Amoebic Meningoencephalitis haunts Kerala as source still remains a mystery

Thiruvananthapuram/Kozhikode: It is more than a year since 27-year-old Akhil died and four others recovered from Amoebic Meningoencephalitis at Athiyanoor on the suburbs of Thiruvananthapuram. But so far the authorities couldn't come out with a conclusive finding on the sources of infection.

Same is the case of eight year old Anaya and another three month old child who died near Thamaraserry on the suburbs of Kozhikode in north Kerala last month.

This year so far 20 persons died and over 70 got infected. Even as Nagleria Fowleri variant of amoeba was found in most of the persons who died due to the infection, so far that variant could not be found in the water samples.

As the disease, which was till recently considered as rare, is being increasingly reported in the state, experts cite the need for serious epidemiology study to be conducted in each case to find the reasons.

It was in 2016 that the first case of Amoebic Meningoencephalitis was reported in Kerala. A child in Alappuzha who was infected died. Till 2023 the total cases reported in the state were eight. In 2024 there was a spike with 36 cases being reported and nine of them dying.

While Primary Amoebic Meningoencephalitis (PAM) is caused by Nagleria Fowleri variant which is considered to be more acute, whereas Granulomatous Amoebic Meningoencephalitis (GAM) is caused by Acanathamoeba, Balamuthia, Sapilnia and Vermamoeba vermicularis variants which are considered to be less acute.

Most of the persons who succumbed to the infection in Kerala were found to be infected by Nagleria Fowleri, whereas, it is reliably learnt that, the state health authorities couldn't find the presence of this variant in any of the waterbodies that were suspected to have caused the infection.

While the death rate of PAM is considered to be over 98 percent, the death rate in GAM is low. As per experts, the amoeba enters human body though nose from contaminated water.

Mystery continues even after a year

Since 2024 July the Kavinkulam pond at Athiyanoor on the suburbs of Thiruvananthapuram continues to be a mute witness of the state health authority's failure in detecting the sources of infection.

Akhil—the one who passed away—and four of his friends who recovered, are believed to have got the infection from the public pond as five of them were engaged in cleaning the pond.

However, the health authorities could not find the presence of the amoeba in the water samples of the pond despite repeated testing.

"Even as the health authorities have instructed that the pond could be used, they are not fully ruling out the chances of the presence of amoeba in the water. This is creating a scare especially among the victim's relatives as well as the survivors," said local ward member Vishnu.

Akhil's brother Anulal asks why Kerala health sector that boasts of many achievements couldn't give a conclusive result on the source of infection on his brother even after a year.

Shyam and Anish, who are among the four recovered, say that they are still unable to stand for quite a long time owing to the frequent collection of cerebrospinal fluid from lower back for PCR tests.

Anaya's sudden death and three-month old child's death too remain unexplained

On August 13 eight year old Anaya was actively participating in the Independence day dance celebration at her school. That evening she complained of headache, mild fever and also vomited. Since the fever persisted even after giving paracetamol, her mother Rambeesha took her to the nearby government hospital the next morning . By noon her condition worsened and she started suffering seizures. Then she was rushed to the Kozhikode medical college hospital. But couldn't be saved.

"Why is that my daughter died all of a sudden whereas all others who died due to the infection were under treatment for at least a week or more. There was a serious lapse on the part of the government taluk hospital in timely shifting her to medical college," says Ayana's father Sanoop.

Though her two siblings, Abhijay and Aarav, were also tested positive for the infection. Both of them recovered.

Even as all of them were found to be infected with the Nagleria Fowleri variant, samples collected from the nearby pond where the children took a bath as well as the pipe water of their house were found to be having the presence of Balamuthia variant only.

"Since Balamuthia variant is present, we assume that Nagleria Fowleri was also present," a health official said, admitting that Nagleria Fowleri presence could not be conclusively found.

Now a blame game is on as the ward member of the locality where the pond is there is from the ruling front whereas the pipe water supply was initiated by a member of an opposition party . There are also attempts to put the blame on families of victims citing contamination of water in overhead tanks in houses.

Meanwhile, the family of the three month old child from Omasserry in Kozhikode asks, "How did our three month old child who did not go swimming or took a shower got the infection?"

The family also flays attempts by some quarters to unleash a campaign that some holy water brought from abroad was poured in the newborn's nose.

High time for in depth epidemiological study

As the state health authorities are still groping in the dark to find the exact source of infection, experts are stressing the need for undertaking in depth epidemiological study.

"A detailed analysis of each case of infection needs to be carried out to find the environmental conditions in which the amoeba grows. Epidemiology intelligence is a highly specialized area and the investigation of each case needs to be done like unraveling a criminal case. It is high time that Kerala initiates in depth epidemiology studies as rare diseases like NIPAH and PAM are being reported again and again in Kerala," said senior virologist T Jacob John.