Brain-Eating Amoeba in Kerala: What It Is, How It Spreads and How to Stay Safe
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Kerala is grappling with an alarming rise in brain-eating amoeba infections, a rare but deadly disease that attacks the brain. In 2025 alone, the state has reported 69 confirmed cases and 19 deaths, a sharp increase compared to fewer than ten cases in the six years before 2023. Health authorities are calling it a major public health concern, as the infection spreads beyond traditional hotspots like Kozhikode and Malappuram.
What Is the Brain-Eating Amoeba ?
The brain-eating amoeba, scientifically known as Naegleria fowleri, causes Primary Amoebic Meningoencephalitis (PAM). This microscopic organism thrives in warm freshwater and soil and invades brain tissue, triggering rapid swelling and inflammation. PAM progresses quickly and is often fatal, with global survival rates under 3%.
Kerala’s health department warns that PAM mainly affects healthy children, teenagers, and young adults. The infection destroys brain tissue, and early detection is critical for any chance of survival.
How Does the Infection Spread ?
Contrary to common myths, the brain-eating amoeba cannot infect people through drinking water or via person-to-person contact. Infection occurs when contaminated water enters the nose during swimming, diving, or bathing in untreated freshwater. The amoeba then travels along the olfactory nerves to the brain, causing severe damage.
Stagnant water bodies like ponds, lakes, rivers, poorly maintained swimming pools, and inadequately chlorinated household tanks provide ideal conditions for the amoeba. High bacterial levels in Kerala’s ponds and wells, often from sewage and waste, supply food for the organism, helping it multiply.
Other free-living amoebae such as Acanthamoeba and Balamuthia can also cause brain infections. Unlike PAM, these infections develop slowly over weeks or months and are harder to detect early.
Recognising the Symptoms
PAM symptoms are similar to bacterial meningitis, which complicates diagnosis. They usually appear between 1–9 days after exposure and can worsen rapidly. Early signs include:
As the infection progresses, patients may experience:
Most patients die within 1–18 days after symptoms appear, often due to brain swelling. In Kerala, delayed diagnosis often reduces the chances of successful treatment.
Why Are Cases Rising in Kerala?
Kerala first reported PAM in 2016, but cases were sporadic until recent years. Last year, 36 cases and nine deaths were recorded. This year, the numbers have nearly doubled. Experts attribute the surge to:
How Deadly Is the Brain-Eating Amoeba?
Globally, PAM has a 97% fatality rate. Kerala’s mortality rate in 2025 is roughly 24%, considerably lower due to quicker diagnosis and early treatment. Rare recoveries, such as two children surviving after exposure, highlight the importance of prompt medical attention.
Treatment Options
There is no standard cure for PAM. Survivors are usually diagnosed before the infection reaches the brain. Kerala doctors are using a combination of drugs, including:
Miltefosine, an anti-parasitic drug, has been linked to successful recoveries worldwide. Early detection is crucial, which is why Kerala’s hospitals now test all meningoencephalitis cases for amoebic infection.
Safety Measures to Prevent Infection
Since PAM has no reliable cure, prevention is essential. Health authorities recommend:
The Kerala health department, along with the National Centre for Disease Control , is monitoring water sources, disinfecting tanks, and running public awareness campaigns.
What Kerala’s Outbreak Signals
Recent deaths - from infants to the elderly - show that the brain-eating amoeba can affect all age groups. Kerala’s “Water is Life” chlorination drive and public education campaigns aim to reduce infection risk during monsoon season.
The sudden rise in cases is a warning for India and the world: warmer waters, poor sanitation, and unsafe water practices are increasing the risk of once-rare infections. Vigilance, proper water safety, early detection, and prompt treatment are now more important than ever to prevent further fatalities.
What Is the Brain-Eating Amoeba ?
The brain-eating amoeba, scientifically known as Naegleria fowleri, causes Primary Amoebic Meningoencephalitis (PAM). This microscopic organism thrives in warm freshwater and soil and invades brain tissue, triggering rapid swelling and inflammation. PAM progresses quickly and is often fatal, with global survival rates under 3%.
