Naegleria fowleri: India’s silent waterborne menace
摘要
The free-living amoeba Naegleria fowleri causes primary amoebic meningoencephalitis (PAM), which has emerged as a significant public health threat in India, particularly in Kerala. As of October 2025, Kerala had 153 laboratory-confirmed cases and over 33 fatalities due to this highly fatal water-borne infection. This correspondence reviews the epidemiological trends, environmental risk factors and public health issues of the increasing prevalence of PAM in India. Literature search, surveillance data and public health guidelines were used to evaluate existing preventive and response measures. Results suggest that climate change, periodic flooding, warm water stagnation, poor chlorination and deteriorating water quality all play a role in the persistence and spread of Naegleria fowleri . The enhanced case detection due to improvements in surveillance and molecular diagnostic facilities, however, is a matter of concern because of delayed and underrecognition. Water safety measures, public awareness campaigns, and rapid public health interventions are important in preventing outbreaks, as evidenced by experiences in the United States, Pakistan, and Australia. To minimize avoidable deaths and enhance preparedness for outbreaks in India, it is crucial to strengthen diagnostic infrastructure, include amoebic risk management in flood preparedness programs and adopt a coordinated One Health approach.