Kerala, an Indian state located in the south and famous for its backwaters and green scenery, is now in the midst of increasing fear. Five individuals—children as young as three months old—have died in the last month alone due to a rare but deadly infection referred to as amoebic meningoencephalitis. The infection, brought on by "brain-eating" amoebae present in tainted water, has shocked the region and attracted worldwide attention to the dangers represented by emerging pathogens.

The newest victim, 56-year-old Malappuram district resident Shobhana, died on September 9 while receiving critical care at Kozhikode Medical College Hospital (MCH). Only a few days ago, another patient, Ratheesh, from Sulthan Bathery had passed away. Three others—a three-month-old infant, a nine-year-old girl, and a 52-year-old woman—also perished in the recent weeks. At least 11 other patients, including children, are still under observation at the state's biggest tertiary care center.

Why This Infection is So Lethal?

The perpetrator is neither a virus nor a bacterium, but free-living amoebae like Naegleria fowleri, Acanthamoeba, and Balamuthia mandrillaris. These are microscopic organisms that live in hot, stagnant freshwater and inadequately maintained sources like rivers, ponds, and untreated wells. The disease occurs in two forms:

Primary Amoebic Meningoencephalitis (PAM): Due to Naegleria fowleri, commonly referred to as the "brain-eating amoeba." It enters via the nose, migrates along the olfactory nerve, and directly infects brain tissue. Symptoms—headache, fever, nausea, stiff neck, seizures—rise within days, frequently terminating in death.

Granulomatous Amoebic Encephalitis (GAE): Due to Acanthamoeba and Balamuthia, these infections spread more slowly, reaching the brain via blood through inhalation or skin injury.

Worldwide, amoebic meningoencephalitis has a case fatality of as much as 97 percent. Infections were rare, having been first reported by India in 1971. But in the past two years, Kerala has witnessed a surge: 36 confirmed cases and nine deaths in 2023 alone, a sharp contrast to eight in the six years that had transpired.

What concerns professionals is not only the increasing figures but also systemic failures. Kerala's public health activists mention lack of coordination between state authorities, local health bodies, and hospitals. There is no unified database available that records confirmed cases, recoveries, or deaths, making health workers and the population oblivious.

Drugs essential in the treatment of patients are not produced locally and have to be imported, in most cases resulting in delays in treatment. Kozhikode MCH officials confirmed that drugs for specialty have been ordered from overseas, but medical practitioners assure that prognosis is still bleak, particularly among patients with comorbid conditions.

Has Climate Change and Environmental Factors Increases Risk Of Infection?

Why is Kerala seeing such an upsurge now? Scientists and doctors think that climate change could be responsible. Temperature increases and unpredictable rainfall patterns are leading to more stagnant water bodies where amoebae can grow.

Dr. Abdul Rauf, a pediatric intensivist from Baby Memorial Hospital at Kozhikode, says that most recent cases have had delayed onset of symptoms—sometimes two weeks—are indicative of other amoebae like Acanthamoeba or Balamuthia as the causative agents. He further states that dirty water with high coliform content, associated with sewage and poor drainage, also raises chances of infection.

This brings into question larger environmental issues. With fast development, poorly designed drainage systems, and houses located near waste disposal grounds, citizens are being subjected to situations that could trigger the spread of unusual pathogens.

Fear and Changing Habits

In northern Kerala—specifically Malappuram, Kozhikode, and Wayanad districts—people are going out of their way to shun ponds and rivers. Parents don't want to let children swim, and villages have gone so far as to declare temporary prohibitions against bathing in communal water bodies. The fear is palpable: each new case contributes to a sense of vulnerability, given how low the survival rates are.

Kerala notched up its very first survivor of PAM in July 2024—a boy of 14 from Kozhikode who became one of only 10 known survivors globally. Although that was celebrated as a rare triumph, it highlighted how slim the chances of survival are.

While amoebic meningoencephalitis is uncommon, Kerala's outbreak highlights a global reality: climate-sensitive diseases once relegated to "medical curiosities" are no longer only found in textbooks. With freshwater sources heating up and sanitation infrastructure coming under strain, more communities around the world may be vulnerable.

For public health officials, the Kerala crisis is a reminder that rapid response, early detection, and open data-sharing are not choices—the choice is lifesaving. For residents, it's a stern call to re-think common interactions with natural water sources.

Kerala's health department has now launched special treatment protocols, pressed local governments to keep a watchful eye on water quality, and stepped up awareness campaigns. Experts caution, however, that these steps need to go beyond firefighting. Long-term investment in sanitation, drainage, and access to clean water will be critical.

Worldwide, experts emphasize the immediate need for stronger surveillance and increased investment in treatment for free-living amoeba infections. Treatments available today are restricted and in some cases, experimental. A more powerful drug pipeline, in addition to prevention with measures such as chlorination of water supplies and improved environmental sanitation, may decrease mortality.

