Rare Brain-Eating Amoeba Alert: Could India Be The Next Hotspot? Expert Shares Preventive Tips (Image Credits: iStock)
Primary Amoebic Meningoencephalitis (PAM) is one of the deadliest infections known to medicine, with a staggering 72.7 per cent mortality rate. This rare but fatal disease is caused by Naegleria fowleri, often referred to as the “brain-eating amoeba.” Found in warm freshwater environments like lakes, rivers, and inadequately chlorinated swimming pools, the amoeba infects individuals when contaminated water enters the nasal passages. From there, it migrates to the brain, leading to rapid and devastating consequences.
Where Are PAM Cases Reported Most Frequently?
According to data from global health organizations, most reported cases of PAM have occurred in regions with warm climates. The United States has documented the highest number of cases, particularly in southern states such as Florida, Texas, and Arizona, where warm water bodies provide a conducive environment for Naegleria fowleri. Cases have also been reported in countries like Australia, Thailand, Pakistan, and various African nations, where similar environmental conditions exist.
PAM is more prevalent during summer and early autumn when water temperatures rise, increasing the amoeba's activity. However, global climate change and rising temperatures are expanding the geographical reach of Naegleria fowleri, raising concerns about its potential emergence in previously unaffected areas.
Is India at Risk?
India, with its tropical climate and abundant freshwater sources, is not immune to the threat of PAM. While cases in India are underreported, confirmed instances have been documented in states like Maharashtra, Tamil Nadu, Kerala, and Karnataka. These areas are particularly vulnerable due to high temperatures, extensive water-related activities, and the presence of poorly maintained water sources.
Dr Aniruddha More, Consultant Neurologist at Jupiter Hospital, Thane, warns, "Rising temperatures in India, especially in the southern and western states, create ideal conditions for Naegleria fowleri. With increasing recreational water activities and limited public awareness, India is at significant risk of seeing more cases in the future."
Further, India's densely populated regions often lack properly maintained swimming pools and water storage facilities, which can further increase the risk.
Symptoms: Early Signs and Rapid Progression
Dr More explains that PAM’s early symptoms, such as headache, fever, nausea, and vomiting, are nonspecific, often leading to delayed diagnosis. As the infection progresses, severe symptoms such as stiff neck, confusion, hallucinations, seizures, and altered mental status emerge. “Late-stage symptoms like photophobia (light sensitivity) and ataxia (loss of coordination) often signal irreversible damage, with death occurring in most untreated cases,” he notes.
How the Amoeba Attacks the Brain
The infection begins when Naegleria fowleri enters the nasal passages and travels along the olfactory nerve to the brain. Once there, it causes widespread inflammation and necrosis. “The amoeba directly destroys brain tissue while triggering a severe inflammatory response, which exacerbates the damage,” explains Dr More. Increased intracranial pressure and brain swelling often result, making the disease nearly always fatal if not treated promptly.
Risk Factors: Who Is Most Vulnerable?Dr More explains that PAM predominantly affects people engaging in water-based recreational activities, particularly in warm freshwater. Poorly chlorinated swimming pools and hot tubs also pose a significant risk.
While the infection can occur in people of any age, children and adolescents are more vulnerable due to their frequent and vigorous participation in water-related activities. Immunocompromised people and those with pre-existing nasal conditions are also at a higher risk.
Diagnosis and Treatment: Challenges in Fighting PAM“PAM is challenging to diagnose because its early symptoms mimic viral meningitis,” says Dr More. Laboratory confirmation requires specific conditions and expertise, as the amoeba is identified through cerebrospinal fluid (CSF) analysis. Unfortunately, many cases are diagnosed posthumously due to delayed recognition.
Treatment options for PAM are limited, and the disease progresses rapidly. A combination therapy using amphotericin B, miltefosine, and rifampin has shown some success when initiated early. Supportive measures, such as managing intracranial pressure and maintaining oxygenation, are critical. “Despite aggressive treatment, survival rates remain grim due to the infection's rapid progression and the extensive brain damage it causes,” Dr More adds.
Prevention Tips
Prevention is critical in combating PAM, as the disease is almost always fatal once symptoms start progressing. Dr More advises the following preventive measures:
1. Avoid Nasal Water Exposure: Use nose clips or avoid submerging your head during water activities in warm freshwater.
2. Proper Pool Maintenance: Ensure swimming pools and hot tubs are well-chlorinated and maintained.
3. Public Education: Awareness campaigns about PAM, especially in high-risk areas, can help reduce cases by promoting preventive practices.
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