Rising Cases of PAM in 2025
Kerala is currently battling a surge of infections caused by Naegleria fowleri, the deadly “brain-eating amoeba.” So far in 2025, health authorities have reported 69 confirmed cases of Primary Amoebic Meningoencephalitis (PAM), resulting in 19 deaths.
Doctors attribute the higher survival rate this year to early detection and aggressive treatment, particularly the use of miltefosine in combination with other therapies.
What Is PAM and How It Spreads
Primary Amoebic Meningoencephalitis (PAM) is a rare but extremely fatal brain infection caused by Naegleria fowleri. The amoeba thrives in warm freshwater sources such as lakes, rivers, hot springs, and poorly maintained swimming pools.
As reported by India Today, infection usually occurs when contaminated water enters the nose while swimming or bathing. From there, the amoeba travels to the brain, triggering rapid and severe inflammation.
“Since this year, there has been a concerning rise in reported cases, with 19 deaths recorded — almost double the number compared to last year,” says Dr. Manisha Arora, Director of Internal Medicine, CK Birla Hospital, Delhi.
Recognising Early Symptoms
PAM can be difficult to distinguish from other forms of meningitis in its early stages.
“Patients may develop intense frontal headache, high fever, nausea, vomiting, and photophobia. Within days, neurological changes such as seizures, hallucinations, altered mental status, and neck stiffness can appear,” says Dr. Girishkumar Soni, Neurology Consultant, Lilavati Hospital, Mumbai.
Symptoms progress rapidly due to cerebral oedema and brain tissue necrosis. Laboratory findings typically show high cerebrospinal fluid pressure, neutrophilic pleocytosis, elevated protein levels, and low glucose.
Doctors can make an early diagnosis by identifying Naegleria fowleri in a wet mount CSF sample. Dr. Soni stresses that a high index of suspicion is necessary, especially in patients with a recent history of swimming in warm freshwater or poorly chlorinated pools.
Aggressive Early Treatment With Miltefosine
Kerala doctors now administer miltefosine alongside amphotericin B and other standard medicines as soon as they suspect PAM, significantly improving survival chances.
Miltefosine is typically given orally — 50 mg two to three times a day for adults, with weight-based dosing for children. Supportive care focuses on reducing intracranial pressure and managing cerebral oedema.
“Miltefosine is most effective if started within the first 24–48 hours of symptoms. Once irreversible brain tissue damage occurs, survival rates drop sharply. Rapid diagnosis and prompt initiation of combination therapy are essential,” explains Dr. Soni.
Side Effects and Access Challenges
While effective, miltefosine can cause gastrointestinal side effects such as nausea, vomiting, abdominal pain, and diarrhoea. It may also affect liver and kidney function, requiring regular monitoring. The drug is teratogenic, making it unsafe for pregnant women, and must be used cautiously in patients with liver or kidney disease.
Access to miltefosine can also be challenging. In India, it is primarily approved for treating visceral leishmaniasis (kala azar), so emergency supply for PAM cases may face delays and cost barriers.
Prevention: The Best Defence
Experts agree that prevention remains the most effective strategy.
Dr. Arora advises avoiding swimming or bathing in untreated ponds, rivers, or unclean pools. Using nose clips in freshwater may reduce the risk of infection.
Maintaining proper chlorination of pools and water sources is crucial. Public health authorities also stress the importance of awareness campaigns to educate people about safe water practices and early symptom recognition.