Kerala: 10-year-old infected with brain-eating amoeba

A 10-year-old boy from Nadutheri, Thalavoor in Kollam has been diagnosed with primary amoebic meningoencephalitis (PAM). He is currently receiving treatment at SAT Hospital in Thiruvananthapuram. This is the first reported case of PAM in Kollam.

The District Rapid Response Team (RRT) will hold a meeting at 10 am on Monday to discuss the situation. Health officials revealed that the boy was initially taken to a hospital in Kollam with symptoms of fever, headache, and vomiting.

District health authorities are investigating whether the boy may have been exposed to any contaminated water sources. Field investigations are underway in areas surrounding the boy's home.

Amoebic meningoencephalitis is caused by *Naegleria fowleri*, a free-living amoeba found in warm, fresh water and soil. The infection occurs when the amoeba enters the body through the nose.

According to data shared by Kerala's Health Minister Veena George in the state Assembly earlier this week, Kerala has reported 29 cases of PAM in 2024, of which five have been fatal. The state health department has reported a mortality rate of 26per cent, significantly lower than the global average of 97 per cent.

Patients with PAM often have a history of swimming, diving, bathing, or playing in warm, typically stagnant freshwater in the 1-9 days prior to developing symptoms, as outlined in the technical guidelines issued by the state health department. In rare instances, patients may experience disorders in smell or taste.

Symptoms of PAM often resemble those of acute bacterial meningitis, with the disease's rapid onset typically occurring over hours to 1-2 days. The neuro-olfactory route provides Naegleria fowleri quick access to the brain, impairing the adaptive immune response and causing a swift progression of the disease.

In the second week of September, ten patients who had been undergoing treatment for amoebic meningoencephalitis were discharged from Medical College in Thiruvananthapuram. These patients had been exposed to contaminated water containing free-living amoebae.

Despite the rise in cases in Kerala—where the number of reported cases has increased from just eight between 2016 and 2023 to 29 this year—24 of the 29 patients diagnosed with PAM in 2024 have survived. Notably, the majority of cases have been concentrated in six districts, with Thiruvananthapuram accounting for 15 of them.

In comparison, according to the US Centres for Disease Control and Prevention, only four of 164 reported cases of PAM in the United States between 1962 and 2023 resulted in survival.

The first reported case of PAM in India occurred in 1971, with approximately two dozen cases recorded until last year. Kerala's first case was reported in 2016. However, in July of this year, 14-year-old Afanan Jasim from Thikkodi in Kozhikode district became the first Indian to survive PAM, and only the 11th PAM survivor globally.

The increase in PAM cases this year has been attributed to a combination of factors, including enhanced testing for acute encephalitis syndrome (AES)—a condition that can be caused by various diseases, including amoebic meningoencephalitis—and environmental factors such as climate change and pollution.

In response, Kerala became the first state in India to issue a special treatment protocol and standard operating procedure for managing PAM cases in July.

The state government has also commissioned a study to investigate the organic and inorganic factors that contribute to the increase in amoeba density in water bodies. This study will be conducted by the Department of Environmental Sciences at Kerala University in collaboration with the State Pollution Control Board.