India’s RT-PCR testing system is capable of detecting the Bundibugyo strain of the Ebola virus, and the chances of missing a confirmed infection are very low when standardized protocols are followed, said health experts after the suspected Ebola case in Bengaluru involving a Ugandan woman tested negative.

The woman, who arrived in Bengaluru from Kampala, Uganda, on May 23, was suspected of Ebola infection after developing mild symptoms including body ache. She was shifted from a hotel to the state-run Epidemic Diseases Hospital on May 26, and her samples were sent to the National Institute of Virology (NIV), Pune. The tests today returned negative. India currently has no reported case of Ebola, the Health Ministry said.

Let’s take a look at how testing for Ebola takes place in India’s virology labs.

Speaking to HealthandMe, Dr. NK Ganguly, former Director General of ICMR, said that RT-PCR remains the confirmatory test for Ebola infection, while rapid diagnostic tests (RDTs) are mainly used for initial screening with limited sensitivity — of around 85-89 per cent.

According to him, the World Health Organization recommends that RT-PCR should only be carried out in specialized reference laboratories due to biosafety requirements. India currently has two designated Ebola reference laboratories — the National Institute of Virology (NIV), Pune, and the National Centre for Disease Control (NCDC).

"The Altona RT-PCR kit is the real star and is highly standardized. It rarely misses Ebola cases when proper protocols are followed,” Dr Ganguly said.

Can India Detect The Bundibugyo Strain?

Bundibugyo is one of the strains of the Ebola virus currently linked to outbreaks in parts of Africa, including Uganda and the Democratic Republic of the Congo (DRC). The rare strain has caused over 900 cases and more than 200 deaths.

Dr. Ganguly said the incubation period for the Bundibugyo strain can range from six to seven days up to 15 days or even three weeks.

“If a person tests RT-PCR negative during this period, the chances of being infectious are lower. However, isolation is still necessary because there may be a short window period during which the infection may not be detected,” he said.

The expert added that travelers arriving from outbreak-hit countries should remain under quarantine even if their initial Ebola test is negative.

Why Ebola Testing Is Complicated

Dr. Ganguly explained that Ebola belongs to the filovirus family, which includes several strains such as Bundibugyo, Sudan, Taï Forest and Zaire viruses.

He noted that Ebola has a high fatality rate, with nearly 50 per cent of infected individuals dying from the disease. He added that the virus can spread through several body fluids including tears, saliva, milk and urine.

In the early stages, Ebola symptoms can resemble flu, malaria or other viral illnesses, including fever, cough, sore throat, headache, diarrhea, skin rashes and body ache, making early diagnosis difficult.

Dr. Ishwar Gilada, a Mumbai-based infectious disease expert, told HealthandMe that the Bengaluru patient’s symptoms were similar to common viral infections, which is why epidemiological history and travel exposure become critical in suspecting Ebola infection.

“The symptoms of Ebola can be a little confusing because they are just like any other flu,” Dr. Gilada said, adding that travelers arriving from Ebola-affected countries should remain under observation for up to 21 days.

Are There Any Limitations In India’s Ebola PCR Testing?

Dr. Jatin Ahuja, Consultant, Infectious Diseases, Indraprastha Apollo Hospital, Delhi, told HealthandMe, there are no major loopholes in India’s Ebola PCR testing system, but there are certain limitations common to all diagnostic tests.

"One key limitation is the timing of testing. If RT-PCR is performed very early in the infection, there is a possibility of a false-negative result because the viral RNA levels may still be too low for detection," he said.

Dr. Ahuja also pointed out that test accuracy depends on whether the PCR targets are correctly aligned with the specific Ebola strain being tested. Improper alignment may reduce sensitivity.

He added that pre-analytical factors such as sample collection, storage, transport and RNA extraction also influence the final test outcome.

“Negative Ebola PCR substantially reduces concern, but interpretation always depends upon the clinical picture, travel history and exposure risk,” Dr. Ahuja said.

Hypertension is the “number one killer” in India, with nearly 1.6 million people dying from the condition every year, said Dr. Ambuj Roy, Professor of Cardiology at the All India Institute of Medical Sciences, New Delhi, today.

Speaking to media persons on hypertension, Dr. Roy said the deaths “linked to high blood pressure are five times higher than tuberculosis fatalities and exceed the combined toll of communicable diseases such as TB, malaria, dengue, and HIV”.

Calling hypertension a “silent but deadly disease,” he said most people remain unaware they have high blood pressure because symptoms are often absent.

“Ninety per cent of the time, hypertension does not cause symptoms. The only way to detect it is through regular screening,” he said.

Dr. Roy also cited the ICMR and NFHS-5 data showing that nearly 30 crore Indians are living with hypertension.

