Article – Deadly brain-eating amoeba cases rise in Kerala

Jai Siya Ram

What is happening

Kerala has seen a surge in Primary Amoebic Meningoencephalitis (PAM) — a rare but almost always fatal brain infection caused by Naegleria fowleri.
As of mid-September 2025, about 67-69 confirmed cases and 18-19 deaths have been reported in Kerala.
Districts affected include Kozhikode, Malappuram, Kannur, Thiruvananthapuram, and others. Some cases are from swimming/bathing in public water bodies, others from pools, and in rare cases, from water sources not obviously outdoors.

Naegleria fowleri is a free-living amoeba found in warm, freshwater bodies (ponds, lakes, poorly chlorinated pools). It enters the body through the nose, especially when water is forced up (swimming, diving, nose-rinsing), travels up the olfactory nerve into the brain.
The disease it causes, PAM, progresses very fast — symptoms appear 1-12 days after exposure (often around 5 days), including severe headache, fever, nausea/vomiting, stiff neck, confusion, seizures. Death often follows in days.
Globally, the fatality rate is ~97%. Very few survivors worldwide.

Kerala has improved its survival rate (much higher than the global average) to somewhere around 24-25% in reported cases. This is attributed to more rapid diagnosis, aggressive treatment, improved hospital protocols, and use of newer drugs.
One significant drug being used is miltefosine, in addition to traditional therapies, which appears to be helping when used early.
Public health measures have been stepped up:
• Chlorination campaigns for wells, water tanks, public bathing sources.
• Awareness campaigns — educating people to avoid swimming in stagnant/unchlorinated water, using nose clips or avoiding putting water up nose.
• Shutdowns of suspicious water sources: e.g. swimming pools (such as Akkulam Tourist Village pool) and testing of water.

It is not always clear where exactly the infections came from in many cases — whether public pools, natural water bodies, or even household water. Some cases have no obvious exposure.
Early symptoms resemble many other illnesses (fever, headache, nausea), so diagnosis is frequently delayed. By the time PAM is identified, disease may have advanced significantly.
Limited treatment options and challenges in infrastructure / ICU care, especially in remote districts. Drugs like miltefosine are helpful but not a guaranteed cure. Supporting care is critical.
Because cases are increasingly sporadic (not always clustered in one location), tracking, source control, and prevention is harder. Health officials note that there is currently no large cluster, but multiple single cases across districts.

Whether more labs / diagnostic centers are upgraded for faster detection (PCR or similar) in each district.
How quickly new cases are identified and treated, especially use of miltefosine.
Water safety enforcement: testing, chlorination, regulation of public swimming/ bathing sites.
Public messaging about symptoms, prevention (especially concerning nasal exposure).
Whether infection curve continues to rise, or starts to get under control with the current health measures.