How an Indian state is fighting against a rare disease

On the eve of Onam, the happiest festival of the state of the Kerala in India, Sobhana, 45, greed at the back of an ambulance, deriving in unconsciousness when his family precipitated it in a medical university hospital.

A few days earlier, the Dalit woman (formerly known under the name of untouchables), which earned her bottled fruit juices in a village in the Malappuram district, had complained of anything more alarming than dizzy and high blood pressure. Doctors prescribed pills and sent her home. But his condition fell from a terrifying speed: the discomfort gave way to fever, to the fever of violent chills, and on September 5 – the main day of the – Sobhana festival was dead.

The culprit was Naegleria Fowleri – commonly known as the brain eater amiba – an infection generally contracted by the nose in fresh water and so rare that most doctors never meet in all their careers. “We were powerless to arrest him. We only learned the disease after the death of Sobhana,” said Ajitha Kathiradath, the victim’s cousin and eminent social worker.

In Kerala this year, more than 70 people have been diagnosed and 19 died of the brain -eating amoeba. Patients have varied from a three -month -old man to a 92 -year -old man.

Normally, feeding on bacteria in warm fresh water, this monocellular organism causes an almost fatal brain infection, known as the primary Amibic meningoecephalitis (PAM). He enters through his nose during swimming and quickly destroyed cerebral tissues.

The Kerala began to detect cases in 2016, only one or two a year, and until recently, almost all were fatal. A new study has only revealed 488 cases have been reported in the world since 1962 – mainly in the United States, Pakistan and Australia. And 95% of victims died of the disease.

But in Kerala, survival seems to improve: last year, there were 39 cases with a death rate of 23% and this year, almost 70 cases were reported with approximately 24.5% mortality. Doctors say that the increase in number reflects better detection, thanks to advanced laboratories.

“Cases are increasing, but deaths decrease. Aggressive tests and early diagnosis have improved survival – a unique strategy in Kerala,” said Aravind Reghukumar, responsible for infectious diseases for the college college and the Thiruvananthapuram hospital, the state capital. Early detection allows personalized treatment: a cocktail of medication of antimicrobials and steroids targeting amoeba can save lives.

Scientists have identified around 400 species of free amoebas, but only six are known to cause a disease in humans – notably Naegleria Fowleri and Acanthamoeba, which can both infect the brain. In Kerala, public health laboratories can now detect the five main pathogenic types, according to officials.

The high dependence of the southern state with regard to groundwater and natural water bodies makes it particularly vulnerable, especially since many ponds and wells are polluted. A small group of cases last year, for example, was linked to young men vaping boiled cannabis mixed with the water of the pond – a risky practice which underlines how contaminated water can become an infection duct.

The Kerala has nearly 5.5 million wells and 55,000 ponds – and millions of people draw their daily water in the wells alone. This pure ubiquity makes it impossible to treat wells or ponds as simple “risk factors” – they are the backbone of life in the state.

“Some infections have occurred in people who bathe in ponds, others of the pools and even by nasal rinsing with water which is a religious ritual. Whether in a polluted pond or a well, the risk is real,” explains Anish TS, a leading epidemiologist.

Public health authorities therefore tried to respond on a large scale: in a single campaign at the end of August, 2.7 million wells were chlorinated.

Local governments have put in place panel planks around the ponds warning against bathing or swimming and mentioned the law on public health to enforce the regular chloration of swimming pools and water tanks. But even with such measures, the ponds cannot be realistic chlorinated – the fish would die – and the police of each source of water in the village in a state of more than 30 million people is impracticable.

Officials are now stressing prohibition awareness: households are invited to clean tanks and swimming pools, to use clean hot water for nasal ablutions, to keep children away from garden jets and to avoid dangerous ponds. Swimmers are advised to protect their noses while keeping their heads underwater, using nose caps and avoiding stirring sediments in stagnant soft waters or not treated.

However, finding a balance between educating the public on real risks – the use of untreated freshwater – and avoiding fear that could disrupt daily life is difficult. Many say that despite the directives published for more than a year, the application remains unequal.

“This is a difficult problem. In some places (Hot Springs), panels are published to warn the possibility of amoebas in the water source. It is not practical in most situations since Amibes can be present in any untreated water source (lakes, ponds, cellular biologies),” said Dennis Kyle, a teacher of infectious diseases and cellular biology at the University of Georgia.

“In more controlled environments, frequent monitoring of appropriate chloration can considerably reduce the risk of infection. These include pools, splash pads and other artificial recreational aquatic activities,” he said.

Scientists warn climate change that amplifies the risk: warmer waters, longer summers and growing temperatures create ideal conditions for amoeba. “Even a 1C climb can trigger its spread in the tropical climate of the Kerala and water pollution combines it more by nourishing the bacteria that the amibe consumes,” said the professor.

Dr. Kyle adds a note of caution, noting that some previous cases may simply have remained unrecognized, the unidentified amoeba as the cause.

This uncertainty can make treatment even more difficult. Current medication cocktails are “sub-optimal”, explains Dr. Kyle, adding that among rare survivors, the diet becomes the norm. “We lack sufficient data to determine if all drugs are really useful or necessary.”

Kerala can catch more patients and save more lives, but the lesson goes far beyond its borders. Climate change can rewrite the card of the disease – and even the rarest pathogens may not remain rare for long.