Kerala’s Reduction in Amoebic Meningoencephalitis Mortality

• Kerala, a state with abundant water bodies, experienced a severe outbreak of amoebic meningoencephalitis, a lethal infection of the central nervous system.
• Despite sporadic infections, the frequency of cases increased, with most affected children aged 5-15.
• In August, an all-adult case cluster of amoebic meningoencephalitis was reported from Thiruvananthapuram.
• Despite 19 cases reported in five months, Kerala managed to save 14 out of 19 cases, reducing the mortality rate from 97% to 26%.
• All 10 persons undergoing treatment at Thiruvananthapuram Government Medical College hospital were discharged on September 12.
• The state set up an experts’ group to develop technical guidelines on the prevention, diagnosis, and treatment of amoebic meningoencephalitis.
• The study adds 14 more persons to the list of survivors, demonstrating the potential of early identification and treatment.

Kerala’s Amoebic Meningoencephalitis Case Cluster

• A cluster of amoebic meningoencephalitis cases was reported in Athiyannoor grama panchayat in Neyyattinkara taluk, Thiruvananthapuram, Kerala.
• The outbreak was not due to exposure to a mossy pond, but risky behavior among a group of youth.
• The youth were mixing tobacco, snuff, and other addictive substances with the water from the pond and inhaling it using handmade contraptions, a risky behavior that provides a direct entry for amoeba into the brain.
• Health officials tracked all the youth who were known to be using snuff and asked them to get admitted to the Medical College Hospital (MCH) as soon as they developed symptoms.
• Seven youths were picked up early and their CSF samples tested positive for amoebic encephalitis.
• A lone case was dealt with where the patient was an urban dweller with no contact with ponds of water bodies.
• The state set up a special medical board and treated the patients with a cocktail of antibiotics.
• The introduction of the drug Miltefosine into the antibiotic cocktail was introduced, which turned the tide in favor of the patients.
• The State health department is now focusing on creating IEC campaigns for the public to narrow down possible risks and incorporate new learnings from the encounter with amoebic encephalitis.
• The current directive to all clinicians is to closely look at the CSF for the presence of amoeba in all cases of meningoencephalitis, irrespective of whether the patient has had direct or indirect contact with water bodies.