Brain-Eating Amoeba Cases Surge in Kerala: Understanding the Threat and How to Stay Safe

Kerala is currently grappling with an alarming health challenge — a sharp rise in infections caused by the so-called “brain-eating amoeba.” In 2025 alone, the state has confirmed 69 cases of Primary Amoebic Meningoencephalitis (PAM), resulting in 19 deaths. What makes the situation especially concerning is that infections are now appearing across different districts and age groups, from infants as young as three months to senior citizens over 90.

This sudden increase is a dramatic shift compared to earlier years when only a handful of cases were reported. Health experts and government authorities have described the situation as one of the most serious public health concerns Kerala has faced in recent times.

What Is the ‘Brain-Eating Amoeba’?

The scientific name of this microorganism is Naegleria fowleri, a free-living amoeba commonly found in warm freshwater and soil. Once it enters the human body, it attacks the central nervous system and causes a condition known as Primary Amoebic Meningoencephalitis (PAM).

The infection is extremely rare but almost always fatal. Popularly nicknamed the “brain-eating amoeba,” it destroys brain tissue at a rapid pace, leading to swelling, neurological damage, and, in most cases, death within days of onset.

Doctors point out that PAM most frequently occurs in healthy children, teenagers, and young adults. The reason: these age groups are more likely to swim or bathe in open water sources such as ponds, lakes, or rivers, where the organism thrives.

How Does Infection Occur?

A key misconception is that PAM spreads by drinking contaminated water. In reality, ingestion does not cause the disease. Instead, infection occurs when water containing the amoeba enters the nasal passages. From there, it travels along the olfactory nerves, crosses into the brain, and triggers inflammation.

The amoeba is usually found in:

• Warm and stagnant freshwater (ponds, lakes, reservoirs)
• Poorly maintained swimming pools
• Household storage tanks with inadequate chlorination
• Water bodies contaminated by sewage or waste
   

Once inside the body, the amoeba multiplies quickly, causing severe brain swelling that often proves fatal.

Symptoms: Why Diagnosis Is Difficult

The symptoms of PAM are strikingly similar to bacterial meningitis, which often delays detection. They usually appear within one to nine days after exposure.

Early signs include:

• Severe headache
• High fever
• Nausea and vomiting

As the infection progresses, patients may experience:

• Stiff neck
• Confusion or altered mental state
• Seizures and hallucinations
• Loss of balance
• Coma within a short period
   

According to the Centers for Disease Control and Prevention (CDC), death usually occurs within 1 to 18 days after symptoms appear, making rapid detection and treatment critical.

Why Are Cases Increasing in Kerala?
 

Kerala reported its first PAM case in 2016, but infections were considered rare until 2023. In that year, the state recorded 36 cases and nine deaths, a number that has nearly doubled in 2025.

Two major factors are believed to be behind the surge:
 

1. Rising Temperatures and Climate Change
 

Warmer water bodies create the perfect environment for Naegleria fowleri. Frequent heatwaves in Kerala are pushing more people to freshwater bodies for swimming or bathing, unknowingly raising their risk of exposure.

2. Poor Water Sanitation

Several of Kerala’s ponds and wells contain high levels of bacteria due to sewage contamination. These bacteria act as a food source for the amoeba, helping it multiply rapidly.
 

Together, these conditions are driving a dangerous rise in cases across the state.
 

How Deadly Is the Infection?

Globally, PAM has a fatality rate of around 97%. However, Kerala’s situation is slightly different. Out of 69 reported cases this year, 19 people have died, putting the state’s mortality rate at roughly 24%.

This comparatively lower death rate is being credited to:

• Faster medical response
• Increased awareness after past outbreaks like Nipah
• Aggressive use of new treatment combinations
   

In a rare sign of hope, at least two children recently survived the infection after receiving early treatment with an anti-parasitic drug called miltefosine, alongside other supportive medicines.
 

Current Treatment Approaches

There is no universally accepted cure for PAM. Almost all known survivors worldwide were treated before the amoeba could cause severe

brain damage, highlighting the importance of early detection.

Doctors in Kerala are using multiple drugs together, including:

• Amphotericin B
• Rifampin
• Miltefosine
• Azithromycin
• Fluconazole
• Dexamethasone
   

Among these, miltefosine has gained attention for improving survival chances when administered early. Despite this, doctors warn that treatment is highly complex, and the infection’s rapid progression makes successful outcomes rare.

Safety Guidelines for the Public

Since prevention is the most effective defense, Kerala’s health department has issued detailed instructions to reduce the risk of PAM:

• Avoid bathing or swimming in stagnant freshwater like ponds and lakes.
• If entering freshwater, use nose clips or keep your head above water.
• For nasal rinsing or religious practices such as jal neti, always use boiled and cooled, distilled, or sterile water.
• Ensure swimming pools, wells, and household tanks are cleaned and chlorinated regularly.
• Cover wounds with waterproof bandages before contact with untreated water.
• Contact lens wearers should use only sterile solutions to avoid related infections.
   

The government has also launched a “Water is Life” chlorination campaign to disinfect common water sources and prevent the spread of the amoeba.
 

What Kerala’s Experience Means for India

The recent surge in PAM cases in Kerala is not just a local issue but a national warning. India’s first recorded case of the brain-eating amoeba dates back to 1971, with sporadic reports from Tamil Nadu, Maharashtra, and other states. However, Kerala is now seeing a sharp and unusual rise in cases.

The lessons are clear:

• Climate change is increasing the risk of rare infections.
• Water contamination is worsening the problem.
• Early detection and quick treatment can save lives, even when dealing with diseases that are almost always fatal.
   

Kerala’s relatively lower mortality rate compared with the global average shows that with vigilance, awareness, and stronger public health systems, survival is possible. But experts caution that without proper water sanitation and community-level precautions, outbreaks could become more frequent.

Conclusion

The surge of brain-eating amoeba infections in Kerala has underscored the urgent need for better water safety, climate resilience, and health surveillance. While rare survivors give hope, the reality is that PAM remains one of the deadliest infections known to medical science.

For now, the best defense is prevention and awareness. Avoiding unsafe water practices, ensuring chlorination, and seeking immediate medical help at the first sign of symptoms are essential steps to staying safe. Kerala’s fight against this microscopic killer offers valuable lessons for the rest of India — vigilance, science, and public cooperation can together make the difference between life and death.