Naegleria fowleri, commonly known as the brain-eating amoeba

Naegleria fowleri

 Naegleria fowleri, commonly known as the brain-eating amoeba, causes a deadly infection in the brain called Primary Amoebic Meningoencephalitis (PAM). Naegleria fowleri is an amoeba found in warm freshwater and soil. It thrives in temperatures up to 115°F (46°C). Recently, a 14-year-old boy named Mridul from Kozhikode, Kerala, tragically lost his life after contracting this disease while bathing in a small pond. This incident highlights the dangers posed by warm freshwater places across the country.



Lifecycle of Naegleria Fowleri

Naegleria fowleri exists in three forms:

  1. Cyst: In adverse conditions, the amoeba forms a cyst, which is resistant to environmental stresses.
  2. Trophozoite: The active feeding stage where the amoeba multiplies and consumes bacteria.
  3. Flagellate: A temporary, non-feeding form that can move in search of a more favorable environment.

The trophozoite stage is the most dangerous to humans as it is the form that causes infection.

How the Disease Affects the Human Body

Naegleria fowleri is a tiny organism that lives in warm freshwater like lakes, rivers, and hot springs. It can also be found in soil. The amoeba becomes particularly dangerous when it enters the human body through the nose. It is most commonly found in:

  • Warm freshwater lakes and rivers
  • Hot springs
  • Geothermal water sources
  • Poorly maintained or unchlorinated swimming pools
  • Water heaters and industrial plants with warm water discharges

Infection Process:

  1. Entry through the Nose: The amoeba enters the nose when someone puts their head in water that contains the amoeba.
  2. Travel to the Brain: After entering the nose, Naegleria fowleri moves to the brain along the olfactory nerve.
  3. Destruction of Brain Tissue: The amoeba multiplies rapidly and starts to destroy brain tissue, causing serious swelling and, eventually, death.

Symptoms of Naegleria Fowleri Infection

Symptoms of PAM can resemble bacterial meningitis, making early diagnosis challenging. Symptoms usually appear 2 to 15 days after exposure and include:

  • Early Signs: Severe headache, fever, nausea, vomiting, and a stiff neck.
  • Later Signs: Confusion, trouble balancing, seizures, hallucinations, and coma. Due to the rapid progression of the infection, it is crucial to seek medical attention immediately if these symptoms occur after being in warm freshwater.

Prevention:

  1. Avoid Standing Water: Stay away from swimming or bathing in warm, still water where the amoeba can live.
  2. Use Nose Clips: Wear nose clips while swimming to prevent water from entering your nose.
  3. Keep Pools Clean: Ensure swimming pools are well chlorinated and maintain good hygiene practices.
  4. Stay Surface Level: Avoid putting your head under water in warm freshwater.

Treatment:

Treatment for PAM aims to improve survival chances through early detection and aggressive therapy. The CDC recommends a combination of:

  • Amphotericin B: Administered through IV and spinal injections to fight the amoeba.
  • Azithromycin: An antibiotic effective against amoebas.
  • Miltefosine: An experimental drug showing promise in treating PAM.
  • Rifampin: Another antibiotic used in combination with other treatments.
  • Dexamethasone: A steroid to reduce brain swelling.

Recent Cases in Kerala:

In 2023, Kerala reported four deaths due to PAM, alarming health officials and the public. Chief Minister Pinarayi Vijayan led a special meeting to address the issue and suggest preventive measures.

Government Response to the Disease:

The Kerala government has taken proactive steps to prevent the spread of this deadly infection. State Health Minister Veena George, Chief Secretary Dr. Venu, and other officials have been actively involved in raising awareness and implementing safety measures. Public health campaigns emphasize keeping water sources clean and educating the public about the risks of Naegleria fowleri.

Historical Cases in India:

While the recent cases in Kerala have received significant attention, PAM is not new in India. According to the Central Government’s Integrated Disease Surveillance Program (IDSP), there have been 22 deaths reported in Kerala, Haryana, and Chandigarh since 2016. Six of these deaths occurred after 2021, indicating an increasing trend in infections.

First Case in Kerala:

The first known case of PAM in Kerala was in 2016. Since then, there have been more deaths, underscoring the need for vigilance and improved public health efforts.

Other Cases

Globally, there have been only a few survivors of Naegleria fowleri infection. In the United States, three people have survived, while five others have survived worldwide. These cases highlight the importance of rapid response and innovative treatment approaches.

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