On the eve of Onam, Kerala’s most celebrated festival, 45-year-old Sobhana lay unconscious in an ambulance, her life slipping away as her family rushed her to a hospital. Just days earlier, the fruit juice bottler from Malappuram district had complained of dizziness and high blood pressure. Doctors prescribed medication, but her condition deteriorated rapidly, culminating in her death on September 5. The cause? Naegleria fowleri, the brain-eating amoeba, a rare but deadly pathogen that enters the body through the nose during freshwater activities.
This year, Kerala has reported over 70 cases of Naegleria fowleri infections, with 19 fatalities. The victims range from a three-month-old infant to a 92-year-old man. The amoeba, which thrives in warm freshwater, causes primary amoebic meningoencephalitis (PAM), a near-fatal brain infection. Since 2016, Kerala has seen a gradual increase in cases, though global numbers remain low, with only 488 reported since 1962, primarily in the US, Pakistan, and Australia. The disease has a staggering 95% fatality rate.
Despite the grim statistics, Kerala has made strides in combating the infection. Improved detection methods and early diagnosis have reduced the fatality rate from 23% last year to 24.5% this year. ‘Aggressive testing and customised treatment with antimicrobials and steroids have saved lives,’ says Dr. Aravind Reghukumar, head of infectious diseases at Thiruvananthapuram Medical College.
Kerala’s heavy reliance on groundwater and natural water bodies makes it particularly vulnerable. Contaminated ponds and wells have become conduits for the amoeba, with some cases linked to risky practices like vaping boiled cannabis mixed with pond water. Public health campaigns have chlorinated 2.7 million wells and posted warnings around ponds, but enforcing these measures across the state’s 5.5 million wells and 55,000 ponds remains a challenge.
Scientists warn that climate change exacerbates the risk, with warmer waters and rising temperatures creating ideal conditions for the amoeba. ‘Even a 1°C rise can trigger its spread,’ says epidemiologist Prof. Anish TS. Despite Kerala’s progress, the global implications are clear: climate change may be reshaping the map of disease, turning rare pathogens into growing threats.