Kerala teen becomes first in India to survive lethal brain fever

Hours after 14-year-old Afnan Jasim of Thikkodi near Payyoli in Kerala’s Kozhikode district walked out of the Baby Memorial Hospital in Kozhikode, miraculously recovering from Primary Amoebic Meningoencephalitis (PAM), a three-and-a-half-year-old from Kannur has been confirmed to have the disease at the same hospital. The child has been receiving treatment for the lethal infection for the past week.

For Afnan and his family, July 22 will be an additional birthday for now on, to celebrate his recovery from PAM, a lethal brain fever. Afnan was completely cured of the disease which has a 97 per cent mortality rate. This is rare in the country.

Survivor’s family joyous

According to the Centre for Disease Control and Prevention in the US, there are records of only eight survivors from 1971 to 2023: the US (4), Pakistan (2) and Australia and Mexico (! Each).

Two weeks earlier, EP Mridul, a Class 7 student at the Farook Higher Secondary School in Kozhikode, succumbed to the brain-eating amoebae.

“This is the happiest day in our life. I thank all the doctors who took care of my son,” said Afnan’s father MK Siddique while going home from the hospital.

Rare recovery
Dr Abdul Rauf, consultant paediatric intensivist at Baby Memorial Hospital, said that when the boy had seizures on the first day of admission, both the doctors and his parents were suspicious because there was a lot of awareness among the public and medical professionals.

“As a result, we were able to start treatment the very next day after identifying the amoeba. The CDC in the US has a brief treatment protocol based on the few survivors worldwide, which involves a cocktail of antibiotics. We administered all the available medicines, and the boy’s condition started to improve,” he said.

Medicine from Germany

“One of the medicines – Miltefosine – had not been available for previous patients. The health department made it available from Germany. In fact, the medicine was imported for the previous patient but, unfortunately, he could receive only two doses. Afnan got the full benefit. But even before that, he was showing signs of improvement. On day eight, his samples were clear of amoebae,” Dr Rauf said.

There have been six cases of the disease across Kerala in the recent past. The latest is a three-and-a-half-year-old child from Kannur who was diagnosed with the disease on July 26 and is under treatment at a private hospital in Kozhikode. Afnan could be India’s first survivor of the deadly disease.

“There may be another case from Himachal Pradesh but it was only suspected without PCR confirmation of the presence of the amoeba,” said Dr Rauf.

High awareness in Kerala

Preventive measures were intensified in the state as soon as amoebic meningoencephalitis was reported. Its first sighting in Kerala in the recent past was in 2017 when a person died in Alappuzha. Then in 2023, another couple of cases were reported from the same district.

This year, it was in May that the disease resurfaced with children falling prey to it. The government sprang into action, with the health department issuing a forewarning and devising a treatment plan.

Maiden treatment guidelines

“At a special meeting on May 28, we decided to prepare treatment guidelines for amoebic meningoencephalitis, which were subsequently released on July 20. This is the first-time comprehensive guidelines for the treatment of amoebic meningoencephalitis have been issued in the country,” said Kerala Health Minister, Veena George.

These technical guidelines cover prevention, diagnosis as well as treatment of the rare and lethal disease.

“There is limited scientific research and findings about this disease, which prompted the state to prepare comprehensive guidelines based on available scientific studies and observations. A committee has been appointed in collaboration with Indian Council of Medical Research (ICMR) for further study and research,” added the sinister.

What is PAM?

Amoebic meningoencephalitis is a very rare disease found in people who come in contact with stagnant or flowing water. Statistics indicate that only one in 2.6 million people who come in contact with such quality of water, develop this disease.

The disease typically occurs when the amoeba, belonging to the Naegleria fowleri group, infects the brain. The disease does not spread from person to person. The amoeba enters the brain through rare perforations in the thin layer separating the nose and brain or through perforations in the eardrum, causing meningoencephalitis.

How the disease attacks

During the summer, as water levels decrease, the amoeba becomes more prevalent. When people enter water, the amoeba from the sediment gets stirred up and enters the body through the nose. Symptoms appear within one to nine days of infection. Diagnosis is done by examining spinal fluid and confirming the disease through PCR testing.

Treatment involves a combination of five drugs believed to be effective against the amoeba. Starting the medication as soon as possible increases the chances of recovery. Therefore, medications should be administered as soon as symptoms begin so as to reduce the mortality rate.

How to stay safe

Children with ear infections should avoid swimming in ponds and stagnant water. Swimming and diving in stagnant water should be minimised. It should be ensured that water in water-themed parks and swimming pools is properly chlorinated and cleaned. Avoid getting the water into the nose and use nasal clips to prevent water from entering the nose.

Primary symptoms include severe headache, fever, nausea, vomiting and difficulty in moving the neck. In severe cases, symptoms like seizures, loss of consciousness and memory loss may occur. Those who swim in stagnant water and exhibit these symptoms should seek medical attention immediately.