Is a Rare Brain-Eating Disease on the Rise in India?

Naegleria fowleri, commonly known as the brain-eating amoeba, poses a critical health threat, particularly in regions reliant on untreated freshwater. This single-celled organism can cause severe brain infections, and its impact has been most acutely felt in Kerala, India. In 2023, Kerala reported over 70 cases, with 19 fatalities. As public health measures evolve, understanding the risks and preventive strategies becomes essential for safety.

Last updated: 08 October 2023 (BST)

Understanding Naegleria fowleri and Its Impact

Naegleria fowleri is an amoeba that primarily thrives in warm freshwater environments, such as lakes, hot springs, and poorly maintained swimming pools. This organism is responsible for primary amoebic meningoencephalitis (PAM), a devastating brain infection that can lead to death within days if not treated promptly. The infection typically occurs when contaminated water enters the body through the nose, often during activities such as swimming or diving.

Key Takeaways

• Naegleria fowleri is a rare but deadly amoeba found in warm freshwater.
• In 2023, Kerala reported a significant rise in cases, with 70 diagnosed and 19 fatalities.
• Public health responses include chlorination of water sources and increased awareness campaigns.
• Climate change is exacerbating the risk of infections as warmer temperatures encourage amoeba growth.
• Early detection and treatment are crucial for improving survival rates.

The Rise of Naegleria fowleri Cases in Kerala

Kerala has witnessed a troubling increase in Naegleria fowleri cases since 2016, with the total number of cases escalating dramatically. Initially, the state observed only one or two cases annually, but 2023 saw a marked increase, reflecting both environmental factors and improvements in detection methods.

The infection's rapid progress is shocking. Symptoms can develop from mild to severe within days, as evidenced by Sobhana's tragic story. Initially presenting with dizziness and high blood pressure, her condition deteriorated quickly, leading to her untimely death. The speed with which Naegleria fowleri can overwhelm the human body underscores the urgent need for awareness and rapid medical response.

Survival Rates and Medical Advances

Historically, Naegleria fowleri infections have had a high fatality rate, with reports indicating that 95% of those infected do not survive. However, recent advancements in medical treatment have shown promise. In 2022, Kerala recorded 39 cases with a 23% fatality rate, and the current year has seen nearly 70 cases with a mortality rate of approximately 24.5%.

According to Dr. Aravind Reghukumar, head of infectious diseases at the Medical College and Hospital in Thiruvananthapuram, the increase in case numbers is a result of improved diagnostic capabilities. "Aggressive testing and early diagnosis have improved survival rates—a strategy unique to Kerala," he states. Early detection allows for customised treatment plans, including a drug cocktail of antimicrobials and steroids designed to combat the amoeba.

Environmental Factors Contributing to Infection

Kerala's geographical and ecological characteristics significantly contribute to its vulnerability to Naegleria fowleri. The state's heavy reliance on groundwater and natural water bodies creates a conducive environment for the amoeba. Over 5.5 million wells and 55,000 ponds dot the landscape, serving as vital water sources for millions. Unfortunately, many of these water bodies are contaminated, increasing the risk of infection.

In 2022, a small cluster of cases was linked to young men who engaged in risky practices, such as vaping boiled cannabis mixed with pond water. This behaviour highlights how contaminated water can serve as a conduit for infections, further complicating public health responses.

Public Health Responses and Awareness Campaigns

In response to the rising number of infections, Kerala's public health authorities have initiated several widespread campaigns. In one notable effort, 2.7 million wells were chlorinated at the end of August 2023. Local governments have also installed warning signs around ponds discouraging swimming and bathing and mandated regular chlorination of public swimming pools and water tanks.

However, chlorinating ponds is impractical as it would kill the aquatic life, and monitoring every water source in a densely populated state like Kerala is unfeasible. Consequently, officials are shifting their focus towards raising public awareness rather than enforcing prohibitive measures.

People are encouraged to clean their water tanks, use only clean water for nasal rinsing, and avoid using untreated freshwater sources for recreational activities. For swimmers, precautions such as keeping heads above water and using nose plugs are advised to minimise the risk of infection.

Balancing Awareness with Daily Life

While educating the public about the risks associated with untreated freshwater is critical, it must be balanced with the need to maintain everyday activities. Overemphasising the dangers could induce unnecessary fear and disrupt daily life. Despite extensive guidelines having been issued, enforcement of these recommendations remains inconsistent across the state.

Experts like Professor Dennis Kyle from the University of Georgia caution that the presence of Naegleria fowleri in untreated water sources can be widespread, complicating risk communication. "In practical terms, the amoebae can be present in any source of untreated water, which makes monitoring and enforcement a significant challenge," he explains.

The Impact of Climate Change

Climate change is complicating the landscape of infectious diseases, including Naegleria fowleri infections. Rising temperatures and prolonged summers create ideal conditions for the amoeba to thrive. Even a slight increase of 1°C can trigger a rise in infections in Kerala's tropical climate, as warmer waters and pollution enhance the bacteria that the amoeba consumes.

Dr. Anish TS, a leading epidemiologist, emphasises the urgency of addressing these environmental changes. "Water pollution not only increases the amoeba's presence but also creates a more hospitable environment for it to spread," he warns.

Although Kerala is making strides in identifying and treating Naegleria fowleri infections, the broader implications of climate change on public health demand attention. As infection rates rise globally, the lessons learned in Kerala may serve as a cautionary tale for other regions grappling with similar threats.

Conclusion: What Lies Ahead

While Kerala's public health measures have improved the detection and survival rates of Naegleria fowleri infections, the ongoing threat of climate change and the challenges of managing water quality remain pressing issues. The rise in cases reflects not only better diagnostic capabilities but also the urgent need for continued public health initiatives and environmental management.

As the threat of Naegleria fowleri persists, it raises broader questions about how communities worldwide will adapt to emerging health risks shaped by climate conditions. The fight against this rare yet deadly amoeba is far from over, and continued vigilance will be necessary to protect public health.

FAQs

What is Naegleria fowleri?

Naegleria fowleri is a single-celled organism that can cause a severe brain infection known as primary amoebic meningoencephalitis (PAM). It typically enters the body through the nose while swimming in warm freshwater.

How does Naegleria fowleri infect individuals?

The infection occurs when contaminated water enters the body through the nose, often during activities like swimming or diving in warm freshwater sources.

What are the symptoms of Naegleria fowleri infection?

Symptoms can start as mild headaches and fever, progressing rapidly to severe symptoms such as vomiting, seizures, and loss of consciousness. The infection can lead to death within days if untreated.

What is the survival rate for Naegleria fowleri infections?

Historically, the survival rate has been low, with about 95% of cases resulting in death. However, improved detection and treatment strategies in places like Kerala have led to better outcomes.

How can individuals protect themselves from Naegleria fowleri?

To reduce the risk, individuals should avoid swimming in untreated freshwater, use nose plugs while swimming, and ensure that water used for nasal rinsing is clean and safe.