Kerala’s health department warns that PAM mainly affects healthy children, teenagers, and young adults. The infection destroys brain tissue, and early detection is critical for any chance of survival.
How Does the Infection Spread ?
Contrary to common myths, the brain-eating amoeba cannot infect people through drinking water or via person-to-person contact. Infection occurs when contaminated water enters the nose during swimming, diving, or bathing in untreated freshwater. The amoeba then travels along the olfactory nerves to the brain, causing severe damage.
Stagnant water bodies like ponds, lakes, rivers, poorly maintained swimming pools, and inadequately chlorinated household tanks provide ideal conditions for the amoeba. High bacterial levels in Kerala’s ponds and wells, often from sewage and waste, supply food for the organism, helping it multiply.
Other free-living amoebae such as Acanthamoeba and Balamuthia can also cause brain infections. Unlike PAM, these infections develop slowly over weeks or months and are harder to detect early.
Recognising the Symptoms
PAM symptoms are similar to bacterial meningitis, which complicates diagnosis. They usually appear between 1–9 days after exposure and can worsen rapidly. Early signs include:
- Headache and fever
- Nausea and vomiting
As the infection progresses, patients may experience:
- Stiff neck and confusion
- Seizures and hallucinations
- Loss of balance and eventual coma
Most patients die within 1–18 days after symptoms appear, often due to brain swelling. In Kerala, delayed diagnosis often reduces the chances of successful treatment.
Why Are Cases Rising in Kerala?
Kerala first reported PAM in 2016, but cases were sporadic until recent years. Last year, 36 cases and nine deaths were recorded. This year, the numbers have nearly doubled. Experts attribute the surge to:
- Climate Change: Rising temperatures and heatwaves create more hospitable conditions for amoebae in stagnant water bodies, increasing human exposure.
- Poor Water Sanitation: Sewage-contaminated ponds, wells, and tanks provide abundant food for the amoeba, raising infection risks.
How Deadly Is the Brain-Eating Amoeba?
Globally, PAM has a 97% fatality rate. Kerala’s mortality rate in 2025 is roughly 24%, considerably lower due to quicker diagnosis and early treatment. Rare recoveries, such as two children surviving after exposure, highlight the importance of prompt medical attention.
Treatment Options
There is no standard cure for PAM. Survivors are usually diagnosed before the infection reaches the brain. Kerala doctors are using a combination of drugs, including:
- Amphotericin B
- Rifampin
- Miltefosine
- Azithromycin, Fluconazole, and Dexamethasone
Miltefosine, an anti-parasitic drug, has been linked to successful recoveries worldwide. Early detection is crucial, which is why Kerala’s hospitals now test all meningoencephalitis cases for amoebic infection.
Safety Measures to Prevent Infection
Since PAM has no reliable cure, prevention is essential. Health authorities recommend:
- Avoid swimming or bathing in untreated freshwater bodies.
- Use nose clips or keep your head above water while in freshwater.
- Use boiled, cooled, distilled, or sterile water for nasal rinsing.
- Maintain proper chlorination of swimming pools, wells, and household tanks.
- Protect open wounds with waterproof bandages.
- Contact lens users should use sterile solutions to prevent Acanthamoeba eye infections.
The Kerala health department, along with the National Centre for Disease Control , is monitoring water sources, disinfecting tanks, and running public awareness campaigns.
What Kerala’s Outbreak Signals
Recent deaths - from infants to the elderly - show that the brain-eating amoeba can affect all age groups. Kerala’s “Water is Life” chlorination drive and public education campaigns aim to reduce infection risk during monsoon season.
The sudden rise in cases is a warning for India and the world: warmer waters, poor sanitation, and unsafe water practices are increasing the risk of once-rare infections. Vigilance, proper water safety, early detection, and prompt treatment are now more important than ever to prevent further fatalities.
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