Primary Amoebic Meningoencephalitis
Kerala’s Kozhikode district recently reported three consecutive cases of primary amoebic meningoencephalitis (PAM). One victim, a nine-year-old girl, died. Two others, including a three-month-old infant, remain critically ill. This rare and often fatal brain infection is caused by Naegleria fowleri, commonly called the brain-eating amoeba. The state has recorded eight cases and two deaths so far in 2025.
About Primary Amoebic Meningoencephalitis (PAM)
- PAM is a rare brain infection caused mainly by Naegleria fowleri.
- This amoeba thrives in warm fresh water and soil.
- Infection occurs when contaminated water enters the nose, allowing the amoeba to reach the brain.
- The disease progresses rapidly and is usually fatal. Symptoms include headache, fever, nausea, and neurological decline.
Transmission and Infection Routes
Naegleria fowleri enters the body through the nasal passages during activities like swimming or bathing in warm freshwater. However, recent cases suggest infection can occur without direct water exposure. The amoeba is also found in dust and soil, which may be a source of infection, especially in infants. Another genus, Acanthamoeba, can cause similar meningoencephalitis but has a longer incubation period and different transmission modes.
Incidence and Mortality in Kerala
Kerala reported its first PAM case in 2016. Since then, the number of cases has slowly increased. In 2024, Kerala recorded 36 positive cases with nine deaths. Globally, PAM has a fatality rate of 97 per cent, but Kerala has reduced this to 25 per cent through improved diagnosis and treatment. The first Indian survivor was a 14-year-old boy from Kozhikode in 2024, one of only 11 survivors worldwide.
Factors Contributing to the Rise in Cases
The rise in PAM cases in Kerala is linked to increased testing for acute encephalitis syndrome (AES), which includes amoebic meningoencephalitis. Environmental changes such as climate change and pollution may also contribute. Warmer temperatures favour the amoeba’s growth. The state has introduced a special treatment protocol and standard operating procedures for managing PAM, becoming the first in India to do so.
Diagnosis and Treatment Advances
Early diagnosis is critical but difficult due to the disease’s rarity and rapid progression. Molecular testing helps identify the specific amoeba causing infection. Kerala’s health authorities have improved diagnostic methods and treatment protocols. These include antifungal and antibiotic combinations and supportive care. Early intervention has improved survival rates in the state.
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