According to him, one in four adults in rural India and one in three adults in urban areas have the condition. However, “only one in three people know they are hypertensive, one in five receive treatment, and just one in twelve achieve proper blood pressure control below 140/90 mmHg”.

Lifestyle Changes Surging Hypertension Risk

Dr Roy said lifestyle changes are driving the growing burden of hypertension in India. Poor diet, obesity, physical inactivity, air pollution, stress, and poor sleep habits are major contributors, particularly among younger people.

He highlighted excessive salt intake as a key concern. While the recommended salt intake is less than 5 grams per day, average consumption in India is around 12 grams daily. He also stressed the importance of potassium-rich foods such as fruits and vegetables, noting that most Indians fail to consume the recommended 400 grams of fruits and vegetables per day.

Pollution: An Emerging Concern

Further, the Cardiologist linked pollution exposure to rising hypertension rates. Referring to studies conducted by AIIMS in collaboration with IIT Delhi, Dr. Roy said areas exposed to crop burning showed a 15 per cent higher prevalence of hypertension.

Another study found that every 10 microgram increase in PM2.5 levels was associated with a 5 per cent higher risk of hypertension.

How To Reduce Hypertension

Dr. Roy said reducing blood pressure by just 10 mmHg can significantly lower the risk of

• cardiovascular mortality by 20 per cent,
• stroke 28 per cent,
• heart failure by 28 per cent,
• coronary artery disease by 17 per cent,
• mortality by 13 per cent.

He also referred to the “TOPSPIN trial,” a large Indian hypertension study, which found that a single-pill combination therapy using two medicines reduced blood pressure by 30–40 mmHg and helped nearly 70 per cent of patients achieve blood pressure control.

The expert stated that around 70 per cent of patients may require long-term treatment or may need it lifelong. However, for nearly 30 per cent of people, hypertension can be reduced by stopping medication through:

• sustained lifestyle changes
• weight loss,
• low-sodium diets,
• exercise,
• better sleep.

‘Do Not Stop BP Medicines Abruptly’

Importantly, Dr Roy cautioned people against stopping blood pressure medicines abruptly once readings improve.

“Blood pressure is controlled because of the medicine. If you stop it suddenly, BP can rise sharply and may trigger a brain stroke or hemorrhage,” he said.

Dr. Roy also dismissed fears around side effects of antihypertensive medicines, calling them among the safest long-term drugs available. “The only side effect they have is benefits,” he remarked, adding that these medicines reduce the risk of heart attack, stroke, and kidney failure.

To reduce blood pressure naturally, the expert advised people to

• remain physically active for at least 150 minutes per week,
• reduce processed and salty foods,
• maintain hydration during heatwaves,
• adopt DASH-style diets rich in fruits and vegetables.

The American Cancer Society (ACS) has updated its colorectal cancer testing guidelines, which bring new screening options for colorectal cancer. This will give the Americans two new options of stool-based tests and blood-based screening tests.

The ACS recommended colorectal cancer screening for citizens as the risk of the disease starts at the age of 45 and continues through age 75 for those with a life expectancy of 10 more years. Thus, to make colorectal cancer tests more accessible to the masses, the new guideline gives nod to blood-based screening tests and FDA-approved new stool sample kits.

Blood-based screening tests must be done in a doctor's office, while one can use stool sample kits for testing at home. Notably, colonoscopy is still the most accurate option for detecting colorectal cancer.

The new guidelines acknowledged the fact that people are likely to choose the most effective colorectal cancer screening test. But still about 20 million eligible Americans remained untested, according to the ACS.

ACS mentions that 1 in 5 colorectal cancer cases is seen in young adults; the new guidelines were a direct result of this huge problem. Though the one who will choose colonoscopy would only have to go through screening every 10 years, on the other hand, the gap between screenings will be every one, three, or five years, depending on the specific method of testing selected.

Early Symptoms Of Colorectal Cancer

Some of the most commonly missed early signs include:

• Persistent changes in bowel habits, especially if they last more than a few days, must be taken seriously. Narrow or ribbon-shaped stools may indicate a tumor partially blocking the colon.
• Blood in the stool is one of the most common and concerning signs. While it might be due to hemorrhoids or fissures, it’s important not to assume. A proper evaluation is critical.
• Unexplained weight loss: Especially when unintentional.
• Abdominal cramps or bloating: Misinterpreted as common digestive issues.

Ignoring such a red flag delays diagnosis and drastically reduces treatment success rates. A timely visit to a healthcare provider can change outcomes.

How To Prevent Colorectal Cancer?

• Diet: More fibre-rich fruits, vegetables, and whole grains; less processed food and red meat.
• Physical activity: “Even 30 minutes of daily walking helps.”
• Screenings: Especially vital for those over 45 or with a family history.