Kerala on Alert: Rise in Rare Amoebic Brain Infections as 11-Year-Old Tests Positive

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Kozhikode, Kerala: An 11-year-old girl from Chelari in Malappuram, Kerala has been hospitalized after testing positive for a rare and often deadly brain infection called primary amoebic meningoencephalitis (PAM), according to authorities at Kozhikode Medical College. This alarming case adds to a growing cluster of reported infections and suspected deaths in the region, raising public health concerns across the state.

What Happened?

On Tuesday, the girl was admitted with a high fever to Kozhikode Medical College, where advanced tests confirmed an amoebic brain infection. “The child’s condition is stable, and treatment in line with approved medical guidelines has begun,” stated Dr. Arun Preet, Superintendent, Institute of Maternal and Child Health, Kozhikode Medical College. The health department has swiftly launched an investigation to identify how the infection was acquired, focusing on recent exposure to local water sources during the warm summer months.

What is Primary Amoebic Meningoencephalitis (PAM)?

Primary amoebic meningoencephalitis is an extremely rare but severe brain infection caused primarily by the free-living amoeba Naegleria fowleri. This organism thrives in warm, shallow freshwater—such as lakes, rivers, and poorly maintained swimming pools. Humans typically contract the infection when contaminated water enters the nose, allowing the amoeba to migrate to the brain, where it rapidly destroys brain tissue. Symptoms usually begin with headache, fever, nausea, and progress to stiff neck, confusion, and seizures. The infection is almost always fatal if not detected and treated promptly.

Recent Cases and Investigative Response

With the girl’s case, there are now three patients under treatment for suspected amoebic meningoencephalitis at Kozhikode Medical College: a three-month-old infant from Omassery, a 40-year-old man from Annassery, and the newly admitted 11-year-old. Tragically, a nine-year-old girl from Thamarassery succumbed to the disease on August 14. Officials also suspect the August 9 death of a 67-year-old woman in Malappuram was related to the same infection.

Since January 2025, Kerala has reported 20 suspected cases of PAM and six suspected deaths, according to state Integrated Disease Surveillance Programme (IDSP) data.

Tracing the Source

Epidemiologists have traced the 11-year-old’s possible exposure to bathing in a local stream near her home at Padat Alungal and using a public swimming pool on July 28. Upon her fever’s onset, she sought care from a family health center and a private hospital before being referred to the medical college as her symptoms worsened. “We have collected water samples from the local stream. Warning signs were placed, and authorities urged residents to avoid public waterbodies,” said Sreejith K M, Health Inspector at Tenhipalam.

Increased surveillance has ensued, with a fever survey conducted in 120 homes in the affected area to detect additional cases early.

Expert Commentary

“The rarity and lethality of PAM means clinicians and the public must stay vigilant—especially during peak summer months when people swim in natural waters,” explained Dr. Shirish Srinivasan, Consultant Neurologist (not involved in these cases). “Any sudden-onset fever, headache, or neurological symptoms following freshwater exposure should be evaluated promptly. Rapid diagnosis and aggressive anti-amoebic treatment can be lifesaving, though outcomes are still grim due to the infection’s aggressive nature.”

Dr. Mona Rajan, Infectious Disease Specialist, further remarks, “Unlike most brain infections, Naegleria fowleri doesn’t spread person-to-person or through drinking water. Nose-to-brain exposure is key, so even simple measures like using nose clips or avoiding submergence in warm freshwater can reduce risk.”

Broader Public Health Implications

These infections, though exceedingly rare, underscore the importance of environmental monitoring, timely public health warnings, and improving water safety standards—particularly in regions with high temperatures and widespread use of natural water bodies for bathing or recreation.

Local authorities have initiated public awareness campaigns and put up warning signs near water sources while suggesting the temporary closure of swimming pools or increased chlorination during outbreaks. The health department is also urging the public to remain alert, seek immediate medical attention for any concerning symptoms after water exposure, and to avoid swimming in warm, stagnant water bodies.

Limits of Current Knowledge

While Naegleria fowleri is well-documented as the main culprit in PAM, other amoeba species such as Balamuthia mandrillaris can also cause similar severe infections, though these are even rarer. It should be noted that not all suspected cases can be conclusively confirmed due to diagnostic limitations, especially post-mortem.

Epidemiologists caution that while case numbers in Kerala are relatively high this year, the actual risk to the population remains extremely low. Most people exposed to the amoeba do not develop illness, and improved water safety and awareness can further reduce the likelihood of infection.

What Can the Public Do?

Avoid swimming in warm, stagnant water bodies, especially during hot weather
Use nose clips or keep your head above water in freshwater ponds, lakes, or poorly chlorinated pools
Ensure public pools are well-maintained and properly chlorinated
Report symptoms such as sudden fever, headache, or confusion after water exposure to healthcare providers promptly

Medical Disclaimer

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.