Despite the high global mortality rate of 97 percent, Kerala has demonstrated that early detection can drastically improve survival outcomes.
Published Oct 03, 2024 | 7:00 AM ⚊ Updated Oct 03, 2024 | 7:00 AM
Flagellate form of the parasite Naegleria fowleri. (iStock)
The health department in Kerala is facing a growing challenge as the state keeps reporting cases of primary amoebic meningoencephalitis (PAM).
This rare and potentially fatal disease, caused by a free-living amoeba — Naegleria fowleri — has left baffled health officials scrambling for answers on the spread of the disease and the mystery surrounding its transmission.
It is learnt that the complexity of PAM has introduced significant challenges, especially as the source of infection remains elusive in certain cases, despite the common connection to waterbodies.
The amoeba responsible for this life-threatening condition thrives in warm freshwater environments such as lakes and rivers and causes the infection when it enters the brain through the nose.
The Kerala health department had earlier announced plans to adopt a “One Health” approach to tackle PAM, aiming to integrate human, animal, and environmental health efforts to understand the dynamics of this deadly infection.
However, as per sources, the ground-level activities have been minimal, leaving many questioning the department’s preparedness for this emerging threat.
In this context, a recent study conducted by researchers from the National Centre for Disease Control (NCDC) titled ‘Primary Amoebic Meningoencephalitis in Kerala – An Emerging Public Health Concern,‘ published in the Journal of Communicable Diseases, has provided crucial insights and recommendations.
The study examined eight PAM cases reported from March 2016 to June 2023.
The NCDC study carried out with the help of District Medical Offices (Health) of Alappuzha, Malappuram, Kozhikode, and Thrissur districts, Central Water Resources Development and Management (CWRDM), Kozhikode, and others, sheds light on the urgent need for better diagnostic and preventive measures.
Some of the key findings include:
– Delayed sample collection: Delays in collecting water samples from the suspected source often result in inconclusive laboratory results, further complicating diagnosis. Timely collection is crucial for confirming the presence of N. fowleri.
– Misdiagnosis: In three of the eight cases examined, patients were initially treated for acute pyogenic meningoencephalitis, and one was treated for bacterial meningitis. Later, all were confirmed as PAM cases, highlighting the frequent misdiagnosis of this rare infection.
– Public health awareness: The study emphasises the need for comprehensive public health measures. Public awareness campaigns, especially in local languages, must inform communities about the dangers of PAM, the mode of transmission, and the importance of early treatment.
– Global concern: Despite the prevalence of N. fowleri in freshwater bodies worldwide, cases remain underreported in India. Misdiagnosis and limited awareness within the medical fraternity often prevent timely intervention. The study calls for practical measures like water surveys and widespread medical training to prevent future outbreaks.
In some cases, the health department’s confusion stems from the absence of a clear source of infection, which has made it difficult to implement preventive measures.
The presence of N. fowleri in Kerala’s waterbodies has been confirmed, yet the unpredictability of infection has left medical professionals and local authorities scrambling for solutions.
Experts believe that many cases of PAM may have gone undetected, misdiagnosed as bacterial meningitis or other brain-related illnesses.
This gap in diagnosis contributes to the higher mortality rates, as effective treatment can only begin once the condition is accurately identified.
Faced with this evolving challenge, Kerala’s health department has now decided to mandate tests for amoebic meningoencephalitis among patients suspected of having brain fever.
This directive came in response to the increasing confirmation of PAM cases and a global trend where 60-70 percent of encephalitis cases remain undiagnosed.
The State Level Rapid Response Team (RRT) convened, on 30 September, under the guidance of Health Minister Veena George, deciding that early detection and treatment could save lives.
Among the decisions made were on the availability of drugs, particularly Miltefosine, to treat amoebic encephalitis.
The department pointed out that despite the high global mortality rate of 97 percent, Kerala has demonstrated that early detection can drastically improve survival outcomes.
It cited the development in which 10 patients were recently cured of amoebic encephalitis from the Government Medical College Hospital, Thiruvananthapuram, reducing the mortality rate in Kerala to 26 percent, a far cry from the grim global statistics.
The state has now taken steps to integrate a One Health approach, a first for India, in studying and tackling amoebic encephalitis.
This approach recognises the interconnectedness of human, animal, and environmental health, acknowledging that diseases like PAM arise at the intersection of these fields.
As part of this strategy, the department recently organised a technical workshop, bringing together experts from institutions such as the Indian Council of Medical Research (ICMR), the Indian Institute of Science (IISc), and the Pollution Control Board to establish a roadmap for further research and preventive measures.
The health minister has directed officials to strengthen these activities. The department said that it is also determined to improve awareness within the medical community and among the general public to curtail the spread of PAM.
As Kerala grapples with the complex challenge of PAM, the confusion around its transmission and diagnosis remains a pressing concern.
“While recent studies have shed some light on the disease, much more work needs to be done to prevent future fatalities. The adoption of a One Health approach, along with early detection strategies and the availability of effective treatment, represents a significant step forward,” said a health official.
At the same time, another section within the health department underscored that without stronger ground-level activities and continuous public health campaigns, the battle against PAM is far from over.
They told South First that the health department’s efforts must extend beyond workshops and directives, ensuring that actionable measures are implemented swiftly and effectively across the state.
For now, Kerala remains a focal point in the fight against amoebic meningoencephalitis, hoping its strategies will set an example for other regions facing similar public health challenges.
(Edited by Majnu Babu).
