Surge In Deadly Brain-Eating Amoeba Cases In Kerala: Why And How It Spreads

Kerala is grappling with a sudden and dangerous health crisis caused by Naegleria fowleri, a free-living microorganism colloquially named the "brain-eating amoeba." In 2025 so far, the state has reported 42 confirmed cases of lethal amoebic meningoencephalitis, including several recent deaths-most tragically, a three-month-old infant and a 52-year-old woman in Kozhikode in late August, bringing the toll to three fatalities in just one month. This follows a tragic chain: a 9-year-old girl had died earlier in August, and multiple active cases, ranging from children to adults, are reportedly under treatment at state hospitals.

The Kerala government has swiftly responded with an aggressive "Water is Life" chlorination campaign, targeting wells, water tanks, and public bathing areas; authorities are also focused on raising public awareness and water safety, especially during the monsoon season. Given the rapid progression and high lethality of this infection caused by Naegleria fowleri amoeba, timely knowledge and precautions are critical. Here's what every Kerala resident, or any reader in similar climates across India and the world, must know.

What Is The Brain-Eating Amoeba, And How Deadly Is It?

Naegleria fowleri is a thermophilic protozoan lurking in warm, freshwater sources, like ponds, lakes, wells, rivers, and poorly chlorinated pools, particularly during summer or monsoon. The amoeba enters the body through the nasal passages, often during swimming, bathing, or nasal irrigation, and swiftly travels to the brain, causing primary amoebic meningoencephalitis (PAM).

Though extraordinarily rare, PAM is almost invariably fatal. Global mortality ranges from 95% to 98%. India has historically recorded very few cases (around 20 across the country), with nearly all resulting in death (directivepublications.org). Since 2024, however, Kerala has seen a surge: 2024 alone saw 36 cases and nine deaths, while earlier decades reported only sporadic infections. Alarmingly, Kerala has now managed some survivors, thanks to early diagnosis and aggressive treatment including miltefosine use, a rare success given the disease's usual outcome.

Past Cases In India: A Disturbing Trend

India's battle with PAM began with isolated reports since the 1970s. The first reported case was in 1971, with rare outbreaks in Tamil Nadu, Maharashtra, and other states. Nearly all ending in death, it was a condition few fully understood at the time due to very little research, globally. Kerala's first recorded death came in Alappuzha in 2016, and since then, case numbers remained low until the alarming spike in 2023-2025.

Why And How It Spreads: The Dangerous Intersection Of Climate & Customs

Warming temperatures and heavy rainfalls are creating a perfect storm for Naegleria fowleri to flourish in freshwater bodies across Kerala and in many parts of India. Contamination of wells, ponds, and community water sources with sewage and organic matter further fuels the algae's spread. Cultural practices, such as ritual nasal cleansing (abhala or jala neti) using unsterile water, also expose people to the risk when water enters the nasal cavity.

Recognising The Warning Signs Of PAM

Symptoms of PAM typically begin 1-12 days post-exposure, with an average onset around 5 days. Early signs include:

• High fever
• Severe headache
• Nausea, vomiting
• Stiff neck, increased sensitivity to light

As the infection accelerates: confusion, hallucinations, seizures, loss of balance, and coma appear, and death often follows within days. A red flag example: a nine-year-old girl in Kozhikode deteriorated from fever to death in less than 24 hours.

Precautions: What You Must Do Now

Once contracted, treating and recovering from PAM is extremely difficult, partially due to how fast the infection progresses especially for vulnerable groups like children and the elderly. But there are some precautions everyone can and must take to prevent this infection:

Water Safety at Home

• Avoid bathing or swimming in untreated wells, stagnant ponds, rivers, or pools lacking proper chlorination.
• Use boiled, filtered, or bottled water for nasal irrigation, ritual cleansing, or neti. Never directly use tap, unfiltered or unchlorinated water.

During Recreational Activities

• Keep your head above water in natural water bodies; avoid diving, splashing, or stirring sediments, where the amoeba may reside.
• Wearing nose clips can reduce the chance of water entering nasal passages.

Community & Government Actions

• Kerala's "Water is Life" campaign is actively chlorinating wells and tanks, placing warning signs, and mobilizing awareness. You can support and comply with these efforts.
• Participate or support local/municipal efforts to clean and disinfect water bodies like ponds, pools, lakes, etc.

Medical Vigilance

• If someone develops fever, headache or vomiting after freshwater exposure, especially within a week, seek immediate medical help. Mention any such exposure clearly to doctors.
• Treatment protocols now include miltefosine (dosage must be prescribed by a certified medical professional) and other aggressive therapies, significantly helping survival odds when started early.

Act Now To Stay Safe

Though this brain-eating amoeba is rare, its toll is devastating, and rising. But Kerala's quick response and early survivor cases show that with awareness, safe water practices, and rapid medical care, some lives can be saved. Stay cautious, avoid dangerous water, and prioritize clean practices, especially this monsoon. After all, the smallest precautions can guard the most precious lives.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

References:

Directive Publications. (2025). Epidemiology of Naegleria fowleri-caused meningoencephalitis in India: A growing trend.

Tandfonline. (2024). Naegleria fowleri infections in Kerala, India.