PAM (Primary Amoebic Meningoencephalitis)

Context:

The Health department in BENGALURU Kerala’s Kozhikode has issued an alert against primary amoebic meningoencephalitis (PAM) in the district in view of the reporting of three cases of the infection and a death in recent days.

PAM (Primary Amoebic Meningoencephalitis)

Causative Organism – Naegleria fowleri

Naegleria fowleri is a free-living amoeba, commonly known as the "brain-eating amoeba."
It thrives in warm freshwater bodies such as lakes, rivers, and poorly maintained swimming pools.
It is thermophilic (heat-loving) and can survive at temperatures up to 46°C, making global warming a potential risk factor for its spread.
It does not survive in salty water (seawater) and chlorinated pools with proper disinfection.

Mode of Transmission

The amoeba infects humans when contaminated water enters the nasal cavity, typically during swimming, diving, or water sports.
From the nasal passages, it migrates along the olfactory nerve to the brain.
It is not transmitted person-to-person, making it a non-communicable disease.

Pathogenesis and Fatality

Once in the brain, Naegleria fowleri rapidly destroys brain tissue, causing inflammation and swelling.
The disease progresses extremely fast: early flu-like symptoms advance to neurological dysfunction, coma, and death within days.
The case fatality rate is over 97%, with only a handful of survivors reported worldwide.

Treatment Protocols

There is no universally effective treatment. Most cases remain fatal despite interventions.
Current management follows CDC guidelines, using a combination therapy of drugs such as:
- Amphotericin B (antifungal, primary drug)
- Miltefosine (antiparasitic, recently used with some success)
- Azithromycin, Fluconazole, Rifampin, and Dexamethasone (as adjunct therapies).
Some rare survivors were treated with early diagnosis, aggressive drug therapy, and induced hypothermia.