Naegleria fowleri: What is this brain-eating amoeba threatening Kerala and its potential risks in Mumbai

Since May, Kerala has reported as many as five cases of people affected by Naegleria fowleri, popularly known as the brain-eating amoeba. With the latest case being that of a 12-year-old in Thrissur, the fear around the infection is rising in the state. Mumbai experts believe the city doesn't have to fear just yet even though it is the monsoon, but say people should be concerned about it.

Usually found in warm fresh water, the amoeba dangerously enters the body through the nose and makes its way towards the brain. Dr Sheetal Goyal, neurologist, Wockhardt Hospitals, Mumbai Central, says, "It usually breeds in contaminated waters or warm freshwater bodies. Once it enters the human body it can cause severe complications and deadly infection. The brain-eating amoeba can negatively destroy brain tissues, resulting in brain inflammation. Experts often call this disease primary amoebic meningoencephalitis (PAM). This severe yet rare infection can affect organs like the brain and spinal cord causing discomfort and pain."

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With more cases being reported, mid-day.com spoke to Dr Sheetal Goyal, neurologist, Wockhardt Hospitals, Mumbai Central, and Dr Vishwanath Iyer, neurosurgeon, Zynova Shalby, to highlight more about the causes and effects of the diseases. While Mumbaikar needn't particularly worry about it, difficulty in diagnosing it should have people worried. The experts share easy precautions that one must undertake especially around water and even food that can be eaten to improve immunity.

What is the brain-eating amoeba and how does it affect people?
Goyal: The brain-eating amoeba, scientifically known as Naegleria fowleri, is a free-living amoeba commonly found in warm fresh water and soil. It typically infects people when contaminated water enters the body through the nose, usually during activities like swimming or diving in warm freshwater bodies. Once in the nasal passages, the amoeba travels to the brain, where it causes a rare but severe and often fatal infection known as primary amoebic meningoencephalitis (PAM). This condition involves destructive inflammation of the brain and its surrounding membranes.

Iyer: Naegleria fowleri also known as a brain-eating amoeba is a single-celled organism, belonging to the species genus Naegleria. It usually breeds in contaminated waters or warm freshwater bodies. Once it enters the human body it can cause severe complications and deadly infection. The brain-eating amoeba can negatively destroy brain tissues, resulting in brain inflammation. Experts often call this disease primary amoebic meningoencephalitis (PAM). This severe yet rare infection can affect organs like the brain and spinal cord causing discomfort and pain.

What are the possible reasons for the increasing number of cases in Kerala? How does this amoeba thrive and enter the body? What are the known incidences of this infection in India or Mumbai?
Goyal: The recent rise in cases in Kerala is likely due to unhygienic and stagnant water sources combined with high temperatures. The amoeba thrives in warm freshwater environments such as lakes, ponds, rivers, and hot springs. It enters the body through the nose during activities like swimming, diving, or using contaminated water for nasal irrigation. In India, only 17 cases of PAM have been reported so far, indicating that the infection is under-diagnosed or misdiagnosed, leading to under-reporting.

Iyer: The brain-eating amoeba enters the human body through the nose. You are at higher risk of getting infected with this amoeba if you come in close contact with warm or fresh water that potentially contains brain-eating amoeba. This can often happen in places like a swimming pool with poor sanitation and improperly maintained, lakes, or hot springs. Once entered through the nose it later travels through the olfactory nerve, which is responsible for regulating the sense of smell in the body. It invades your brain tissues resulting in severe damage to the brain tissues and disrupting the functions of the brain.

What are the symptoms of being infected by this amoeba and when should people consult a doctor?
Goyal: Initial symptoms of PAM include headache, fever, nausea, vomiting, and a stiff neck. As the infection progresses, it can cause confusion, loss of balance, seizures, hallucinations, and coma. People experiencing these symptoms after recent exposure to warm freshwater should seek immediate medical attention.

Iyer: The symptoms of brain-eating amoeba can initially start as severe and worsen over time if left untreated. One can experience symptoms like high fever, persistent headache, episodes of vomiting, nausea, increased sensitivity to light, stiffness in the neck, and mental confusion. It becomes essential to immediately consult experts or doctors for prompt diagnosis for positive outcomes. Early detection can be helpful in effectively managing the condition and minimizing the damage caused.

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What are the effects after being infected by the amoeba?
Goyal: Infection with Naegleria fowleri leads to serious brain damage and swelling. Despite its common name, the amoeba does not consume brain tissue but causes severe inflammation and destruction of brain cells, often resulting in death.

Iyer: Symptoms associated with brain-eating amoeba typically start to develop after 1 to 9 days after being infected. As the infection begins to progress, symptoms worsen causing discomfort and hindrance in performing daily activities. The brain-eating amoeba rapidly starts to multiply in larger quantities while invading brain cells. The central nervous system breaks down destroying brain cells and disrupting the daily functions of the brain. This can sometimes lead to experiencing neurological defects like brain injuries, dementia, Alzheimer's disease, disability in learning, epilepsy, autism, cerebral palsy, brain tumours, and stroke.

