Already challenged by the Nipah virus, Kerala’s health system faced a significant test between June and September this year when several sporadic cases of the deadly primary amoebic meningoencephalitis (PAM) were reported from many parts of the State. S.R. Praveen travels to Navaikulam in rural Thiruvananthapuram, where a few cases were reported, to explore the nature of water-borne amoebic infections and the evolving treatment protocols