This decision comes in the wake of recurrent cases of Primary Amoebic Meningoencephalitis (PAM) reported in the state, triggering a wave of fear among the public.
Brain-eating amoeba Naegleria fowleri. (iStock)
The Kerala government is set to introduce a special guideline to address the growing concern over the Primary Amoebic Meningoencephalitis (PAM), commonly known as brain-eating amoeba infection.
State Health Minister Veena George convened a high-level meeting on Monday, 1 July, to assess the situation and formulate a robust response. During the meeting, Minister George emphasized the need to strengthen public awareness about this deadly infection.
“Children with pus in their ears should avoid bathing in ponds, stagnant water, and other similar water bodies,” the minister advised. She also urged the public to seek immediate medical attention if any symptoms of the infection are observed.
This decision comes in response to the recurrent cases of PAM reported in the state, triggering a wave of fear among the public.
The Health Department will spearhead a comprehensive awareness campaign to educate the public on the risks and preventive measures associated with PAM.
Amoebic meningoencephalitis is a rare brain infection that is caused by Naegleria fowleri. Naegleria fowleri is commonly found in warm freshwater environments, such as lakes, hot springs, and poorly maintained swimming pools.
The amoeba enters the body through the nose, and it then travels to the brain where it causes infection and inflammation.
Another way of entry could be through a ritual, where people rinse their nostrils and nasal passages using water, including tap water.
Once inside the nasal passage, Naegleria fowleri travels through the olfactory nerve to the brain, where it causes severe damage to the tissues. The infection typically progresses rapidly, leading to inflammation of the brain and the meninges.
Unfortunately, the prognosis for PAM is extremely poor, with a high fatality rate. The infection progresses rapidly and, if left untreated, it can lead to death within a matter of days.
Immediate medical attention is crucial in increasing the chances of survival. Treatment options include aggressive use of antifungal and antimicrobial drugs, as well as measures to reduce brain swelling and inflammation.
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.
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).
In Kerala, three cases of the infection have been reported so far.
Health authorities on 28 June, reported that a 12-year-old boy from Irumooliparamabu, near Farook College, had been infected by the disease.
The boy who was admitted to a private hospital is said to be in a critical condition. He reportedly, swam in Achamkulam lake and after six days developed some symptoms.
On 25 June, a 13-year-old girl, from Kannur, who passed away at a private hospital in Kozhikode was infected with a rare variety of free-living amoeba. It might have entered her body from a swimming pool that she accessed while on a tour from school on 28 January.
On 21 May, a five-year-old child who was undergoing treatment at the Government Medical College Hospital in Kozhikode, for amoebic meningoencephalitis also lost her life.
The child, a native of Kaliyattamukku in the Mooniyoor grama panchayath of the Malappuram district, is suspected to have been infected with the amoeba after she swam along with her relatives in the nearby Kadalundi River.
(Edited by Shauqueen Mizaj)
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