Kerala is grappling with an unusual and deadly public-health challenge. Over the past two years, the state has seen a steep rise in Amoebic Meningoencephalitis – a rare brain infection caused by the free-living amoeba Naegleria fowleri, often dubbed the “brain-eating amoeba.” Health department data and multiple media reports indicate that, as of mid-October 2025, Kerala has recorded 109 confirmed cases and 25 deaths, making it the most affected region in India’s history of this disease.
A Statewide Concern
The first confirmed case in Kerala was reported in March 2016 from Alappuzha district. For the next several years, the infection remained an obscure laboratory diagnosis, known only to a few neurologists and microbiologists. Between 2017 and 2023, only seven scattered cases surfaced across the state. Most were detected post-mortem, after patients died of what initially appeared to be bacterial meningitis or viral encephalitis.
That changed abruptly in 2024, when Kerala recorded 36 laboratory-confirmed cases, including nine deaths. Health officials noted that these infections were geographically dispersed — from coastal Alappuzha and Kollam to inland districts like Kottayam and Malappuram — suggesting environmental rather than local transmission.
By 2025, the situation had escalated dramatically. As of October, over 100 individuals had been infected and at least 25 had died, with the highest number of cases reported from Thiruvananthapuram, Ernakulam, and Kozhikode districts. The disease, once a medical rarity, is now being investigated as an emerging environmental health crisis in Kerala.
What Causes the Infection?
Amoebic Meningoencephalitis is caused by Naegleria fowleri, a microscopic organism found naturally in warm freshwater – ponds, lakes, rivers, and poorly maintained swimming pools. Infection occurs when contaminated water enters the body through the nose, usually while swimming, diving, or bathing. The amoeba then travels along the olfactory nerve to the brain, where it destroys brain tissue. Symptoms start within days and resemble bacterial meningitis: fever, headache, nausea, and neck stiffness. As the infection progresses, confusion, seizures, and coma set in rapidly. The disease is almost always fatal, global survival rates are under 5%.
Doctors in Kerala say the hot and humid climate, along with rising water temperatures and erratic rainfall patterns, may be creating ideal conditions for the amoeba to thrive. “We are seeing the effects of climate variability on waterborne pathogens,” said a senior microbiologist at Government Medical College, Thiruvananthapuram. “It’s not that the organism is new – our detection capacity and environmental exposure have changed.”
Why Kerala Is Seeing More Cases Now?
Kerala’s dense network of freshwater bodies, coupled with widespread recreational and domestic use of pond and river water, makes it especially vulnerable. Experts point to a combination of environmental and infrastructural factors:
Rising Temperatures: Water bodies across Kerala have recorded temperature increases of 1–2°C over the past decade, encouraging microbial proliferation.
Reduced Chlorination: Many public pools and rural water sources lack proper chlorination or periodic cleaning.
Increased Waterlogging: Post-monsoon stagnation of water in low-lying areas creates natural reservoirs for amoebae.
Improved Detection: Kerala’s upgraded microbiology labs and mandatory cerebrospinal-fluid testing have improved reporting accuracy.
In July 2025, the Mahatma Gandhi University inaugurated the state’s first water testing facility dedicated to amoebic surveillance, allowing rapid identification of Naegleria fowleri in environmental samples.
The Human Toll
The first cases of 2025 involved children and young adults who developed sudden fever and seizures after swimming in local ponds. One of the most publicized cases was that of a nine-year-old girl from Kozhikode, who died within 48 hours of admission. Her parents had no idea that the pond near their home could harbor such an organism. By August, reports from Kollam, Ernakulam, and Pathanamthitta confirmed multiple deaths in rapid succession. Panic spread as rumors circulated on social media about “brain-eating amoeba” in tap water, forcing the Health Department to issue public advisories. Officials clarified that drinking water is safe, as infection occurs only through the nasal route, not ingestion.
The state health minister, Veena George, urged people to avoid swimming in untreated freshwater bodies and to use nose clips while bathing in ponds or rivers. “We are monitoring the situation closely. All district surveillance units have been alerted, and diagnostic protocols have been standardized,” she said in a recent briefing.
Treatment and Research Efforts:
Treatment remains challenging. Once symptoms appear, the infection progresses rapidly. The antiparasitic drug Miltefosine, in combination with antibiotics and antifungal agents, offers some hope if administered early. Kerala hospitals have been stocking Miltefosine since mid-2024, following WHO advisories. A few patients have survived due to early recognition and aggressive therapy. Doctors credit the use of PCR-based diagnostic tests for faster confirmation. Research collaborations between the ICMR, state health services, and academic institutions are now underway to understand the ecology of Naegleria fowleri in Indian waters.
A few patients have survived due to early recognition and aggressive therapy. Doctors credit the use of PCR-based diagnostic tests for faster confirmation. Research collaborations between the ICMR, state health services, and academic institutions are now underway to understand the ecology of Naegleria fowleri in Indian waters.
