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On the eve of a major festival, a 45-year-old woman was trembling in an ambulance compartment, drifting into unconsciousness as loved ones rushed her to a medical college hospital.

Only a few days earlier, the woman, who earned her living bottling beverages in a rural area near a city, had reported nothing more alarming than dizziness and hypertension. Physicians provided pills and sent her home. But her state deteriorated with alarming speed: uneasiness turned into high temperature, fever to violent shivers, and on 5 September, she succumbed.

The culprit was Naegleria fowleri – referred to as the brain-destroying organism – a condition commonly ingested through the nose in natural water sources and so infrequent that healthcare workers rarely see a occurrence in their professional lives.

Within the state this year, over 70 people tested positive and nineteen have died from the deadly organism. Patients spanned from a three-month-old to an elderly person.

Normally eating bacteria in warm freshwater, this single-cell organism leads to a life-threatening neurological disease, referred to as primary amoebic meningoencephalitis (PAM). It infiltrates via the nasal route while in water and rapidly damages brain tissue.

The state began detecting instances in recent years, a handful a annually, and until recently the majority were lethal. A latest analysis has indicated that just 488 instances have been reported internationally since the mid-20th century – mostly in the United States, South Asia and Australia. And almost all of the patients have succumbed from the disease.

Within the state, survival seems to be improving: last year there were 39 cases with a nearly one-quarter mortality, and in the present period, almost 70 cases have been documented with approximately a similar mortality. Medical experts explain the increase in numbers points to improved diagnosis, due to modern facilities.

"Infections are rising but fatalities are decreasing. Widespread screening and quick identification have boosted patient outcomes – a method unique to Kerala," noted an expert infectious diseases professional.

Prompt diagnosis allows customised treatment: a drug cocktail of antimicrobials and steroids fighting the amoeba can prevent deaths.

Experts have identified around 400 types of microorganisms, but just six are identified as cause disease in humans – like Naegleria fowleri and Acanthamoeba, which can infect the central nervous system. In Kerala, medical facilities can now diagnose the five key disease-causing varieties, experts state.

The southern state's significant dependence on natural sources and natural water bodies makes it highly susceptible, especially as numerous ponds and wells are contaminated. A group of infections recently, for instance, was tied to young men consuming an mixture mixed with non-potable water – a dangerous habit that underscores how contaminated water can become a conduit for infection.

Kerala has nearly millions of wells and tens of thousands of ponds – and many residents collect their everyday supply from these sources alone. That pervasiveness makes it impossible to manage wells or ponds as basic "dangers" – they are the foundation of living in the region.

"Some infections have occurred in people washing in ponds, some from chlorinated pools, and additionally through nasal rinsing with non-sterile water which is a religious ritual," says a leading specialist.

So health officials have tried to act broadly: in a single campaign at the end of August, 2.7 million water sources were treated.

Local governments have placed sign boards around ponds warning against water contact and implemented the Public Health Act to enforce frequent treatment of recreational water and storage containers. But even with such measures, natural bodies cannot realistically be chlorinated – fish would perish – and policing all community pond in a state of above millions of people is impractical.

Experts now stress public information over restrictions: families are urged to maintain tanks and pools, use clean boiled water for ritual rinsing, prevent kids from using outdoor water systems and refrain from untreated ponds. Swimmers are advised to protect their noses by keeping their heads above water, using protective gear and minimizing agitating debris in stagnant or untreated water.

Yet, striking a balance between informing the community about actual dangers – of using untreated freshwater – and preventing panic that could disturb daily life is challenging. Many {