A rare but deadly "brain-eating" amoeba, Naegleria fowleri, is causing increasing concern in Kerala, India, with a surge in cases of Primary Amoebic Meningoencephalitis (PAM). This infection affects the central nervous system and is contracted when contaminated freshwater enters the nose, often during swimming, bathing, or diving. The amoeba then travels to the brain, destroying tissue and causing swelling, which is usually fatal.

In 2025, Kerala has reported a significant spike in PAM cases, with 69 confirmed infections and 19 deaths. This is a sharp increase compared to the previous year, which saw 36 cases and nine deaths. The rise in cases has prompted health authorities to issue alerts and implement preventative measures across the state.

PAM is caused by Naegleria fowleri, a free-living amoeba found in warm freshwater environments like lakes and rivers. The infection is rare, but its high fatality rate makes it a serious public health concern. Symptoms of PAM include severe headache, fever, nausea, vomiting, and a stiff neck in the early stages. As the disease progresses, patients may experience confusion, seizures, and coma. The rapid progression of the illness often leads to death within one to two weeks.

Health Minister Veena George stated that every case of meningoencephalitis is being tested for amoeba so treatment can start immediately if confirmed. Kerala's hospitals are now using multi-disciplinary teams to manage confirmed cases. Treatment typically involves a combination of antifungal and antimicrobial drugs, such as amphotericin B, miltefosine, and rifampicin, along with therapies to control brain swelling. Despite aggressive treatment, survival rates remain low.

The Kerala government and health officials are taking several steps to control the spread of the infection. These include chlorinating wells, water tanks, and public bathing areas. The public is advised to avoid swimming or bathing in untreated or stagnant freshwater sources such as ponds and lakes. Paddling pools should be cleaned daily, and hygiene standards must be maintained in spas and theme parks.

One positive development is that four patients have recently recovered from amoebic meningoencephalitis at the Government Medical College Hospital in Kozhikode. One of the recovered patients is an 11-year-old girl from Malappuram who was discharged after her body fluid samples tested negative twice over 15 days. Currently, nine patients are undergoing treatment at Kozhikode MCH, and another is receiving treatment at a private hospital in Kozhikode.

The geographical spread of PAM cases is also a concern. Previously, cases were primarily clustered in Kozhikode, Malappuram, and Kannur. However, this year, cases have appeared sporadically across different districts, complicating epidemiological investigations. This shift indicates that the risk is no longer confined to specific water sources, making prevention and awareness even more critical.