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):
- 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
- 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
- Which region in India has witnessed the highest number of PAM cases?
- A) Alappuzha
- B) Malappuram
- C) Kozhikode
- D) Thrissur
- Answer: C) Kozhikode