A growing health crisis is unfolding in Kerala, India, as a surge in infections and fatalities caused by the "brain-eating amoeba," Naegleria fowleri, has prompted a state-wide alert. Since the start of 2025, there have been 72 reported infections and 19 deaths, a significant increase compared to the 36 cases and nine deaths reported in 2024. Among the recent fatalities was a three-month-old infant.
Naegleria fowleri is a free-living amoeba found in warm freshwater environments such as lakes, rivers, ponds, and even contaminated soil. Infection occurs when contaminated water enters the nose, allowing the amoeba to travel to the brain and cause primary amoebic meningoencephalitis (PAM), a devastating infection that destroys brain tissue. The World Health Organization (WHO) notes that initial symptoms include headache, fever, and vomiting, which rapidly progress to seizures, altered mental status, hallucinations, and coma. If the amoeba reaches the brain, the infection proves fatal in over 95% of cases.
Health officials are concerned about the increasing number of cases, with three deaths, including the infant, occurring in the past month. Unlike the previous year, the current infections do not appear to be linked to a single water source, complicating epidemiological investigations.
The Kerala government has initiated several measures to control the outbreak. These include chlorinating wells, water tanks, and public bathing areas to eliminate the amoeba in potentially contaminated water sources. The state's health minister, Veena George, emphasized that these are isolated cases, which complicates epidemiological investigations.
The rise in PAM cases in Kerala is a growing concern, although infections remained rare until recent years. Between 2016 and 2022, the state reported only eight cases, but in 2023, that number jumped to 36 infections with nine deaths. While the global survival rate for PAM is around 3%, Kerala has achieved a 24% survival rate due to advanced testing and early diagnosis. In July 2024, a 14-year-old boy from Kozhikode became the first person in India to survive the infection, joining a small group of approximately 10 known survivors worldwide.
Experts suggest that climate change may be a contributing factor to the increase in amoebic encephalitis cases in Kerala. According to TS Anish, nodal officer at the Kerala One Health Centre for Nipah Research and Resilience in Kozhikode, rising atmospheric temperatures create favorable conditions for microorganisms like Naegleria fowleri to thrive. The amoeba feeds on bacteria and algae, and contamination from coliform bacteria, commonly found in fecal matter, can exacerbate the problem.
While PAM remains a rare disease, its high fatality rate and the recent surge in cases in Kerala underscore the need for increased vigilance and public health measures. The Kerala government is working to raise awareness, improve water sanitation, and enhance diagnostic capabilities to combat this deadly infection.