Which age group is vulnerable to the infection?
Goyal: PAM primarily affects children and young adults, with about 83 per cent of cases occurring in individuals under the age of 18. The median age of those affected is 12 years, and the majority of infections occur in the 5-14 age group. Males are more commonly affected than females, with a ratio of 3:1.

Iyer: Children and young adults are more likely to develop an onset of brain-eating amoeba. Children are at higher risk as they are more likely to actively participate in water activities like swimming or diving in lakes, and rivers that might be contaminated with this amoeba. This rare yet severe infection mostly occurs in occurs in summer. It can also happen after using tap water to wash your face or nose, allowing them to enter through your nose.

What is the known treatment for this infection, and does it differ according to the age group?
Goyal: There is no established treatment for PAM, but some success has been observed with a combination of medications including amphotericin B (administered intravenously and intrathecally), azithromycin, miltefosine, and dexamethasone. The efficacy of these treatments remains uncertain, and the approach does not significantly differ by age group.

Iyer: To effectively manage and treat primary amoebic meningoencephalitis (PAM), an infection caused by brain-eating amoeba with the combination of medications and drugs. Your doctor might prescribe certain drugs like antifungal or anti-parasitic medication to reduce the intensity of the symptoms. These drugs can significantly help kill the brain-eating amoeba to treat the onset of infection.

Can the infection be prevented? If yes, how can it be done?
Goyal: Yes, the infection can be prevented by taking certain precautions:
1. Avoid swimming in warm freshwater bodies such as lakes, ponds, and poorly-maintained pools.
2. Use nose clips or hold your nose shut when swimming or diving in warm freshwater.
3. Keep your head above water in hot springs.
4. Avoid disturbing the sediment in shallow warm water areas.
5. Use distilled or boiled tap water for nasal irrigation or cleansing.

Iyer: Yes, with necessary precautions one can significantly lower their chances of getting infected with brain-eating amoeba. Avoid swimming or engaging in water activities in fresh waters like hot springs, lakes, and chlorinated pools without nose plugs for better protection. Be aware of the cases of brain-eating amoeba and refrain from visiting those places to ensure your safety. Boiling water can help kill any pathogens like germs, viruses, and bacteria present in the water.

What are the foods that people can eat as a part of the treatment for the infection or for its prevention?
Goyal: There are no specific foods that can treat or prevent the infection directly. However, maintaining a balanced diet to support overall health and immune function is beneficial. During treatment, patients should follow their healthcare provider's dietary recommendations to support their recovery.

Iyer: There is no specific food or diet for effectively treating an infection caused by brain-eating amoeba. However, maintaining healthy eating habits can help strengthen your immune system, lowering the chances of developing brain-eating amoeba. Fruits and vegetables like oranges, berries, leafy green vegetables, bell peppers, whole grains, probiotics, and lean proteins can potentially improve your immunity. They are rich in vitamins and antioxidants which are known to boost your immune system.

What are the chances of people being affected by the disease in Mumbai with the monsoon underway?
Goyal: The risk of infection in Mumbai during the monsoon is relatively low as Naegleria fowleri typically thrives in warm freshwater environments rather than in the cooler, often less stagnant water associated with heavy rains and monsoon conditions. However, caution should still be exercised when engaging in water-related activities in freshwater bodies.

Iyer: It is impossible to reveal the exact percentage of people being affected by brain-eating amoebae in Mumbai during monsoon.

What are the common misconceptions that people have about water-borne diseases, and should they be more careful during the monsoon season?
Goyal: Common misconceptions include the belief that all water-borne diseases are highly contagious or that all freshwater bodies are unsafe. During the monsoon season, people should be more careful due to increased chances of water contamination and the spread of water-borne diseases. Ensuring clean drinking water, avoiding swimming in stagnant or polluted water, and practicing good hygiene are essential precautions.

Iyer: The chances of developing water-borne diseases significantly rise during monsoon. The increased humidity and frequent changes in atmospheric pressure can weaken your immune system. This creates a perfect atmosphere for pathogens like germs, viruses, bacteria, and pollutants to breed. They are available everywhere, in the water, and the air. The common misconception is that waterborne diseases only occur in adults. However, it can occur to anyone irrespective of their age. Children are at higher risk as their immune systems are yet to be developed which is essential in combating viruses and infections like brain-eating amoeba.

Lastly, why should people be worried about this infection?
Goyal: People should be concerned about PAM because it is a rare but often fatal disease with a high mortality rate. Early symptoms can be easily mistaken for more common illnesses, delaying diagnosis and treatment. Awareness and preventive measures are crucial to reduce the risk of infection.

Iyer: Worrying about brain-eating amoeba becomes crucial as it is a rare but severe infection. This can significantly affect your overall well-being. The symptoms of this infection develop quickly and can be even fatal if left untreated. What makes it more concerning is the effective treatments for managing brain-eating amoeba are limited. This is why early detection can be lifesaving and increase the chances of positive outcomes. It can cause severe complications like brain damage, intense headaches, seizures, and even coma in some cases.

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