Last week, 14-year-old Afnan Jasim from Thikkodi in Kerala’s Kozhikode district became one of only 11 people in the world to survive primary amoebic meningoencephalitis (PAM), the brain-eating amoeba disease, and the first Indian. The mortality rate of those infected with this disease is 97 percent.
BAM is produced by the amoeba Naegleria foleri. It is an amoeba found in soil and untreated swimming pools such as lakes, rivers and ponds. According to the US Centers for Disease Control and Prevention (CDC), “Most people with BAM die within 1 to 18 days of the onset of symptoms. It usually leads to coma and death after 5 days.
Usually, the amoeba enters the body through the nose and without early intervention, progresses rapidly. The disease is suspected to have been around for at least a century – with the first suspected case in Britain in 1909 – with Kerala reporting its first case in 2016.
Five people have been infected with this disease in the last two months alone in the state of Kerala.
It all started on June 26 when Afnan, a class 10 student, swam in a local pool with his friends. Four days later, he started showing symptoms. First came the headache. On the afternoon of June 30, he developed convulsions and fever. , his father MK Siddiqui took him to a private hospital in Baioli.
“Scrolling through social media, I saw news about brain-eating amoeba and how children are being affected by swimming in pools. Kerala has already had a few such victims. Also, no one in the family had epilepsy. So I told the doctor that my son swam in the local pool four days ago and the doctor noticed,” said Siddiqui, a daily wage labourer.
On the same night, Afnan was referred to another hospital in the nearby city of Vadakara. But in the absence of a pediatric consultant, the family went to Baby Memorial Hospital (PMH), a private hospital in Kozhikode, 47 km from the village.
BMH Pediatric Intensive Care Specialist Dr. Abdul Rauf examined Afnan and immediately took him for some tests. The hospital has already seen two cases of amoebic meningoencephalitis – one of whom is still being treated at the hospital.
“The child’s symptoms and the fact that he went swimming in a pool indicated BAM. We started treatment immediately,” the doctor said.
Their suspicion was confirmed within 24 hours by PCR testing. “On the day the disease was confirmed, the doctor advised us and told us about its mortality rate. Our world was turned upside down. He is our only son and I was afraid he was on the verge of death,” his father said.
Meanwhile, the Kerala government has already started procuring Miltefosine as one PAM patient in PMH-C is already unwell. It is one of the drugs approved for the treatment of BAM. Originally developed in the 1980s as an anticancer drug, miltefosine is a broad-spectrum antimicrobial, anti-leishmanial, phospholipid drug.
According to Dr. Rauf, this drug is not easily available in India and has to be brought from Germany. On July 4 – before the boy could be given the medicine – 12-year-old EP Mritul, another child who was being treated for the disease, died. The event exacerbated fears for Afnan’s life: For nine days, Siddiqui and his wife Rehanath waited outside the hospital’s intensive care unit, praying for their son’s recovery.
“Doctors and nurses tried to allay our fears by telling us that we caught the disease in its early stages. But it didn’t help that we know that no one survives this disease,” his father said.
According to Dr. Raub, it was the parents’ quick thinking that helped them intervene early in Afnan’s case.
“Within 24 hours, Afanon developed symptoms, so we could diagnose the disease and start treatment. Compared to other types of meningitis, the disease progresses very quickly and the patient’s condition deteriorates within 2-3 days. Therefore, early detection of symptoms of the disease can help protect a patient with a PAM. .Very few people recover from this disease,” he says, adding that a combination of five drugs is used to treat BAM.
It was only after he left the hospital on July 22 that Afnan understood the enormity of his survival. By then he had been in the hospital for 22 days.
“I was never told about my problem. I was informed about the seriousness of the disease only on the day of discharge from the hospital. My parents told me it was a cure for epilepsy,” says Afnan.
According to Kerala Health Minister Veena George, the disease was diagnosed mainly because of the robust diagnostic system practiced in the state.
“We have a standing instruction to all government and private hospitals in the state to keep all meningitis victims under close surveillance. The disease was first reported in Kerala in 2016. Now there is concern that the disease has recurred in 2024. However, now there is early diagnosis, which is crucial to save patients. ,” said the Kerala Health Minister.
According to the minister, the state health department plans to collaborate with the Indian Council of Medical Research (ICMR) to study why there is a resurgence of PAM cases in Kerala.
