Three children, including a 5-year-old, have succumbed to an infection from a rare brain-eating amoeba in India in the past two months.

The most recent victim, 14-year-old Mridul from the southern state of Kerala, passed away Thursday after developing primary amebic meningoencephalitis (PAM). Mridul contracted the infection from Naegleria fowleri, a free-living amoeba while bathing in a pond in Kozhikode, Kerala.

The other two victims of the same infection, all from the same state, a five-year-old girl from Malappuram died on May 21, and a 13-year-old girl from Kannur died on June 25.

Naegleria fowleri is a one-celled organism typically found in soil and warm freshwater lakes, rivers, ponds, and hot springs worldwide. In rare instances, it can also be found in poorly maintained swimming pools, splash pads, and tap water.

PAM is a highly fatal infection that occurs when Naegleria fowleri enters through the nose, travels up to the brain, and destroys the brain tissue. Each year, fewer than 10 cases of PAM are reported in the U.S. and nearly all of them succumb to the disease.

Signs of infection:

The symptoms appear within a week after the amoeba enters the body while swimming, diving, bathing, or playing in warm, generally stagnant freshwater. The most common signs include headache, fever, nausea, and vomiting. The patients may also experience behavioral abnormalities, seizures, and altered mental status.

The disease progresses at a rapid state typically leading to coma and death after 5 days. As the disease progresses, the patients may also develop a stiff neck, confusion, lack of attention to people and surroundings, loss of balance, and hallucinations.

Transmission:

The typical mode of transmission is through nasal passage while swimming in contaminated water. In rare cases, people have contracted the amoeba from tap water while rinsing their nasal passages, from recreational water that does not have enough chlorine like splash pads, and from a surf park. However, the amoeba cannot enter the body from swallowing water, nor can the infection be transmitted from one person to another.

Here's how to reduce risk:

To minimize the risk of Naegleria fowleri infection, avoid swimming in untreated freshwater, particularly during warm weather when the amoeba thrives.

If you do enter, hold your nose or wear a nose clip when jumping into fresh water. Keep your head above water in hot springs, and avoid digging in shallow areas where the amoeba is more likely to thrive. Use distilled or boiled tap water for rinsing your sinuses or cleaning your nasal passages.

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