Kerala is facing a significant public health challenge due to a rise in the number of cases of Primary Amoebic Meningoencephalitis (PAM); there have been 77 confirmed cases and 21 deaths so far.
The government is implementing mass awareness campaigns and preventive measures, focussing on improving sanitation and water quality.
Rajeev Jayadevan, Convenor, Research Cell, Kerala State Indian Medical Association said, “Meningoencephalitis is an infection of the brain, a serious condition that can cause severe disability or death. Most cases are due to bacteria or viruses, with only a minority caused by fungi, parasites, or amoebae. In India, published papers suggest over 600,000 cases a year and more than 50,000 deaths. Despite routine investigations, in about 70 per cent of patients, the exact cause remains unknown.”
Earlier studies from India have suggested that 1-7 per cent of these undiagnosed cases may, in fact, be amoebic. The problem is that amoebic meningoencephalitis (sometimes referred to as brain-eating amoeba) is missed unless specific tests are performed, and in many centres they are not routinely done. Kerala has recently changed its protocols to include direct microscopic examination of cerebrospinal fluid for amoebae. As a result, several cases have now been correctly identified, which otherwise would have been labelled “unknown” or “viral”, he said.
For individuals, he said the best preventative strategy is to avoid forcing water into the nose while swimming or bathing or for other purposes. The nasal cavity is complex, with small chambers where water can get trapped. From there, amoebae can sometimes cross into the brain through a tiny piece of bone called the cribriform plate. Multiple studies confirm the nasal route as the entry point for brain infection.
The death rate for amoebic meningoencephalitis worldwide remains high, largely because diagnosis is delayed or made only after death, during post-mortem. Kerala’s experience shows that when detected early and treated promptly, there is a good chance of survival, he added.
Veena George, Health Minister, said that there is no cluster of PAM cases this year, compared to 2024 when it was linked to a common water source. The government has issued strict instructions to investigate every meningoencephalitis case and directed doctors to check the cause. All districts have microbiology lab facilities for testing for PAM, she said, adding that higher detection is leading to more cases being classified as PAM instead of encephalitis.
Published on September 23, 2025
