Kerala is grappling with an alarming rise in cases of *Naegleria fowleri*, the so-called “brain-eating amoeba,” which has left health authorities and the public deeply concerned. Since the beginning of 2025, the state has reported 69 confirmed infections of Primary Amoebic Meningoencephalitis (PAM), resulting in 19 deaths. Last year, there were 36 cases with nine fatalities, but the current spread is more widespread and sporadic, affecting multiple districts. Victims include people of all ages, from a three-month-old infant to a 52-year-old woman, underscoring the severity of the outbreak.
The amoeba thrives in warm, stagnant or untreated freshwater bodies such as lakes, rivers, and poorly maintained wells or tanks. It infects people when contaminated water enters through the nose, usually during bathing or swimming, and then migrates to the brain. Once inside, it causes severe inflammation that progresses rapidly. Symptoms often begin with headaches, fever, nausea, and vomiting, but quickly escalate to confusion, seizures, coma, and almost always death. Because early signs resemble meningitis or encephalitis, diagnosis is often delayed, further complicating treatment.
Globally, survival rates from PAM are extremely low, but Kerala has reported better outcomes compared to international averages. Around a quarter of patients have survived, thanks to the use of drugs like miltefosine in combination with amphotericin B and intensive medical care. Still, doctors emphasize that early detection remains the most crucial factor in saving lives.
The Kerala government has stepped up preventive measures, including widespread chlorination of wells, tanks, and public water bodies, along with environmental sampling to identify possible sources of contamination. Public health advisories are urging residents to avoid swimming in untreated water, use nose clips while bathing in open water, and ensure their household water sources are properly maintained. Officials are also stressing the need for immediate medical attention if people develop symptoms after freshwater exposure.
Experts point to rising temperatures and increased human interaction with untreated water sources as major factors behind the surge in cases. Climate conditions have created a more favorable environment for the amoeba, while lapses in water treatment and reliance on unsafe water in rural areas have added to the risk.
Health authorities in Kerala believe the situation calls for sustained public awareness, stronger medical preparedness, and vigilant monitoring of water bodies to prevent further spread. For now, the state remains on high alert as it battles an invisible but deadly threat lurking in its waters.
