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What is Primary Amoebic Meningoencephalitis

  • Causative Agent:
    • Caused by Naegleria fowleri (a free-living, thermophilic amoeba).
    • Commonly found in warm freshwater (ponds, lakes, poorly maintained swimming pools, stagnant water).
  • Mode of Transmission:
    • Amoeba enters the human body through the nose while swimming, bathing, or diving in contaminated water.
    • Reaches the brain through the olfactory nerve (cribriform plate).
    • Not transmitted person-to-person.
  • Pathophysiology:
    • Amoeba invades the central nervous system → acute inflammation of brain and meninges.
    • Causes Primary Amoebic Meningoencephalitis (PAM) → often fatal.

Relevance : GS 2(Health), GS 3(Science and Technology)

Symptoms & Clinical Course

  • Incubation period: 5–10 days after exposure.
  • Early Symptoms:
    • Severe headache, fever, nausea, vomiting.
    • Stiff neck, photophobia (light sensitivity).
    • Children: refusal to eat, irritability, lethargy.
  • Progressive Symptoms:
    • Confusion, altered behavior.
    • Seizures, epilepsy.
    • Memory loss, fainting.
    • Coma → death (usually within 1–2 weeks of symptom onset).
  • Mortality: Extremely high (95–99%), with very few survivors globally.

Risk Factors

  • Swimming or bathing in stagnant or warm freshwater (especially during summer).
  • Children at higher risk (due to thinner cribriform plate → easier entry to brain).
  • Ear/nose surgeries or injuries may increase susceptibility.
  • No risk from drinking contaminated water (infection occurs only through nose).

Recent Outbreak in Kerala

  • Kozhikode (2024): 3 cases detected, 1 death reported.
  • Previous local outbreaks in Kerala had led to warning boards near ponds to alert public.
  • Current alert: Issued by Kerala Health Department to raise awareness and encourage precaution.

Preventive Measures

  • Avoid swimming or bathing in stagnant/unclean ponds, lakes, and warm water bodies.
  • Use nose clips while swimming to prevent water entry.
  • Ensure chlorination and cleaning of public water sources and swimming pools.
  • People with nasal/ear surgeries should avoid exposure to stagnant water.
  • Public awareness campaigns: leaflets, boards near ponds, media outreach.

Treatment Challenges

  • No single guaranteed cure.
  • Drugs used (in combinations):
    • Amphotericin BMiltefosineAzoles (Fluconazole, Ketoconazole).
    • Treatment effective only if started very early.
  • Supportive care (ICU, ventilator support) often required.

Broader Public Health Concerns

  • Rarity but Deadliness: Cases are rare, but nearly always fatal → high fear factor.
  • Climate Change Link: Rising temperatures and water stagnation may increase risk.
  • Surveillance & Rapid Diagnosis:
    • Need early identification at hospitals.
    • Train health workers to recognize neurological symptoms after water exposure.

Bottom Line:

  • PAM is a rare but almost always fatal brain infection caused by Naegleria fowleri.
  • Kerala’s alert in Kozhikode is precautionary due to recent cases and a death.
  • Preventive steps (avoiding stagnant water, using nose clips, awareness campaigns) are critical, as treatment options are limited and survival rates are very low.

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