How to prevent Kerala’s amoeba infections and deaths? Doctors explain

An amoeba is a single-cell microorganism that thrives in hot weather conditions. As the monsoon subsides and the sun shines brighter in Kerala, amoeba has become the most significant cause of concern for the health department in the state. The number of patients diagnosed with amoebic meningitis has skyrocketed, while the death rate is also higher. The panel of doctors who attended the discussion conducted by Malayala Manorama stated that a unified and comprehensive approach by the government, health workers and the general public is required to prevent the challenges posed by amoeba.

The presence of amoeba had been detected in the soil and water bodies of Kerala for ages. However, a detailed study is required to understand why it has been rampantly causing infections lately. Research should be conducted to see whether amoeba has undergone any genetic mutations. Besides, an expert committee should be appointed to study all the cases, including the deaths that have been reported in the state. Meanwhile, the doctors said that the rise in temperature due to global warming creates a favourable environment for the amoeba to grow and thrive.

“There should be serious studies about amoebic meningoencephalitis that is spreading in Kerala. An excellent treatment protocol could be developed only with efficient research,” says Dr. KP Vinayan, head of the department of paediatric neurology, Amrita Hospital, Kochi.

In most cases, it is impossible to find the exact source of infection. Many patients do not have any history of swimming or bathing in ponds or other natural water sources. So, the doctors assume that the amoeba might have entered their nasal cavity through any other source.

Treatment protocol
There aren’t proper answers to queries like whether a standard treatment protocol could be developed for all kinds of amoebic meningoencephalitis or whether it will be effective in all cases. Dr Vinayan says that extensive research is required to establish proper treatment protocols. In Kerala, the hospitals mostly follow the treatment protocols adopted by foreign countries. However, the condition in the state is different, as a variety of amoeba causes infection. So, there should be a unique and effective treatment protocol to treat the infections here. There have been cases where the presence of amoeba was detected even in persons with no apparent symptoms. So, the doctors are doubtful whether the medications will cause side effects in such patients. Besides, preventive vaccines haven’t been developed yet, as amoebic meningoencephalitis is considered a rare disease.

“All the wells in the infected areas should be chlorinated. The local self-government institutions and the water authority should work hand in hand to prevent the disease,” says Dr A Althaf, professor of community medicine, Government Medical College, Thiruvananthapuram.

Most effective test to diagnose amoeba
The number of patients skyrocketed during August and September this year. An amoeba is likely to have remained on the water's surface when the temperature rose after the rains. People might take a swim in the ponds and other natural water sources when the weather is hot and humid, increasing the risk of amoeba entering their bodies through the nasal cavity.

Doctors often suspect amoebic meningoencephalitis in patients seeking treatment with symptoms of meningitis. Therefore, they recommend additional tests to rule out the risk of infections caused by amoebas. Dr Abdul Rauf, consultant paediatric intensivist at the Baby Memorial Hospital in Kozhikode, says that cerebrospinal fluid analysis or CSF wetmount test is the most effective test to diagnose the infection. He adds that doctors have been increasingly prescribing this test, resulting in the rapid rise in the number of patients lately.

Prevention is key
Dr Althaf says that amoeba reaches the brain only through the soft layers in the nasal cavity. So, avoiding such instances is the only way to prevent the risk of amoebic meningoencephalitis.

Meanwhile, Dr SS Lal, member of the international committee of the World Health Organisation, states that a proper protocol should be developed to fight the presence of amoeba in Kerala, where there are hundreds of ponds and natural water sources. International organisations recommend preventive measures like refraining from dipping the head or swimming in untreated or polluted warm water. Additionally, boiled and cooled, or distilled water should be used when administering medicines through the nose. Moreover, the swimming pools should be cleaned and chlorinated well.

Dr SS Lal said that effective prevention is possible only by creating awareness and giving warnings, as there are no unified treatment protocols, medicines or preventive measures. Additionally, the government should establish laboratory facilities in all districts to prevent delays in diagnosis.

1)Water safety – Swimming and diving in lakes, ponds and natural water sources with warm water should be avoided. Even if you swim, make sure that you do not dip your head in the water.
2) Cleaning nose – Boiled and cooled or distilled water should be used to clean the nose.
3) Water quality – Make sure that swimming pools, spas and other water bodies are chlorinated and maintain the quality of water.
4) Public water sources – Water authorities should regulate the quantity of disinfectants in case the water is infected. Besides, the distribution channels and equipment should be flushed and cleaned.
5) Awareness programs – Local media, schools and community leaders should take the initiative to organise extensive campaigns and programs in regional languages to create awareness among the public.

Coordinated efforts from health workers
1) Public wells, tanks and other water sources should be regularly chlorinated during the summer months.
2) The symptoms of this disease may be similar to bacterial meningitis. So, be alert if someone shows such symptoms.
3) The presence of Naegleria fowleri amoeba should be swiftly confirmed by doing tests like metagenomic sequencing of the cerebrospinal fluids that cover the brain and spinal cord.
4) Currently, a concoction of drugs that protects the brain and destroys amoeba has been effectively used.
5) All the cases in which meningitis is suspected should be strictly reported. It should also include the guidelines for testing the presence of amoeba.