Why is amoebic meningoencephalitis 'spreading' in Kerala? What are its early signs? Doctor explains

For the past few days, the spread of 'Amoebic Meningoencephalitis' has been making the headlines both in Kerala and outside the state. Recently, a nine-year-old girl passed away due to the disease, making it the fourth death in the state this year.
A three-month-old baby and four other people are also currently under treatment for the disease. Of the 22 people who sought treatment in Kerala with symptoms, eight were confirmed to have amoeba meningoencephalitis (or brain infection caused by amoeba).

The deceased nine-year-old girl and her seven-year-old brother, who is currently under treatment, contracted the disease from a neighbourhood water body where they swam recently. However, the three-month-old baby fell ill after a bath in water drawn from their domestic well, according to the toddler's family.
Dr Anish T S, Nipah Research Nodal Officer and Community Medicine Professor at the Manjeri Government Medical College, explains the reasons for the alleged spread, early signs to look out for and more:

Is amoebic meningoencephalitis spreading in Kerala?
"There are three reasons to suspect that the disease is spreading in Kerala," he said. 
1) As compared to the rest of the country, Kerala has better facilities to detect the disease. "As our media often reports it, doctors and citizens are also aware of it. If any child is brought to hospitals with symptoms even remotely similar, doctors ensure they are tested for amoeba meningoencephalitis."

The doctor said that amoeba and the meningoencephalitis it causes have been prevalent among us in the past, too. "It is also present in all parts of India and other countries with a similar tropical climate," he explained. "It is good that we are detecting the disease now. That will help us provide patients with treatment as early as possible. The only flipside is the false narrative that 'Kerala waters are amoeba-infested,'" he said.

2) Due to climate change, the temperature of the surface water in our water bodies has gone up, just like in the rest of the country. This lukewarm water creates the perfect 'home' for the form of amoeba that causes diseases like amoebic meningoencephalitis. 

3) Pollution of our water bodies. Not every microorganism thrives in the environment where amoebas flourish. In their absence, amoebas feed on the bacteria in our polluted waters and multiply in numbers. This is also true across the country, though the awareness about it hasn't reached other parts yet, effectively. 

Detection and availability of facilities
Dr Anish pointed out that while amoebas are more prevalent in tropical regions like India and Africa, the detection of diseases like amoebic meningoencephalitis is reported more from the US. "While the US is mostly considered a cold country, it also has regions with hot springs, water bodies contaminated with industrial waste and swimming pools that aren't maintained well. Moreover, their facilities for detecting the disease are significantly better than those of others. This does not mean the US has more amoebic infections than other regions. It's just a proof of better facilities," he explained. 

Who gets affected by amoebic meningoencephalitis?
According to Dr Anish, not everyone is susceptible to the disease. Therefore, not everyone who takes a dip in polluted water or gets exposed to unsafe water sources might get infected with amoeba. Here are the conditions for its susceptibility:
1) People with genetically wide nasal turbinates, the portion inside our nose that filters and warms the air we breathe, trap dust and help detect smell. Amoeba in its trophozoite form (the form that causes amoebic meningoencephalitis) can enter our olfactory nerve and spread to the brain, causing Primary Amoebic Meningoencephalitis (PAM).

2) Individuals with weak immune systems.
3) People who have had brain surgeries. Interestingly, some of the people who were affected by PAM in the past were those who had brain surgeries but took a dip in unsafe waters.
4) Children, whose nasal turbinates are still developing. 

5) Children or individuals who inhaled unsafe water through their nose as part of religious rituals like baptism, dips in rivers or sniffing the preserved holy water, Dr Anish explained.

Early symptoms of Amoebic Meningoencephalitis
Unfortunately, the symptoms of the disease aren't specific or uniform across everyone. However, here are a few to watch out for, according to the doctor. 
1) Strong headache
2) Fever
3) Disorientation
4) Motor deficit
5) Unresponsiveness of one side of the body
6) Seizures (A PAM symptom shown in the advanced stage of the disease)
Note: Similar symptoms also appear for diseases like West Nile fever, Nipah, and Japanese Encephalitis. 

Points to note
1. It's tough to kill amoeba once a person is infected. Therefore, a combination of medicines is prescribed. 
2. Any polluted water body, including those in which cows are given a bath, will have amoeba. Avoid swimming in non-chlorinated water bodies. 
3. Boil the water before drinking. Boiling the water will kill the amoeba.