Kerala: Battling a Rare Brain-Eating Disease

On the eve of Onam, Kerala’s most celebrated festival, tragedy struck when 45-year-old Sobhana succumbed to a rare and deadly infection caused by the brain-eating amoeba, Naegleria fowleri. Just days before her death, Sobhana, who lived in Malappuram district and worked bottling fruit juices, had only reported mild symptoms such as dizziness and high blood pressure. After a brief visit to the doctor, she was sent home with medication. However, her condition deteriorated rapidly, leading to her death on September 5, the main day of the festival. Sobhana’s case is a grim reminder of the dangers posed by this rare organism, which is typically contracted through contaminated freshwater.

The Threat of Naegleria fowleri

Naegleria fowleri is a single-celled organism that thrives in warm freshwater environments. It is known to cause a severe brain infection called primary amoebic meningoencephalitis (PAM), which can lead to rapid brain tissue destruction. The amoeba typically enters the body through the nose during activities such as swimming in lakes, rivers, or hot springs. Globally, cases of PAM are extremely rare, with only 488 confirmed since 1962, primarily in the United States, Pakistan, and Australia. Tragically, approximately 95% of those infected have died from the disease.

In Kerala, the situation has escalated alarmingly. This year alone, over 70 cases have been reported, with 19 fatalities. The patients affected range from a mere three months old to a 92-year-old man. Ajitha Kathiradath, a cousin of Sobhana and a social worker, expressed the helplessness felt by her family, stating, “We were powerless to stop it. We learnt about the disease only after Sobhana’s death.”

Rising Cases and Improving Survival Rates

Since Kerala began identifying cases of Naegleria fowleri in 2016, the state has seen a gradual increase in reported infections. Initially, only one or two cases were recorded each year, and nearly all resulted in death. However, recent statistics indicate a shift in this trend. In 2022, there were 39 cases with a fatality rate of 23%. This year, while nearly 70 cases have emerged, the mortality rate has slightly increased to about 24.5%.

Health experts attribute this rise in cases to improved detection methods, facilitated by advanced laboratory capabilities. Dr. Aravind Reghukumar, head of infectious diseases at the Medical College and Hospital in Thiruvananthapuram, noted, “Cases are rising but deaths are falling. Aggressive testing and early diagnosis have improved survival—a strategy unique to Kerala.” Early diagnosis allows for tailored treatment, including a cocktail of antimicrobials and steroids aimed at combating the amoeba.

The Vulnerability of Kerala’s Water Sources

Kerala’s geographical reliance on groundwater and natural water bodies heightens the risk of Naegleria fowleri infections. The state boasts approximately 5.5 million wells and 55,000 ponds, with many residents depending on these sources for daily water needs. Unfortunately, these water bodies are often polluted, creating an environment conducive to the amoeba’s proliferation.

An alarming incident last year linked a cluster of infections to young men who were vaping boiled cannabis mixed with pond water, highlighting the dangers of using contaminated water. Epidemiologist Anish TS emphasized the threat posed by both polluted ponds and wells, stating, “Some infections have occurred in people bathing in ponds, others from swimming pools, and even through nasal rinsing with water which is a religious ritual.”

Public Health Responses

In response to the rising threat of Naegleria fowleri, Kerala’s public health authorities have launched extensive campaigns to mitigate risks. In a recent initiative, 2.7 million wells were chlorinated to reduce contamination. Local governments have also erected warning signs around ponds, advising against swimming and bathing. Additionally, the Public Health Act has been invoked to ensure regular chlorination of swimming pools and water tanks.

Despite these efforts, chlorinating ponds remains impractical due to ecological concerns, such as the potential harm to fish populations. Furthermore, enforcing water safety regulations across a state with over 30 million residents proves challenging. Public health officials are now prioritizing awareness campaigns over prohibitions, urging households to maintain clean water sources and avoid using untreated freshwater for nasal rinsing. Swimmers are also advised to take precautions, such as using nose plugs and avoiding stagnant water.

The Impact of Climate Change

Compounding the issue, scientists warn that climate change is exacerbating the risk of Naegleria fowleri infections. Rising temperatures and prolonged summers create favorable conditions for the amoeba’s survival and proliferation. Professor Anish TS pointed out that even a minor increase in temperature can facilitate its spread in Kerala’s tropical climate. Additionally, water pollution further contributes to the amoeba’s growth by providing nutrients from bacteria that it consumes.

Dr. Dennis Kyle, a professor of infectious diseases, cautioned that some past cases may have gone unrecognized, complicating treatment options. Current drug regimens for treating PAM are considered “sub-optimal,” and the lack of comprehensive data makes it challenging to ascertain the effectiveness of various treatments.

Conclusion: A Broader Lesson

While Kerala has made strides in detecting and treating Naegleria fowleri infections, the lessons learned extend beyond its borders. As climate change continues to reshape the landscape of infectious diseases, even the rarest pathogens may become more prevalent. The situation in Kerala serves as a critical reminder of the importance of public health preparedness in the face of emerging health threats.

Key Facts

– Sobhana, a 45-year-old woman from Kerala, died from Naegleria fowleri on September 5.
– Over 70 cases of the brain-eating amoeba have been reported in Kerala this year, with 19 fatalities.
– The state has seen an increase in cases since 2016, but improvements in detection have led to a decline in mortality rates.
– Kerala’s reliance on contaminated freshwater sources increases the risk of infections.
– Public health campaigns are underway to raise awareness and improve water safety practices.

Source: www.bbc.com