‘Brain-eating amoeba’ claims 3 Kerala children’s lives: What is Naegleria fowleri?

Three children in Kerala have lost their lives due to an infection caused by the ‘brain-eating amoeba’, Naegleria fowleri.

Since May, the state has reported four cases of primary amoebic meningoencephalitis (PAM), a rare brain infection caused by a free-living amoeba. All those affected have been children.

Earlier this month, a 14-year-old boy infected with the free-living amoeba died in Kozhikode. Prior to that, two others — a five-year-old girl from Malappuram and a 13-year-old girl from Kannur — died on May 21 and June 25, respectively, due to the rare brain infection.

The disease was earlier reported in coastal Alappuzha district in the state in 2023 and 2017.

What is ‘brain-eating amoeba’?

Naegleria fowleri is an amoeba (type of one-celled organism) that thrives in warm freshwater lakes, rivers, and hot springs. It is often called the ‘brain-eating amoeba’ because it can infect the brain and destroy brain tissue. Brain infections caused by Naegleria fowleri are very rare but nearly always fatal, according to the Centers for Disease Control and Prevention (CDC), which is the national public health agency of the United States.

According to CDC, in “very rare cases”, Naegleria fowleri has been found in poorly maintained swimming pools, splash pads, and other recreational venues. The amoeba also has been found in tap water.

Infections through nose

Young children who swim or dive in contaminated water, may get infected with ‘brain-eating amoeba’ as Naegleria fowleri amoebae travels through the nose and then enters into the brain. This causes the disease primary amoebic meningoencephalitis (PAM), which destroys brain tissue and causes brain swelling and death.

According to doctors, ‘brain-eating amoeba’ infections happen during summer months.

As per CDC, one cannot get a Naegleria fowleri infection from swallowing water containing the amoeba, and also one can’t get an infection from someone else or pass it on to others. Also, Naegleria fowleri is not found in salt water, like the sea.

Symptoms and treatment

Those infected will see symptoms after five days that can include headache, fever, nausea, or vomiting. Later, they could feel stiff neck, loss of balance, seizures.

“After symptoms start, the disease causes death within about 5 days (but can range from 1 to 18 days),” CDC said.

“Naegleria fowleri can destroy brain tissue and cause the brain to swell. Unfortunately, more than 97% of people with PAM have died from the infection. PAM progresses very quickly. This has made treatments for the disease difficult to identify. There is some evidence that certain drugs may be effective,” it added.

“Although most people who get PAM caused by a Naegleria fowleri infection don’t survive,” said CDC but added that there were documented cases of survivors in North America who were given Amphotericin B (IV and intrathecal), Rifampin, Miconazole, Fluconazole, Miltefosine, Dexamethasone, Phenytoin, Azithromycin.

“A timely diagnosis can be ensured by a high clinical suspicion and spinal fluid or CSF PCR, CSF analysis for motile trophozoites, apart from the routine tests,” Dr Drishya Pillai, a consultant physician at Meditrina Hospital, Palakkad, Kerala, was quoted as saying in a report in India Today.

5-month-old infant’s death in Karnataka

In a research paper titled ‘Primary Meningoencephalitis by Naegleria fowleri: First Reported Case from Mangalore, South India’ by Shalini Shenoy, Godwin Wilson, H. V. Prashanth, K. Vidyalakshmi, B. Dhanashree, and R. Bharath, Department of Microbiology, Kasturba Medical College, Mangalore, Karnataka, the authors have described how a five-month-old infant died from ‘brain-eating amoeba’ after bathing from water from a well in Mangalore.

“We report on a case of primary amoebic meningoencephalitis (PAM) in an infant who had not been swimming… A 5-month-old infant presented with a history of fever, vomiting for one week, and convulsions for three days. On physical examination, the child was febrile (38.5°C), continuous convulsions were present, and the pupils were reactive. There was a progressive deterioration of consciousness, leading to coma,” the authors wrote in the paper submitted in the year 2001.

“Naegleria fowleri was isolated from well water, which was used to bathe the child. The well water was not chlorinated,” they added.

How to protect yourself from infection

Doctors advise young children to avoid water-related activities to protect themselves from getting infected with ‘brain-eating amoeba’.

If one chooses to swim, he/she can reduce the risk of infection by limiting the amount of water that goes up the nose.

“Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater. Avoid putting your head under water in hot springs and other untreated geothermal waters.

“Avoid water-related activities in warm freshwater during periods of high water temperatures. Avoid digging in, or stirring up, the sediment while taking part in water-related activities in shallow, warm freshwater areas,” advises CDC.