Kerala on alert as ‘brain-eating amoeba’ kills 19: Why cases are rising and how to stay safe

Dubai: Kerala health authorities are on high alert after reporting 69 cases and 19 deaths from Primary Amoebic Meningoencephalitis (PAM) in 2025.

The rare and often fatal brain infection is caused by Naegleria fowleri, commonly known as the brain-eating amoeba. Cases have been recorded across multiple districts, affecting people from a three-month-old infant to a 91-year-old.

Health Minister Veena George said the infections are isolated, not clusters, which has complicated epidemiological investigations. “These are single cases. In 2024, we did see a cluster because people were exposed to the same water source. But this year, there are no clusters, only sporadic cases,” she told ANI.

The National Centre for Disease Control (NCDC) and the Kerala Health Department are closely monitoring the outbreak, which has seen multiple deaths reported in August and September.

Kerala has reported similar cases in previous years, including outbreaks in Kozhikode, Malappuram, and Kannur during June–July 2024.

Kerala’s PAM case profile

• Confirmed cases in 2025: 69 so far

• Age range: 3 months to 91 years

• Outbreak pattern: Multiple clusters in August–September 2025, the state’s most intense on record

• Previous cases: 2024 saw infections in Kozhikode, Malappuram, and Kannur, prompting central investigation and health guidelines

What is the brain-eating amoeba?

Primary Amoebic Meningoencephalitis, also known as naegleriasis, is a brain infection caused by the protozoan Naegleria fowleri. The amoeba thrives in warm freshwater such as ponds, lakes, and poorly chlorinated pools.

Once water enters the nose, the amoeba can travel to the brain, destroying tissue. Symptoms typically include headache, fever, nausea, vomiting, seizures, and hallucinations. It is not spread by drinking contaminated water or through person-to-person contact. The disease is almost always fatal if not diagnosed early. 

How the infection happens

• Entry point: Nose, during swimming, bathing, or diving in contaminated water

• Risk factors: Untreated wells, ponds, rivers, and poorly chlorinated pools

• Not found in seawater

Global warming and higher freshwater use are increasing encounters with the pathogen, experts warn.

Who is at risk?

This year, cases range from a 3-month-old baby to a 91-year-old. Affected patients include 33 males and 19 females. Unlike previous years, recent infections are scattered, with some patients having no exposure to ponds — raising new concerns.

Symptoms to watch for

Early (1–12 days after exposure):

• High fever

• Severe headache

• Nausea, vomiting

• Stiff neck

Later:

• Confusion, seizures, hallucinations

• Loss of balance, coma

Death often occurs within 5–7 days if untreated.

Kerala’s response

• “Water is Life” chlorination drive across wells, tanks, and public bathing areas

• Fever surveys in affected regions

• Environmental water sampling

• Hospitals placed on high alert

• Awareness drives warning against swimming in untreated freshwater

Kerala’s survival rate — at 24% — is significantly higher than the global 3%, thanks to early detection and aggressive use of drugs like miltefosine.

How you can stay safe

• Avoid swimming or bathing in untreated freshwater sources

• Chlorinate household wells and swimming pools

• Use boiled or filtered water for nasal cleansing/neti pots

• Wear nose clips when in freshwater

• Seek immediate care if fever or neurological symptoms appear after water exposure

Kerala is facing a rare but deadly outbreak of brain-eating amoeba infections. While the disease remains almost always fatal worldwide, early awareness, safe water practices, and rapid treatment are the state’s best defence.