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Management of ‘brain-eating amoeba’ instances.

Management of 'brain-eating amoeba' instances.
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Primary amoebic meningoencephalitis is an uncommon and dangerous disease. What are its symptoms?


In the past two months, Kerala has seen four cases of the rare but fatal primary amoebic meningoencephalitis (PAM), with three deaths. A 14-year-old kid from Thikkodi, Kozhikode district, tested positive for the illness on July 5.
He is currently receiving medical treatment and is said to be stable.


Where were the fatalities?

E.P. Mridul, a 12-year-old from Feroke in Kozhikode district, passed away on July 3 in a private hospital in Kozhikode. V. Dakshina, a 13-year-old Kannur resident, passed away at a private hospital on June 12.
Fadva, a 5-year-old from Munniyur, Malappuram, died on May 20 at the Government Medical College Hospital in Kozhikode.


What exactly is PAM?

Naegleria fowleri, an amoeba found in warm freshwater bodies, causes primary amoebic meningoencephalitis (PAM). In rare instances, it can live in poorly maintained swimming pools. This one-celled creature is known as the ‘brain-eating amoeba’ because to its ability to infect and destroy brain tissues.
These infections are rare but devastating, with 97% of patients dying. Infection occurs when people swim in lakes, ponds, or rivers throughout the summer. Experts suggest that it could happen when the weather is high and water levels are low. The amoeba enters the body through the nose and moves to the brain. It kills brain tissues and produces edoema.
Recent studies indicate that youngsters are more susceptible to it. The virus is not transmitted from person to person. Swallowing water containing the amoeba does not result in infection.

What are the signs and symptoms of PAM?

The U.S. Centres for Disease Control and Prevention (CDC) reports that early symptoms include headache, fever, nausea, and vomiting.
However, the condition has the potential to progress fast. Later symptoms include stiff neck, confusion, loss of focus, balance issues, and hallucinations. According to the CDC, it typically causes a coma and death within five days. Most patients die between one to eighteen days.
Warming of the atmosphere and unsanitary water supplies may contribute to infection, according to experts. This species of amoeba thrives in warm water.


What is the diagnosis and treatment?

Cerebrospinal fluid PCR assays can detect the illness. However, due to its rarity, PAM might be difficult to diagnose. Doctors at the Government Medical College Hospital in Kozhikode suspected a 5-year-old child from Malappuram had symptoms comparable to bacterial meningitis, which has decreased in recent years due to immunisation.
Due to the lack of established treatment approaches, clinicians are currently adhering to CDC guidelines.

The State Health Department has purchased miltefosine, a broad-spectrum anti-microbial medication, from Germany to treat affected individuals. Paediatricians recommend Azithromycin and Amphotericin B, which are both available.


Has it previously been reported in Kerala?

The virus was first discovered in Alappuzha in 2016, and has since spread to Malappuram in 2019, Kozhikode in 2020, Thrissur in 2022, and Alappuzha in 2023. On July 1, Health Minister Veena George summoned a meeting to assess the situation and decide on special treatment protocols.
According to health officials, the amoeba may enter the brain through gaps in the nose-brain barrier or the eardrum. Children with ear infections should avoid bathing in stagnant water. Diving should be avoided.

Water theme parks and swimming pools are required to regularly chlorinate their water. Kerala Chief Minister Pinarayi Vijayan held a meeting on July 5 and issued directives to maintain clean water resources.
Children are advised to use swimming nose clips to prevent infection.


What steps may be taken to lessen the risk?

To prevent infection, it is recommended to wear a nasal clip or hold the nose when jumping or diving into fresh water. Maintain a high head position when entering heated water. Experts recommend avoiding digging in shallow seas. To clear nasal passages, use distilled or heated water.









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