July 20, 2024

Lukmaan IAS

A Blog for IAS Examination



THE CONTEXT: Kerala is on high alert after the northern region reported four cases of primary amoebic meningoencephalitis (PAM) in the last two months, resulting in the deaths of three children.


  • This rare but deadly infection has prompted health authorities to take immediate action to prevent further cases and understand the reasons behind the rise in infections.

Recent Cases and Victims

  • May 20, 2024: The first recent case was confirmed when five-year-old Fadva from Munniyur in Malappuram district died while undergoing treatment at the Government Medical College Hospital in Kozhikode.
  • June 12, 2024: Thirteen-year-old V Dakshina from Kannur succumbed to the infection in a local private hospital.
  • July 3, 2024: Twelve-year-old EP Mridul from Feroke, on the outskirts of Kozhikode city, died from the infection at a local private hospital.
  • July 5, 2024: A fourteen-year-old boy from Thikkodi village in Kozhikode district tested positive for the infection and is currently undergoing medical treatment with his condition believed to be stable.
  • PAM was first detected in Kerala in the Alappuzha municipality in 2016.

Pathogen and Mode of Infection

  • The causative agent of primary amoebic meningoencephalitis (PAM) is Naegleria fowleri, an amoeba that thrives in warm freshwater environments, such as lakes, ponds, rivers, and poorly maintained swimming pools.
  • It infects individuals by entering through the nose and then migrating to the brain, where it destroys brain tissue and causes swelling.
  • Early symptoms of PAM include headache, fever, nausea, and vomiting.
  • As the infection progresses, patients may experience stiff neck, confusion, loss of balance, hallucinations, and other severe neurological symptoms.
  • The infection typically leads to a coma and death within five days, with most victims dying between one and 18 days after symptoms begin.

Challenges in Diagnosis and Treatment

  • Diagnosing PAM is challenging due to its rarity and the similarity of its symptoms to those of bacterial meningitis.
  • Detection usually requires PCR tests of cerebrospinal fluid.
  • Currently, there is no standard treatment for PAM.
  • Doctors in Kerala are following guidelines from the Centers for Disease Control and Prevention (CDC) in the United States.
  • The state health department has acquired miltefosine, a broad-spectrum antibiotic, from Germany for treatment.
  • Other medications, such as Azithromycin and Amphotericin B, are also being used.

Preventative Measures

  • Children with Ear Infections: Advised against bathing or diving in ponds or stagnant water due to the risk of amoeba entering the brain through the eardrum.
  • Water Theme Parks and Swimming Pools: Operators instructed to chlorinate water regularly.
  • Personal Precautions: Individuals are advised to hold their nose or wear a nose clip when diving into freshwater, keep their head above water when entering warm water, and use distilled or boiled water for nasal cleansing.
  • Experts believe the rise in PAM cases may be due to unhygienic and stagnant water sources combined with high atmospheric temperatures.
  • Naegleria fowleri is more active in warm water, and conditions in Kerala may be conducive to the proliferation of this amoeba.

Government Response and Public Health Initiatives

  • Increased Vigilance
    • Medical practitioners across Kerala have been instructed to remain vigilant for potential PAM cases, using patient medical history and symptoms as indicators.
  • Specialized Treatment Facilities
    • Health Minister emphasized the need to direct suspicious cases to specialized facilities for treatment.
    • The health department is also focusing on raising public awareness about the risks of PAM and the importance of taking preventive measures.
  • Historical Public Health Challenges in Kozhikode
    • Kozhikode has faced multiple public health challenges in recent years, including outbreaks of Nipah and West Nile viruses and Kyasanur Forest Disease.
    • The recent surge in PAM cases adds to the public health burden in the region.
  • Urgent Call for Caution
    • Health Minister has urged the public to exercise extreme caution regarding water consumption and recreational water activities until the situation improves.
    • She stressed the importance of avoiding exposure to potentially contaminated water sources to prevent further infections.

What is Naegleria fowleri?

  • Naegleria fowleri is a single-celled organism found in warm fresh water and soil globally.
  • It thrives in high temperatures up to 115°F (46°C) and can survive briefly in warm environments.
  • Typical habitats include:
    • Warm freshwater bodies (lakes, rivers)
    • Geothermal water sources (hot springs)
    • Poorly maintained swimming pools
    • Splash pads and surf parks with insufficient chlorination
  • This free-living amoeba causes a rare but fatal brain infection known as Primary Amebic Meningoencephalitis (PAM).
  • The recent death of a five-year-old girl in Kerala has once again highlighted the dangers posed by this microorganism.
  • Infection occurs when water containing the amoeba enters the body through the nose.
  • This typically happens during swimming or other water activities.
  • Once inside the nasal passages, Naegleria fowleri migrates to the brain via the olfactory nerve, where it begins to destroy brain tissue, causing inflammation and swelling.
  • Key Points of Infection:
    • Entry Point: Through the nose, not through drinking contaminated water.
    • Non-Communicable: The infection does not spread from person to person.

SOURCE: https://www.downtoearth.org.in/health/kerala-on-high-alert-as-deadly-primary-amoebic-meningoencephalitis-kills-3-children-in-states-northern-districts

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