Environmental biomass management: The overlooked key in the mitigation of amoebic meningoencephalitis in Kerala, India

Amoebic meningoencephalitis (AME), caused by thermophilic free-living amoebae such as Naegleria fowleri (the causative agent of primary amoebic meningoencephalitis, PAM), Acanthamoeba spp ., Vermamoeba vermiformis, and Balamuthia mandrillaris, is emerging as a critical yet underrecognized environmental health challenge in Kerala, India. This communication hypothesizes the ecological drivers associated with AME in Kerala and highlights the potential role of environmental biomass management as a preventive public-health strategy. The relationships discussed are largely based on ecological associations and are intended to generate hypotheses rather than establish direct causality. While N. fowleri is the primary etiological agent of PAM, other free-living amoebae are included to provide broader ecological context, as they share similar environmental niches and public-health relevance. The disease, acquired primarily through nasal exposure to contaminated freshwater, reflects not only microbial risk but also ecological conditions that may favour the proliferation of free-living amoebae, potentially increasing the likelihood of human exposure to infection. Unmanaged organic biomass, derived from decomposing vegetation, algal mats, and anthropogenic waste, creates nutrient-enriched microhabitats that support microbial biofilms, thereby providing trophic support for pathogenic amoebae. Kerala’s tropical hydrology, coupled with post-monsoon warming and sewage inflow, amplifies this risk. Current public-health responses remain reactive, emphasizing clinical management rather than environmental prevention. Routine surveillance of aquatic ecosystems using microbial and physicochemical indicators, supported by district-level diagnostic capacity and community-based action, is urgently needed. Integrating environmental biomass management, through desilting, eutrophication control, and wastewater regulation, into local water governance may serve as an effective and sustainable preventive intervention, although region-specific validation is required. Reframing AME as an ecological disease within a One Health governance framework aligns disease prevention with environmental sustainability, offering a replicable model for managing emerging environmentally acquired pathogens in tropical ecosystems.