Tragic Case of Primary Amoebic Meningoencephalitis (PAM) Highlights Risks of Contaminated Water Bodies

Tragic Case of Primary Amoebic Meningoencephalitis (PAM) Highlights Risks of Contaminated Water Bodies

Primary Amoebic Meningoencephalitis (PAM) is a rare but deadly brain infection caused by Naegleria fowleri, commonly known as the “brain-eating amoeba.” This infection is associated with specific circumstances and exhibits distinctive symptoms.

Circumstances of Infection

  • Source of Infection: Naegleria fowleri is found in warm freshwater and soil globally, particularly in poorly maintained or minimally chlorinated recreational water bodies.
  • Mode of Entry: The amoeba enters the body through the nose, typically during activities such as swimming or diving in contaminated water.
  • Environmental Conditions: Naegleria fowleri thrives in warm temperatures, with higher growth rates observed in temperatures up to 115°F (46°C).

Symptoms of PAM

  • Initial Stage Symptoms: Headache, fever, nausea, and vomiting.
  • Progressive Symptoms: Stiff neck, confusion, seizures, hallucinations, and coma.
  • Timeline of Progression: Symptoms can escalate rapidly, with most patients experiencing coma and death within 1 to 18 days after the onset of symptoms.

Case Study: Kozhikode Incident

  • Incident: A five-year-old girl undergoing treatment for PAM died at the Government Medical College Hospital in Kozhikode.
  • Suspected Cause: The girl likely contracted the infection while swimming in a local river, highlighting the risk associated with contaminated freshwater bodies.
  • Absence of Transmission: PAM is not communicable between individuals and cannot be contracted through drinking water contaminated with Naegleria fowleri.

Treatment and Outlook

  • Current Treatment: There is no established effective treatment for PAM. Doctors typically use a combination of drugs, including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, and dexamethasone.
  • Outcome: PAM has a high fatality rate, with most cases resulting in coma and death within days of symptom onset.

Epidemiology of PAM in India

  • Incidence: India has reported 20 cases of PAM, with Kerala being particularly affected.
  • Regional Patterns: Kerala has witnessed seven cases, with instances reported in Alappuzha, Malappuram, Kozhikode, and Thrissur, likely due to the abundance of water bodies in the region.

Multiple Choice Questions (MCQs):

  1. How does Naegleria fowleri typically enter the human body?
    • A) Through ingestion of contaminated water
    • B) Through open wounds
    • C) Through the nose
    • D) Through skin contact
    • Answer: C) Through the nose
  2. What are the initial symptoms of Primary Amoebic Meningoencephalitis (PAM)?
    • A) Stiff neck and confusion
    • B) Headache, fever, nausea, and vomiting
    • C) Hallucinations and seizures
    • D) Coma and death
    • Answer: B) Headache, fever, nausea, and vomiting
  3. Which region in India has witnessed the highest number of PAM cases?
    • A) Alappuzha
    • B) Malappuram
    • C) Kozhikode
    • D) Thrissur
    • Answer: C) Kozhikode