Cases of the fatal brain-eating amoeba, first spotted in Kerala in 2024, continue to rise in the state as yet another person – a 17-year-old boy in Thiruvananthapuram has been detected with the infection. The total cases of amoebic meningoencephalitis now stand at 67 with 18 deaths, according to Integrated Disease Surveillance Programme data on September 14.

The boy contracted an infection from a pool after he took a bath with his friends. Post the diagnosis, the Kerala health department has closed the swimming pool at Akkulam Tourist Village and has sent water samples for testing.

What is amoebic meningoencephalitis?

Naegleria fowleri, also referred to as brain-eating amoeba, can cause Primary Amebic Meningoencephalitis (PAM). It is named after Malcolm Fowler, who described the earliest reported cases of N. fowleri PAM in 1965 in Australia.

The first reported case of the brain-eating amoeba was in May 2024 when a five-year-old girl was diagnosed with the infection. In the same year, a 13-year-old girl and two 14-year-old boys were diagnosed with the disease. None of the four children could survive the infection. The five-year-old girl had bathed in a local river, according to PubMed Central.

The biggest risk factors

“The amoeba usually lives in warm freshwater such as lakes, ponds, rivers, and unchlorinated swimming pools. It can also be found in hot springs and poorly maintained water systems. The infection occurs when water containing the amoeba enters the nose. Once inside, the amoeba travels to the brain and causes a life-threatening infection called primary amoebic meningoencephalitis (PAM),” Dr Swati Rajagopal, Consultant – Infectious Disease & Travel Medicine, Aster CMI Hospital, Bangalore, told Financial Express.com.

All over the world, 381 cases of the rare brain infection have been reported, and the number of reported cases increased by 1.6% each year from 1965 to 2016, according to the CDC.

The infection can lead to extensive cortical hemorrhage, tissue necrosis, and edema of the brain tissue, with the olfactory bulb and cerebellum being the most affected parts, according to PubMed Central.

“The symptoms appear within a few days after exposure. Early signs include headache, fever, nausea, vomiting, and general discomfort,” says Dr Rajagopal.

The expert adds that as the infection progresses, people may experience stiff neck, confusion, loss of balance, seizures, and hallucinations.

“The disease advances rapidly, often leading to death within a week or two if not treated promptly. Because symptoms resemble other common illnesses like flu or meningitis, early diagnosis can be difficult,” she adds.

Kerala Health Minister Veena George has said people need to be aware about the water safety and sanitation, as the disease grows rapidly in the state.

“We have to create a strong defence against amoebic meningoencephalitis. We must ensure that we do not wash our face or take a bath in stagnant or polluted water, including water bodies where cattle are bathed,” she said.

The Minister advises people to keep their water storage facilities at home clean, as the amoeba enters the brain through nose.

How to prevent the deadly infection

“Prevention is the most effective way to protect yourself. Avoid swimming or diving in warm, stagnant freshwater. Use nose clips if you swim in lakes or rivers. Do not put your head underwater in hot springs or untreated water. Always ensure swimming pools are properly cleaned and chlorinated. Avoid water-related activities in areas with poor sanitation or unknown water quality,” says Dr Rajagopal.

If you develop symptoms such as headache, fever, or nausea after swimming in freshwater, seek medical attention immediately. Early treatment with specific medications can improve the chances of survival, though success is limited, says the expert.

Dr Praveen Gupta, Chairman – Marengo Asia International Institute of Neuro & Spine (MAIINS), Marengo Asia Hospitals Gurugram, says the disease progresses very fast and it’s important to reach the hospital as soon as possible.

Can it be treated?

Treatment is challenging because the infection progresses rapidly, but doctors may use a combination of strong medicines.

“Amphotericin B, an antifungal drug, is considered the mainstay and is sometimes given directly into the fluid around the brain and spinal cord. A newer medicine called miltefosine has also shown promise when used early,” says Dr Tushar Tayal, Associate Director, Internal Medicine, CK Birla Hospital, Gurugram.

“Other supportive treatments aim to reduce brain swelling, control seizures, and maintain vital functions. Despite these efforts, the infection has a very high fatality rate worldwide, which makes prevention the best protection,” adds Dr Tayal.