Kerala is grappling with a deadly microscopic threat that has claimed 19 lives across the state this year. A sharp increase in cases of the rare but fatal brain infection caused by the so-called brain-eating amoeba has sparked widespread public concern and prompted urgent action by health authorities to contain its spread.
The infection, known medically as Primary Amoebic Meningoencephalitis (PAM), is caused by Naegleria fowleri, an amoeba that thrives in warm, stagnant freshwater sources such as ponds, lakes, and untreated wells. The parasite enters the body through the nose, usually while swimming or bathing, then travels to the brain, rapidly destroying tissue and causing severe inflammation that is often fatal.
Widening Outbreak Across Kerala
In 2025 alone, Kerala has reported 69 confirmed PAM cases, with 19 fatalities recorded across multiple districts. Unlike in previous years, where infections were confined to specific areas, cases are now appearing across a broader range of regions and affecting individuals from children to older adults.
“This is no longer an isolated health issue; it has become a state-wide concern,” said Dr. Sreedevi Nair, an infectious disease specialist. “Early diagnosis is critical but challenging, as the initial symptoms closely resemble those of more common infections.”
A Ray of Hope: Miltefosine Treatment
While PAM carries a global fatality rate exceeding 95%, Kerala has seen a notable improvement, with survival rates nearing 24% this year. This progress is attributed largely to the introduction of miltefosine, an anti-parasitic drug originally developed to treat leishmaniasis. It is now being used in combination with amphotericin B and other antifungal medications.
Kerala hospitals follow treatment protocols similar to those recommended by the US Centers for Disease Control and Prevention (CDC), administering miltefosine based on the patient’s weight and age, often for 28 days or longer in severe cases. However, success hinges heavily on how quickly treatment is initiated.
“Even with the best medications available, time is the critical factor,” explained Dr. Anil Kumar, a neurologist in Ernakulam. “The infection progresses so rapidly that even a delay of 24 hours can be deadly.”
Symptoms and How It Spreads
Symptoms of PAM usually emerge within one to nine days following exposure to contaminated water. Initial signs include severe headache, fever, and vomiting, followed by neck stiffness, confusion, and sometimes hallucinations. As the infection advances swiftly, it may cause seizures and coma. Due to its aggressive nature, PAM is often fatal within five to seven days after symptom onset.
The amoeba is not contagious from person to person and does not infect through drinking contaminated water. Infection occurs only when water carrying the amoeba enters the nasal passages.
Preventive Measures
To minimize risk, the Kerala Health Department advises the public to avoid swimming or diving in warm, stagnant freshwater bodies where the amoeba is likely to thrive. If such exposure is unavoidable, using nose clips can help prevent contaminated water from entering the nasal passages. Additionally, regular cleaning and chlorination of water tanks, wells, and other domestic water sources are essential.
Residents are urged to remain vigilant for symptoms after any freshwater exposure and to seek immediate medical attention if symptoms develop.
Government Response and Public Awareness
The state government has launched awareness campaigns at the district level, targeting schools and rural communities. Hospitals have been instructed to stock miltefosine and enhance emergency protocols for suspected PAM cases. Water quality monitoring has intensified, with local authorities stepping up chlorination efforts in affected areas.
Experts warn that as climate change continues to increase temperatures, creating more favorable conditions for organisms like Naegleria fowleri, such outbreaks may become more frequent. Kerala’s ongoing battle with this deadly amoeba highlights the urgent need for improved water safety regulations, early disease surveillance, and increased community awareness to prevent this rare but devastating infection from becoming a recurring public health crisis.
Also Read: Kerala Facing Alarming Surge in Brain-Eating Amoeba Cases?
