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PAM cases in Kerala: Three cases of the rare primary amoebic meningoencephalitis (PAM) have been reported in Kerala in recent days, leading to the death of a nine-year-old and infecting a three-month-old baby. PAM is a rare brain infection caused by Naegleria fowleri, also called ‘brain-eating amoeba’.
What also raised questions for the state health department is the fact that there appears to be no common factor among the three cases, which were reported from different villages in the Kozhikode district.
The first case of PAM in India was reported in 1971, and the first case in Kerala was reported in 2016. From 2016 to 2023, the state had only eight cases. Last year, Kerala had 36 cases and nine deaths. Here is what to know about the disease and how the amoeba infects people.
PAM is caused by Naegleria fowleri, a free-living amoeba or a single-celled living organism. It lives in warm, fresh water and soil around the world, and infects people when it enters the body through the nose. Higher temperatures of up to 115°F (46°C) are conducive to its growth, and it can survive for short periods in warm environments.
The amoeba can be found in warm freshwater, such as lakes and rivers, swimming pools, splash pads, surf parks, or other recreational venues that are poorly maintained or minimally chlorinated.
Naegleria fowleri enters the body through the nose, usually when people are swimming. It then travels up to the brain, where it destroys the brain tissue and causes swelling.
In a Kozhikode case in 2024, it was suspected that the girl was infected while swimming in a local river. However, the other children who swam with her did not get infected. Notably, people cannot get infected with Naegleria fowleri from drinking water contaminated with the amoeba. PAM is also non-communicable.
In the initial stage, the symptoms include headache, fever, nausea and vomiting. Later on, the patient may have a stiff neck and experience confusion, seizures, hallucinations and slip into a state of coma.
According to the US Centers for Disease Control and Prevention (CDC), “Most people with PAM die within 1 to 18 days after symptoms begin. It usually leads to coma and death after 5 days.”
As earlier reported, scientists haven’t been able to identify any effective treatments for the disease yet. At present, doctors treat it with a combination of drugs, including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone.
Past incidents of infection
The first incident in Kerala was reported in Alappuzha in 2016, perhaps due to its large number of water bodies. Since then, infections have been reported in Malappuram, Kozhikode and Thrissur.
Compared to a 97 per cent fatality rate for the disease globally, Kerala stands at 25 per cent. All reported cases in India had led to the patient’s death until July 2024, when a 14-year-old boy in Kozhikode district became the first Indian to survive the disease. He was only the 11th PAM survivor in the world.
One of the reasons for the spike in cases in Kerala has been increased testing for acute encephalitis syndrome (AES) – a condition that can be caused by various diseases, including PAM – as well as other factors such as climate change and environmental pollution. In the new cases, another possibility could be that the PAM was caused by a different category of amoeba, which is found in dust and soil, according to health department officials.
