Kerala is grappling with a concerning uptick in cases of primary amoebic meningoencephalitis (PAM), a rare and often fatal brain infection caused by the free-living amoeba Naegleria fowleri. As of September 9, 2025, five fatalities have been reported within a month, highlighting the urgency of the situation.
The latest victim, a 56-year-old woman named Shobhana from Vandoor in Malappuram district, succumbed to the infection while undergoing critical treatment at Kozhikode Medical College Hospital. Her death on Thursday came just two days after another patient, 45-year-old Ratheesh from Sulthan Bathery, died from the same infection at the same facility. Health officials noted that Ratheesh had pre-existing cardiac complications, which may have contributed to the severity of the disease.
Currently, 11 patients exhibiting symptoms of PAM are being treated and monitored at Kozhikode Medical College Hospital.
PAM is a rare but devastating infection caused by Naegleria fowleri, an amoeba typically found in warm, contaminated freshwater environments. The infection occurs when water containing the amoeba enters the body through the nose, often during activities such as swimming, diving, or bathing in infected water bodies. Once in the nasal passages, the amoeba travels to the brain, leading to inflammation and tissue destruction.
Symptoms of PAM begin 1–12 days after exposure and can include headache, fever, nausea, vomiting, stiff neck, confusion, lack of attention to people and surroundings, loss of balance, and hallucinations. The disease progresses rapidly, and death usually occurs within 1 to 18 days after symptoms begin. According to the Centers for Disease Control and Prevention (CDC), of the 164 reported cases in the United States between 1962 and 2023, only four individuals survived.
Globally, Naegleria fowleri has been detected in every country except Antarctica. Between 1965 and 2018, a total of 381 PAM cases were reported worldwide, with the number of cases increasing by 1.6% each year during that period. In India, Kerala has reported a significant number of cases, with over 20 instances of Naegleria fowleri infections, including seven in the past two months alone.
In other countries, such as Pakistan, there has been a rise in Naegleria fowleri cases in recent years, with over a hundred deaths reported since the first infection in 2008. Similarly, South Korea reported its first death from the brain-eating amoeba in 2022, with a total of 381 cases reported globally by that time.
Health Advisory and Preventive Measures
In response to the outbreak, Kerala’s Health Department has issued special guidelines to healthcare professionals regarding treatment protocols. The infection is not transmitted from person to person but is contracted when contaminated water enters the body through the nose. Health advisories recommend avoiding swimming in freshwater lakes and stagnant ponds, particularly during the warm summer months when water levels are low and temperatures are higher, conditions in which the amoeba thrives.
Individuals are also advised to ensure their water supply is clean and chlorinated and to avoid allowing water to enter the nasal passages during bathing or ritual purification practices.
Also Read: Nepal’s Youth Riot Over Social Media Ban and Corruption Allegations
