Guwahati: Kerala health authorities have issued a high alert following a sudden spike in cases of Primary Amoebic Meningoencephalitis (PAM), a rare but often fatal brain infection caused by Naegleria fowleri, commonly referred to as the “brain-eating amoeba.”
As of mid-September 2025, the state has reported 69 confirmed cases and 19 deaths, with many fatalities occurring in recent weeks.
Infections Rise, Spread Widens Across Kerala
Health Minister Veena George confirmed that Kerala is facing a serious public health crisis. While earlier outbreaks were concentrated in districts like Kozhikode and Malappuram, recent cases have appeared across multiple regions without a common water source, making it harder for health officials to trace and contain the infection.
“We’re dealing with isolated cases now, which complicates our epidemiological investigations,” George said. Patients have ranged from a three-month-old infant to a 91-year-old adult, reflecting the wide demographic affected by the disease.
What Is PAM and How Does It Spread?
Primary Amoebic Meningoencephalitis is a rare infection that attacks the central nervous system, rapidly destroying brain tissue and causing severe swelling. According to Kerala government data, the amoeba typically enters the body through the nasal cavity when individuals swim, dive, or bathe in warm, stagnant freshwater such as lakes, ponds, and poorly maintained water tanks. Drinking contaminated water, however, does not cause the illness.
Officials also warned that climate change may be worsening the risk. Rising temperatures and increased recreational use of freshwater bodies provide ideal conditions for Naegleria fowleri to thrive. “Warmer water and higher exposure make the infection more likely,” a government report stated.
Importantly, PAM does not spread from person to person.
Symptoms and Diagnosis: Why PAM Is So Deadly
PAM’s symptoms closely resemble bacterial meningitis, including fever, headache, nausea, vomiting, and neck stiffness. These similarities make early diagnosis difficult. “Most patients seek medical help only after the infection reaches the brain,” the government said. By that time, the condition often progresses too rapidly for effective treatment.
Symptoms can appear 1 to 9 days after exposure, and the disease may advance within hours to a couple of days, particularly due to how quickly the amoeba travels via the neuro-olfactory route to the brain.
Treatment Options and Challenges
Health experts stress that early diagnosis and aggressive treatment are critical to survival. While almost all PAM survivors worldwide were diagnosed before the infection reached the brain, doctors often struggle to make a timely diagnosis because of the disease’s rarity and speed.
Experts recommend using an antimicrobial cocktail with drugs capable of crossing the blood-brain barrier. However, due to the small number of cases globally, researchers haven’t been able to rigorously evaluate the most effective drug regimens.
“The delay in diagnosis and the rapid progression of the disease have severely limited our ability to evaluate treatments,” the government acknowledged.
Preventive Measures: What You Can Do
To prevent new infections, the Kerala health department has urged residents to avoid swimming or bathing in untreated or stagnant water sources, especially during warmer months. Officials advise:
- Avoiding ponds, lakes, and poorly maintained water tanks
- Wearing nose clips while swimming in freshwater
- Cleaning and chlorinating wells and domestic water tanks regularly
- Seeking immediate medical attention after exposure if symptoms appear
Spike in Cases Since 2023
Kerala reported its first PAM case in 2016, with only eight confirmed cases until 2023. However, in 2024, the state saw a dramatic increase: 36 cases and 9 deaths. The numbers have nearly doubled in 2025, with 69 cases and 19 deaths already confirmed—an alarming trend that continues to grow.
Government’s Response and Surveillance Efforts
The state government, in collaboration with the National Centre for Disease Control (NCDC), has begun environmental sampling to detect potential contamination sources. Health teams are also monitoring high-risk water bodies and launching awareness campaigns in vulnerable communities.
“We must treat this as a public health emergency,” said Minister Veena George, emphasizing the need for both public awareness and rapid medical response.