Primary Amoebic Meningoencephalitis in Kerala – An Emerging Public Health Concern
Abstract
Primary Amoebic Meningoencephalitis (PAM) is an acute and often fatal infection of the brain caused by the free living amoeboflagellate Naegleria fowleri. These amoebae are ubiquitous and found naturally in freshwater environments, such as pools, ponds, canals, lakes and rivers. It is commonly called the ‘brain eating amoeba’ because it can cause a brain infection when water containing the amoeba move into the nose. PAM is often found in immuno-competent children and young adults, especially after having exposure with amoeba- contaminated water. Increasing incidence is reported worldwide. PAM is set apart by a mortality rate of 98% and the high mortality has been imputed to rapid onset of the illness, delayed diagnosis and lack of effective treatment protocol. In Kerala, the first confirmed PAM case was reported in Alappuzha district in March 2016, and since then seven more cases were reported from the state, and all of them succumbed to the infection. The deadly clinical condition is often misdiagnosed and is grossly under-reported. This highly necessitates that ample awareness and education should be given to the health care providers and the public about the etiology of the illness with special emphasis on the mode of transmission and clinical presentations. This paper discusses the geo-demographic details and epidemiological and pathological information about N.fowleri cases reported in Kerala and emphasizes on the need of public health awareness and intervention activities to prevent the occurrence and spread of the disease in Kerala.
How to cite this article:
Regu K, Rajendran R, Bhaskaran K S, Rajendran
A, Tamizharasu W. Primary Amoebic
Meningoencephalitis in Kerala – An Emerging
Public Health Concern. J Commun Dis.
2024;56(1):25-35.
References
Visvesvara GS, Moura H, Schuster FL. Pathogenic and opportunistic free-living amoebae: Acanthamoeba
spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappina diploidea. FEMS Immunol Med Microbiol.
;50(1):1-26. [PubMed] [Google Scholar]
Fowler M, Carter RF. Acute pyogenic meningitis probably due to Acanthamoeba sp.: a preliminary report. Br Med J. 1965;2(5464):740-2. [PubMed] [Google Scholar]
Pugh JJ, Levy RA. Naegleria fowleri: diagnosis, pathophysiology of brain inflammation, and
antimicrobial treatments. ACS Chem Neurosci. 2016;7(9):1178-9. [PubMed] [Google Scholar]
Gharpure R, Bliton J, Goodman A, Ali IK, Yoder J, Cope JR. Epidemiology and clinical characteristics of primary amoebic meningoencephalitis caused by Naegleria fowleri: a global review. Clin Infect Dis. 2021;73(1):e19-
[PubMed] [Google Scholar]
Suseela KV, Khan F, Kottoor SJ. An unusual case of neutrocytic, culture-negative meningitis
in an immunocompetent adult. JRSM Open. 2021;12(5):20542704211009354. [PubMed] [Google Scholar]
Joseph RB, Rauf A, Chettali AM, Pillai R, Vijayan A, Poornima MV. Primary amoebic meningoencephalitis in children - report of two cases from South India. Trop Doct. 2022;52(4):553-5. [PubMed] [Google Scholar]
Zamzuri MA, Majid FN, Mihat M, Ibrahim SS, Ismail M, Aziz SA, Mohamed Z, Rejali L, Yahaya H, Abdullah Z, Hassan MR, Dapari R, Isa AM. Systematic review of brain-eating amoeba: a decade update. Int J Environ Res Public Health. 2023;20(4):3021. [PubMed] [Google Scholar]
Wang Q, Li J, Ji J, Yang L, Chen L, Zhou R, Yang Y, Zheng H, Yuan J, Li L, Bi Y, Gao GF, Ma J, Liu Y. A case of Naegleria fowleri related primary amoebic meningoencephalitis in China diagnosed by next-generation sequencing. BMJ Infect Dis. 2018;18(1):349. [PubMed] [Google Scholar]
Guemez A, Garcia E. Primary amoebic meningoencephalitis by Naegleria fowleri: pathogenesis and treatments. Biomolecules. 2021;11(9):1320. [PubMed] [Google Scholar]
Gajula SN, Nalla LV. Fighting with brain-eating amoeba: challenges and new insights to open a road for the treatment of Naegleria fowleri infection. Expert Rev Anti Infect Ther. 2023;21(12):1277-9. [PubMed] [Google Scholar]
Sarfraz MR, Tariq H, Rehman S, Khan S. Naegleria fowleri - the brain-eating amoeba: an emerging threat
in Pakistan. Acta Biomed. 2023;94(2):e2023024. [PubMed] [Google Scholar]
Stubhaug TT, Reiakvam OM, Stensvold CR, Hermansen NO, Holberg-Petersen M, Antal EA, Gustad K, Forde IS,
Heger B. Fatal primary amoebic meningoencephalitis in a Norwegian tourist returning from Thailand. JMM Case
Rep. 2016;3(3):e005042. [PubMed] [Google Scholar]
McLaughlin A, O’Gorman T. A local case of fulminant primary amoebic meningoencephalitis due to Naegleria
fowleri. Rural Remote Health. 2019;19(2):4313. [PubMed] [Google Scholar]
Sazzad HM, Luby SP, Sejvar J, Rahman M, Gurley ES, Hill V, Murphy JL, Roy S, Cope JR, Ali IK. A case of primary
amoebic meningoencephalitis caused by Naegleria fowleri in Bangladesh. Parasitol Res. 2020;119(1):339-
[PubMed] [Google Scholar]
Baig AM. Global warming favors pathogenecity of the brain-eating amoebae. Anti Infect Agents. 2019;17(1):2-
[Google Scholar]
Diaz J. Seasonal primary amebic meningoencephalitis (PAM) in the south: summer time is PAM time. J La
State Med Soc. 2012;164(3):148-50, 152-5. [PubMed] [Google Scholar]
Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, Hill VR, Wilson JD, Linscott
AJ, Crager R, Kozak NA, Sriram R, Narayanan J, Mull B, Kahler AM, Schneeberger C, da Silva AJ, Poudel M, Baumgarten KL, Xiao L, Beach MJ. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012;55(9):e79-85. [PubMed] [Google Scholar]
Krol-Turminska K, Olender A. Human infections caused by free-living amoebae. Ann Agric Environ Med.
;24(2):254-60. [PubMed] [Google Scholar]
Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962-2008. Epidemiol Infect. 2010;138(7):968-75. [PubMed] [Google Scholar]
Centers for Disease Control and Prevention (CDC). Investigational drug available directly from CDC for the treatment of infections with free-living amoebae. MMWR Morb Mortal Wkly Rep. 2013;62(33):666. [PubMed] [Google Scholar]
Baig AM, Khan NA. Tackling infection owing to brain- eating amoeba. Acta Trop. 2015;142:86-8. [PubMed]
[Google Scholar]
Stahl LM, Olson JB. Environmental abiotic and biotic factors affecting the distribution and abundance
of Naegleria fowleri. FEMS Microbiol Ecol. 2021;97(1):fiaa238. [PubMed] [Google Scholar]
Gupta S. Isolation of Naegleria fowleri from pond water in West Bengal, India. Trans R Soc Trop Med Hyg. 1992;86(1):46. [PubMed] [Google Scholar]
Panda A, Khalil S, Mirdha BR, Singh Y, Kaushik S. Prevalence of Naegleria fowleri in environmental samples from northern part of India. PLoS One. 2015;10(10):e0137736. [PubMed] [Google Scholar]
Copyright (c) 2024 Journal of Communicable Diseases (E-ISSN: 2581-351X & P-ISSN: 0019-5138)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.