Kerala health authorities are on high alert after a sharp rise in cases of Primary Amoebic Meningoencephalitis (PAM). The deadly brain infection is caused by Naegleria fowleri, often called the “brain-eating amoeba”.
So far this year, Kerala has reported 61 confirmed cases and 19 deaths, most of them in recent weeks.
State Health Minister Veena George called the outbreak a major public health challenge. She said the infection, once limited to clusters in Kozhikode and Malappuram, is now appearing as isolated cases across the state.
“Unlike last year, we are not seeing clusters linked to a single water source. These are single, isolated cases, and this has complicated our epidemiological investigations,” she explained.
Patients affected range from a three-month-old baby to a 91-year-old.
What Is PAM and How Does It Spread?
According to a Kerala government document, PAM (Primary Amoebic Meningoencephalitis) attacks the central nervous system. It destroys brain tissue, causing severe swelling and leading to death in most cases. The infection is rare and usually affects healthy children, teenagers, and young adults.
The brain-eating amoeba lives in warm, stagnant freshwater. People become infected when water containing the amoeba enters through the nose while swimming, diving, or bathing. Drinking contaminated water does not cause the disease.
The document also warned that climate change could worsen the problem. Rising temperatures and more people swimming in freshwater increase the risk of exposure. The infection does not spread from person to person.
Symptoms of PAM Infection
Doctors say PAM is hard to detect because its symptoms resemble bacterial meningitis. Patients may develop headache, fever, nausea, and vomiting.
“By the time other more common causes of meningitis are ruled out and the diagnosis of PAM is considered, it is often too late to save the patient from the cerebral edema that quickly develops and causes death,” the health document said.
Symptoms usually appear within one to nine days of exposure. The disease progresses quickly, with patients deteriorating within hours or days.
“The neuro-olfactory route provides N.fowleri quick access to the brain and results in impaired adaptive immune response, causing a very rapid disease course,” the report added.
Treatment Challenges
Treatment for PAM is difficult, and survival rates are very low. Almost all survivors in the past were diagnosed early, before the brain was severely affected.
“This shows that early diagnosis of PAM and timely initiation of an antimicrobial cocktail might be lifesaving,” the document noted.
Minister Veena George also stressed that “early detection is key”.
Doctors say the best possible treatment must include a drug, or a mix of drugs, that can cross the blood-brain barrier and directly attack the amoeba. However, the rarity of the disease and the delay in diagnosis make it difficult to test treatment methods.
Preventive Measures for the Public
The Kerala government has urged people to seek medical help immediately if they show meningitis-like symptoms after contact with stagnant water.
Authorities are also advising people to avoid swimming or bathing in untreated or stagnant water bodies such as ponds and lakes. Those who do swim in freshwater are encouraged to use nose clips.
The government has suggested proper chlorination and cleaning of wells and water tanks.
The health department, along with the National Centre for Disease Control (NCDC), is conducting water sampling to trace possible sources of the amoeba.
Rising Cases in Kerala
Kerala reported its first PAM case in 2016. From then until 2023, the state saw only eight confirmed cases. But in 2023 alone, 36 cases and nine deaths were recorded.
This year, the number has already jumped to 61 confirmed cases and 19 deaths — nearly double last year’s toll.
As Kerala battles the outbreak, health officials are focusing on prevention, early diagnosis, and public awareness to stop further deaths.
