KOZHIKODE: Concern is mounting in the state as the death toll of amoebic meningoencephalitis continues to climb, touching five in just one month. Experts and health officials warn that inadequate coordination between departments and delayed interventions are hampering effective containment efforts, leaving both patients and the public vulnerable.
Shobhana, 56, of Thiruvali near Wandoor in Malappuram, is the latest victim of the rare but deadly brain infection. Diagnosed on September 6, she had been under critical care at Kozhikode Medical College Hospital (MCH) and passed away on Monday. Just two days ago, Ratheesh, a resident of Sulthan Bathery, died of the disease .
Three others died over the past few weeks: A three-month-old from Omassery in Kozhikode, Ramla, 52, from Malappuram, and a nine-year-old girl from Thamarassery, who died while receiving treatment at the Institute of Maternal and Child Health, Kozhikode. Eleven patients, including children, are under observation at the Kozhikode MCH.
Despite repeated alerts, there appears to be no consolidated data on total number of confirmed cases, recoveries or fatalities. Public health activists criticise the lack of coordination between the health department, hospitals and local bodies, pointing out that the absence of a unified strategy is prolonging the crisis.
Officials at Kozhikode MCH confirmed that specialised medicines are being procured from abroad to treat critically-ill patients. However, doctors acknowledge that treatment remains complicated, especially in patients with other health issues. Meanwhile, the health department has instructed local authorities to intensify preventive measures, such as monitoring water quality and raising awareness about potential sources of infection.
Amoebic meningoencephalitis is primarily caused by amoebae present in stagnant water, soil and poorly-maintained freshwater sources such as ponds, rivers and even contaminated wells.
The disease manifests in two major forms, Primary Amoebic Meningoencephalitis (PAM), triggered by Naegleria fowleri, which attacks brain cells directly, leading to severe swelling and tissue destruction and Granulomatous Amoebic Encephalitis (GAE), associated with amoebae like Acanthamoeba and Balamuthia mandrillaris, which typically reach the brain through the bloodstream after entering via inhalation or skin wounds. In recent years, a shift has been observed in the pattern of infections. While earlier cases were mostly linked to Naegleria fowleri and developed rapidly after exposure, current cases are showing delayed onset of symptoms, sometimes appearing two weeks post-infection.
Dr Abdul Rauf, a consultant paediatric intensivist at Baby Memorial Hospital, Kozhikode, said the delay may be due to the slower activity of Acanthamoeba and Balamuthia amoeba.
He said climate change, evolving characteristics of the amoebae and broader testing for encephalitis cases could also be driving the surge in diagnoses.Experts have highlighted that contaminated water sources are a major contributing factor. Amoebae are often detected in water with high coliform levels, suggesting contamination from sewage or septic systems. Poor drainage, coupled with houses built close to waste disposal areas, may be accelerating the spread.
An infectious disease specialist from Kozhikode noted that further research is urgently needed to determine why these amoebae are becoming more prevalent in Kerala’s environment. The rising toll has instilled fear in residents, especially in northern Kerala. With cases repeatedly reported from Malappuram, Kozhikode and Wayanad, people are increasingly cautious about bathing in ponds, swimming in rivers, or using untreated well water.
Public health experts warn that the state cannot afford delays in consolidating data, coordinating responses and conducting large-scale awareness campaigns. While medicines are being sourced and hospitals are preparing for additional cases, preventive strategies at the community level remain the most critical line of defence.