Fighting the Brain-Eating Amoeba in Kerala: A Public Health Crisis

Sun Oct 19 2025 20:26:00 GMT+0300 (Eastern European Summer Time)

The rise of Naegleria fowleri infections in Kerala is alarming as public health officials grapple with understanding and addressing this rare but deadly condition. With 70 cases reported and a growing number of fatalities, the situation underscores the urgent need for awareness and preventive measures.

In Kerala, India, the brain-eating amoeba Naegleria fowleri has caused a surge in cases, with more than 70 infections this year alone and 19 fatalities. Although historically rare, this health crisis is being exacerbated by climate change and contaminated water sources. While advancements in detection and early diagnosis offer hope for better outcomes, public health responses continue to evolve to manage this growing threat.

On the eve of Onam, the most joyous festival in India's Kerala state, 45-year-old Sobhana lay shivering in the back of an ambulance, drifting into unconsciousness as her family rushed her to a medical college hospital.

Just days earlier, the Dalit woman had complained of dizziness and high blood pressure. Doctors prescribed pills and sent her home. But her condition spiraled with terrifying speed: uneasiness gave way to fever, fever to violent shivers, and on 5 September, Sobhana was dead.

The culprit was Naegleria fowleri - commonly known as the brain-eating amoeba - an infection contracted through the nose in freshwater, so rare that most doctors never encounter it. We were powerless to stop it. We learned about the disease only after Sobhana's death, says Ajitha Kathiradath, a cousin of the victim.

This year, Kerala has seen over 70 diagnosed cases of this amoeba, resulting in 19 deaths. Normally feeding on bacteria in warm freshwater, Naegleria fowleri can cause a near-fatal brain infection, known as primary amoebic meningoencephalitis (PAM).

Kerala began detecting cases in 2016, with typically one or two cases per year, most of which were fatal. Recent findings highlight the global rarity of the disease, with only 488 cases reported since 1962, primarily in the US, Pakistan, and Australia.

Yet in Kerala, survival rates seem to be improving. Last year, 39 cases were reported with a 23% fatality rate. This year, with nearly 70 cases, the mortality rate is about 24.5%. Health experts attribute this improvement to aggressive testing and early diagnosis.

Many infections arise from swimming in contaminated ponds, which is particularly concerning in a state with millions of wells and ponds. Public health authorities have chlorinated 2.7 million wells in response to the crisis, but challenges in enforcing water safety regulations remain.

As climate change impacts water temperatures, the risk of infection may rise. Experts warn that as conditions become more favorable for amoeba proliferation, the likelihood of exposure increases.

The crisis in Kerala offers an important lesson in public health and highlights the potential for rare pathogens to become more common as environmental factors shift. Increasing awareness and effective interventions remain crucial in the fight against this deadly microorganism.