Recent news about Primary Amoebic Meningoencephalitis (PAM), caused by the brain-eating amoeba Naegleria fowleri, highlights a concerning outbreak in Kerala's Kozhikode district.

• The health department has issued alerts after three consecutive cases were reported there recently. Among the patients are a 9-year-old girl who died, a critical 3-month-old baby, and a 40-year-old man currently under treatment at Kozhikode Medical College. Tests found the amoeba in water sources around one patient's home, raising public health concerns.
• PAM is a rare but almost always fatal infection with a mortality rate exceeding 95%.
• It primarily affects young and active individuals, caused by amoeba present in warm freshwater; infection occurs when contaminated water enters the nose, allowing the amoeba to reach and destroy brain tissue.
• While treatment options are limited and survival is rare, early diagnosis and prompt administration of specific antimicrobial drugs can sometimes improve chances of survival, as illustrated by a few known survivors globally. Preventive measures focus on avoiding freshwater exposure by vulnerable populations and maintaining proper chlorination of recreational water facilities.
• These recent cases have drawn attention to the need for improved awareness, early testing, and preventive strategies in affected areas, especially in Kerala, where the disease has seen an unusual surge this year.
• This outbreak and related information have been reported and updated through various credible sources including health departments and hospitals in Kerala as of August 2025.

About Primary Amoebic Meningoencephalitis

Primary Amoebic Meningoencephalitis (PAM) is a rare but usually fatal brain infection caused by the amoeba Naegleria fowleri, often referred to as the "brain-eating amoeba." This microscopic organism infects people when contaminated warm freshwater enters the body through the nose, commonly during swimming or diving in lakes, rivers, or warm freshwater bodies. The amoeba then travels through the olfactory nerves into the brain, where it destroys brain tissue, causing severe swelling and inflammation.

Key features of PAM include:

• It mainly affects children, teens, and young adults who are otherwise healthy.
• Symptoms typically appear 1 to 9 days after exposure and initially resemble bacterial meningitis — headache, fever, nausea, and vomiting.
• As the infection progresses, symptoms worsen with stiff neck, confusion, loss of balance, seizures, hallucinations, and coma.
• Disease progression is rapid and usually leads to death within about 5 days from symptom onset.
• PAM cannot be transmitted from person to person; infection occurs only by direct entry of contaminated water into the nose.
• Diagnosis is difficult as early symptoms mimic other forms of meningitis. It is confirmed by detecting the amoeba in cerebrospinal fluid or brain tissue using specialized tests.
• Prevention involves avoiding swimming in untreated warm freshwater during hot weather, using nose clips, and avoiding diving or forceful water entry into the nose.
• Treatment options exist but have limited success, with a very high fatality rate of approximately 95%.

If symptoms resembling meningitis appear shortly after freshwater exposure, urgent medical care is essential because early diagnosis may improve chances of survival.

Key Early Symptoms of PAM

The key early symptoms of Primary Amoebic Meningoencephalitis (PAM) to watch for usually begin about 1 to 12 days after exposure to the amoeba and often start around 5 days after infection. These early symptoms include:

• Headache
• Fever
• Nausea
• Vomiting
• Severe headache near the front of the head
• Sometimes changes in smell and taste

As the disease progresses rapidly, more severe symptoms can appear such as stiff neck, confusion, seizures, hallucinations, loss of balance, and coma. Because early symptoms resemble other illnesses like bacterial meningitis or viral infections, immediate medical attention is critical if someone suddenly develops fever, headache, vomiting, or stiff neck—especially if they have recently been exposed to warm freshwater where the amoeba thrives.
In summary, the earliest signs to watch for are headache, fever, nausea, and vomiting, with urgent care needed as symptoms escalate quickly to neurological problems. Early diagnosis and treatment may improve chances of survival given the aggressive nature of PAM.

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