Brain-Eating Amoeba Surge in Kerala: Miltefosine Therapy Lifts Survival Rate to 24% Against Global 3%
Brain-Eating Amoeba Surge in Kerala: Miltefosine Therapy Lifts Survival Rate to 24% Against Global 3%
State records 24% survival rate in Primary Amoebic Meningoencephalitis cases, far above global average of under 3%
Kerala is battling a surge in infections caused by Naegleria fowleri, the so-called “brain-eating amoeba”, which leads to Primary Amoebic Meningoencephalitis (PAM)—a rare but usually fatal brain infection. In 2025 alone, the state has reported 69 confirmed cases, including 19 deaths.
Globally, PAM has a mortality rate of over 95%, but Kerala’s survival rate has improved to about 24%. Experts credit this remarkable progress to early diagnosis, stronger supportive care, and the inclusion of the drug miltefosine in treatment protocols.
Miltefosine, originally developed as an anti-parasitic drug, is being deployed in Kerala as part of early combination therapy, alongside amphotericin B and other antimicrobials. While no globally standardised regimen exists, Kerala doctors are adapting recommendations from the US CDC. Typical adult dosing involves 50 mg three times daily for 28 days or longer, with weight-adjusted doses for children. Crucially, it is always given as part of a drug cocktail plus intensive ICU support.
Several factors explain Kerala’s improved outcomes:
- Rapid detection of PAM in patients with meningitis-like symptoms and freshwater exposure.
- Combination therapy with multiple anti-amoebic agents to attack the infection from different angles.
- Enhanced hospital care, including monitoring brain swelling and managing seizures.
- Public health measures, such as chlorination drives and awareness campaigns, which help in both prevention and early medical presentation.
The amoeba typically enters through the nose while swimming in warm freshwater, attacking brain tissue within days. Since its first detection in Kerala in 2016, initial cases were almost universally fatal. But with greater awareness and aggressive testing, outcomes are improving.
Globally, only 488 PAM cases have been recorded since 1962, mostly in the US, Pakistan, and Australia with 95% ending in death. Kerala’s strategy now stands out as a rare success story.
“This year, cases are rising but deaths are falling. Aggressive testing and early diagnosis have improved survival, a strategy unique to Kerala,” said Dr. Aravind Reghukumar, head of infectious diseases at Thiruvananthapuram Medical College.
Disclaimer: Experts caution that miltefosine is not a cure-all and can have side effects, but when used correctly, it improves survival chances significantly. Moving forward, authorities stress that prevention through safe water practices, combined with medical readiness, is key to containing the threat.
