A small state in south India is grappling with a surge of meningoencephalitis cases. A rare and often fatal brain infection caused by the brain eating amoeba-naegleria fowleri. A total of 80 cases and 21 deaths due to amoebic meningoencephalitis has been recorded in the state.

Primarily caused by naegleria fowleri but other species like balamuthia mandarillans and acanthamoeba have also been detected in Kerala.

Infection occurs when water enters nasal passages typically during swimming or bathing in contaminated fresh water. Early symptoms can resemble those of bacterial meningitis and prompt medical attention is crucial for potential survival.n.fowleri is thermophilic and one of its food sources is cyanobacteria which flourishes  in  warm water. Climate change raising the water exposure is likely to increase the encounter with this pathogen.

Two clinical syndromes reported

Primary amoebic meningoencephalitis

Granulomatous amoebic meningoencephalitis

Diagnosis relies on imaging, CSF analysis &tissue biopsy. PCR from CSF facilitates rapid detection. CDC recommends microscopic examination of fresh, unfrozen, non-refrigerated CSF for presumptive diagnosis. If amoeba are identified, diagnosis should be confirmed by PCR.CT & MRI brain findings are nonspecific.

Treatment-rarity of disease, delay in diagnosis, fulminant clinical course &difficulty in making a rapid diagnosis have hampered evaluation of drug regimen. amphotericin b,rifampicin. fluconazole, miltefosine are being tried for the treatment.

Prevention is by avoidance of diving and jumping into stagnant fresh water. nose plugs to be used for unavoidable exposure. swimming pools, water theme parks& spas should be kept clean. public awareness & mass chlorination drives are underway in Kerala to combat the presence of amoeba in water sources.

TBA