Current Situation in Kerala

• Kerala has reported around 69 confirmed cases of Naegleria fowleri infection in 2025, with 19 deaths so far.
• The infection is known as Primary Amoebic Meningoencephalitis (PAM) — extremely rare but highly fatal.
• Unlike global trends (~97% fatality), Kerala has achieved improved survival (~24%) due to early detection and aggressive treatment.

 

The Organism & Infection Route

• Causative agent: Naegleria fowleri, a free-living amoeba.
• Habitat: warm freshwater — ponds, lakes, rivers, hot springs, untreated wells, and poorly maintained swimming pools.
• Mode of infection:
• Water containing the amoeba enters the nose, often during swimming, bathing, diving, or nasal cleansing.
• The amoeba travels along the olfactory nerves, crosses the skull base (cribriform plate), and reaches the brain.
• Not transmitted by: drinking contaminated water or human-to-human contact.
• Incubation period: 1-9 days before symptoms appear.

 

Clinical Features

Early symptoms (resemble viral/bacterial meningitis):

• Severe headache
• Fever
• Nausea and vomiting
• General malaise

Progressive symptoms (neurological):

• Stiff neck
• Confusion and disorientation
• Seizures
• Hallucinations
• Loss of balance
• Coma and rapid deterioration

Diagnosis

• CSF (cerebrospinal fluid) analysis:
• High neutrophil count (like bacterial meningitis)
• High protein, low glucose
• Wet-mount microscopy: motile amoebic trophozoites sometimes visible.

Definitive tests:

• PCR on CSF/tissue
• Immunofluorescence assays
• Culture in specialized labs

Key challenge: PAM is often mistaken for bacterial/viral meningitis unless clinicians suspect it after
recent freshwater exposure

Treatment

• No guaranteed cure — survival remains rare globally.
• Medications tried:
• Amphotericin B (IV + sometimes intrathecal)
• Miltefosine (an anti-parasitic showing promise in survivors)
• Rifampicin, azithromycin, fluconazole
• Supportive measures: aggressive ICU care, controlling intracranial pressure.
• Kerala’s outcome: some improvement in survival due to early use of miltefosine + supportive care

 

Public Health Response in Kerala

Government actions:

• Regular chlorination of swimming pools, tanks, and wells.
• Testing community water sources
• Public advisories on safe bathing practices
• Rapid referral protocols to tertiary hospitals with diagnostic capacity

Pattern of cases:

• Cases are sporadic across districts in 2025, not confined to one outbreak.
• Affected population: all age groups (infants to elderly).

 

Prevention Measures

For Individuals:

• Avoid swimming or diving in warm, stagnant freshwater.
• Use nose clips or keep head above water when swimming
• Do not use tap or well water for nasal rinsing/neti pots unless it is:
• Boiled and cooled, or
• Distilled/sterile, or
• Properly filtered.
• Maintain private water tanks and ensure regular cleaning + chlorination .

For Communities/Policy:

• Routine chlorination of public water bodies and wells .
• Awareness campaigns to explain nasal route of infection.
• Strengthened surveillance & diagnostics at district and tertiary hospital levels.

Research & Challenges

• Why hard to control: amoeba naturally occurs in freshwater — cannot be fully eliminated.
• Research focus;
• Rapid diagnostics (PCR, point-of-care tests)
• Development of new anti-amoebic drugs.
• Clinical protocols for aggressive therapy
• Kerala’s uniqueness: proactive detection and management have improved survival, making it a case study for other regions.

 

CONCLUSION

• Rare but deadly: Naegleria fowleri infection is almost always fatal if untreated.
• Kerala alert: ~69 cases, 19 deaths in 2025 so far.
• Survival possible: Early diagnosis + aggressive therapy (miltefosine, amphotericin B, supportive care) are critical.
• Best defense: Prevention through safe water practices and strong public health measures.