In an extremely rare occurance, 14-year-old Kerala boy recovers from Amoebic Meningoencephalitis

Minister Veena George noted that, 'Only 11 people worldwide have recovered from this disease, which has a mortality rate of 97 percent.'

South First Desk

Published Jul 22, 2024 | 4:57 PM ⚊ Updated Jul 22, 2024 | 4:57 PM

Brain-eating amoeba Naegleria fowleri. (iStock)

In a rare event, a 14-year-old boy, a native of Melady in Kozhikode, who was undergoing treatment for Amoebic Meningoencephalitis— the rare brain-eating amoeba infection has recovered.

Health Minister Veena George shared the news, stating that it is a rare incident in the world itself.

“Only 11 people worldwide have recovered from this disease, which has a mortality rate of 97 percent. The health department had taken special measures to treat the boy, including providing the medicine Miltefosine,” said Veena.

According to an official statement in Kozhikode , when the case was reported, a meeting was convened under the health minister’s leadership, and special cautionary instructions were issued.

Health workers at the Primary Health Centre in Melady in this district suspected that the boy’s symptoms might be meningoencephalitis and alerted the authorities.

“The boy had an epileptic seizure and was admitted to a private hospital in Kozhikode on the same day. The Health department provided Miltefosine medicine (a broad-spectrum anti-microbial used to treat free-living amoeba infections), and he recovered after three weeks of treatment. Early detection and access to available treatments contributed to his recovery,” the statement said.

The minister added that the department had also taken steps to strengthen preventive measures after the disease was reported in the state.

The disease which has been causing panic in the state, has so far recorded six cases since May, and all the patients are children, three of whom have already died.

The latest case reported was on Saturday, 20 July. Amebic meningoencephalitis is a rare but deadly infection that has a high mortality rate. The infection occurs when the Naegleria fowleri amoeba enters the body through the nasal cavity and travels to the brain, causing severe inflammation and damage.

Prevention and protocol

A special meeting was held under the chairmanship of Chief Minister Pinarayi Vijayan on 5 July, and a molecular diagnostic system was set up in collaboration with the Institute of Advanced Virology to detect the disease in its early stages.

In the meeting, it was also suggested that there should be proper chlorination of swimming pools and children should be careful when entering water bodies as they are mostly affected by this disease, the statement said.

Using swimming nose clips to prevent infection by the free-living amoeba was also suggested in the meeting.

The chief minister also said that everyone should take care to keep the water bodies clean.

A treatment protocol for the disease was also released on 20 July.

This is the first time a comprehensive treatment protocol has been released for Amoebic Meningoencephalitis in the country.

Kerala’s initiative marks a significant step forward in the fight against the brain-eating amoeba, setting a model for other regions to follow.

Also Read: Kerala sets benchmark, releases guidelines for managing Amoebic Meningoencephalitis

The SOP

Here are the key Standard Operating Procedures (SOPs) recommended by the state government to manage it:

• Any patient presenting with the symptoms of acute meningitis should be asked about nasal exposure to fresh water in the past 14 days. This step is crucial for early identification and prompt intervention.
• For patients with a recent history of nasal exposure to fresh water, Cerebrospinal Fluid (CSF) specimen should be rapidly tested for N. fowleri/FLA. Microbiologists should be immediately alerted about clinical suspicions before sending the CSF sample to ensure timely and accurate testing.
• In cases where bacterial meningitis patients do not respond to antibiotics or deteriorate rapidly, Primary Amoebic Meningoencephalitis (PAM) should be considered, even without fresh water exposure. This measure is vital for diagnosing atypical cases where standard treatments are ineffective.
• Wet mount examination of all turbid or opalescent CSF samples is mandatory as it helps in the early detection of PAM, facilitating prompt treatment. It refers to a specific type of microscopic examination of a CSF sample that appears cloudy or has a milky or opalescent appearance.
• PAM cases confirmed through CSF microscopy should immediately receive the recommended multi-drug regimen and supportive therapy to lower intracranial pressure. Immediate initiation of treatment is critical to improving patient outcomes.
• Confirmed PAM cases must be reported to the District Surveillance Officer (DSO), with CSF samples sent for PCR and genome sequencing if necessary. This ensures comprehensive tracking and understanding of the disease at a genetic level.
• Treatment of PAM should involve a multi-disciplinary team, including Physicians, Pediatricians, Intensivists, Infectious Disease Specialists, Neurologists, and Microbiologists. Collaborative care ensures that patients receive comprehensive and specialised treatment.
• Decisions regarding the use of advanced treatments like intrathecal amphotericin B, immunomodulators, therapeutic hypothermia, and pentobarbital protocol should be made by the Institutional Medical Board. This approach ensures that complex treatment decisions are made by a team of experts.

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