Thiruvananthapuram: The health department is on alert in Kerala’s Kozhikode district after the deadly primary amoebic meningoencephalitis (PAM) once again saw a surge in the southern state.
Caused by the amoeba Naegleria fowleri, PAM was first reported in Kerala in 2016. There were 37 cases till 2024, of which 13 succumbed to the disease that has a survival rate of less than five percent, according to the health department.
This year, eight cases and two fatalities have been reported, so far. Half of these cases were from Kozhikode, including the latest death, which was reported in Thamarassery after a nine-year-old girl succumbed 14 August.
An official with the Kozhikode District Medical Office (DMO) told ThePrint that the administration has surveyed 38 households near where the case was reported. “We identified four cases of fever. But there is nothing to be worried about yet,” the official said.
Kozhikode District Medical Officer Dr. Rajaram K.K. urged the public to avoid swimming or bathing in stagnant water, adding that individuals who have recently undergone nasal or ear surgery should refrain from swimming.
The statement said that authorities should ensure that all swimming pools and water theme parks are properly chlorinated. The public at large was advised to chlorinate well water regularly and scrub swimming pools under the guidance of health workers.
The above-mentioned DMO official said the administration and local bodies are yet to begin surveying the water bodies in the district.
ThePrint reached the office of Dr Reetha K.P., Additional Director of Health Services, to understand the statewide protocol regarding the disease, but she refused to comment.
Dr. P. Jayesh Kumar, former professor and head of general medicine, Kozhikode Medical College, told ThePrint that the amoeba usually enters the body when people swim or bathe in stagnant water in natural ponds, swimming pools, or even tap water that is not properly chlorinated.
He added that besides Naegleria fowler, commonly called the ‘brain-eating amoeba’, pathogens such as Acanthamoeba, Balamuthia, Sappinia, and Vermamoeba also cause types of amoebic encephalitis.
According to health professionals, the pathogens enter through tiny openings in the thin membrane separating the nose and brain, or through perforations in the eardrum. The infected individual shows symptoms within five to 10 days, and they often mimic meningitis with fever, severe headache, nausea, vomiting, stiffness of the neck, and sensitivity to light. The infection doesn’t spread from human to human.
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The Kerala factor
A 2020 report, ‘Epidemiology and Clinical Characteristics of Primary Amebic Meningoencephalitis Caused by Naegleria fowleri: A Global Review’, published by Oxford University Press, reported that a total of 381 PAM cases were diagnosed in 33 countries as of 2018.
The highest number of reported cases have been in the US (41 percent), Pakistan (11 percent), and Mexico (9 percent). The report added that the patients were predominantly male (75 percent), with a median age of 14 years. As per the Centers for Disease Control and Prevention (CDC), more than 97 percent of people with PAM have died from the infection.
While Kerala continues to report the infection, its prevalence in other states has been reportedly lower. Though there is no centrally collated data, a report titled, ‘Understanding the true burden of Naegleria fowleri in patients from Northern states of India: Source tracking and significance’, published in 2020 in the European Journal of Protistology, says only 17 cases were reported nationally till 2020.
“The concerning fact is that the mortality rate is really high, for which early diagnosis and treatment is key. Early diagnosis is the reason for our survival rate,” Jayesh said, adding that Kerala was able to show a significantly high recovery rate compared to international standards due to early diagnosis.
Environmental factors, such as climate change, may be contributing to the growth of these amoebae in water bodies. He added that it’s also pertinent to study if humans are more vulnerable to the infection after the COVID-19 pandemic.
“They are free-living amoebas living in water and soil. They need a high temperature to be active in water. So global warming and temperature could be a cause,” he said, adding that studies should be conducted to see if the quality or condition of water is contributing to its prevalence in Kerala, especially in the districts of Kozhikode, Wayanad, and Malappuram.
(Edited by Tony Rai)
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