs of people in the state use ponds/rivers/lakes/pools and only two to three people have lost their lives. Though it’s an unfortunate incident, we can’t consider this as a public health problem,” he told South First.

“PAM cases are not a recent phenomenon. We have had such cases earlier also. The only difference is that the state’s surveillance /diagnosis mechanisms are strong and it captures such cases,” Dr Aravind opined.

The Kerala Health Department is urging people to take precautions while engaging in freshwater activities.

“Avoid swimming/diving in stagnant water bodies. Proper maintenance and chlorination of swimming pools and various rides in water-theme parks can significantly reduce the risk,” a health official said. The amoeba enters the human body through the nostrils.

Also Read: Five-year-old girl succumbs to amoebic meningoencephalitis 

The disease

An epidemiologist with the health department explained that Naegleria fowleri is a thermophilic amoeba, thriving in water when temperatures exceed 30°C.

“With the anticipated temperature increase due to global warming, we may see more cases of PAM,” the epidemiologist noted.

“N. fowleri is susceptible to chlorine at one part per million, so adequate chlorination of heavily used swimming pools, particularly during summer months, can control amoeba proliferation,” he said.

“However, factors like sunlight and organic matter in swimming pools can diminish chlorine’s effectiveness. Unfortunately, it is not feasible to chlorinate natural bodies of water such as lakes, ponds, and streams, where N. fowleri can thrive,” the epidemiologist added.

The official also warned that, in high-risk areas, local public health authorities should consider monitoring recreational waters for N. fowleri amoeba, especially during hot summer months, and issue appropriate warnings.

It is also recommended to advise children not to immerse their heads in potentially contaminated waters.

Also Read: Kerala boy gets rare brain infection while swimming in river

Children and young adults are most susceptible

According to the World Health Organization, infection typically occurs in healthy children and young adults with recent exposure to warm freshwater, including polluted water in ponds, swimming pools, and man-made lakes with a high fatality rate of around 95 percent.

The amoeba has also been found in artificially heated industrial water sources and domestic water supplies.

It is said that the number of reported PAM cases has increased worldwide in recent years.

This rise may be attributed to greater awareness of the disease or the development of more rapid, highly sensitive, and specific diagnostic methods such as PCR.

Additionally, changes in environmental conditions, thermal pollution from industrial activities, and the development of industrial areas with nuclear power plants and cooling towers—which support the growth of amoebae and their bacterial food sources—may provide more opportunities for infection.

In its early stages, symptoms of PAM are similar to symptoms of bacterial meningitis.

Initial symptoms of PAM start one to seven days after infection. The initial symptoms include headache, fever, nausea, vomiting, and stiff neck.

Later symptoms include confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations.

After the start of symptoms, the disease progresses rapidly and usually causes death within about five days (range one to 12 days).

(Edited by Majnu Babu)

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