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Just before of a major festival, one 45-year-old female resident rested shaking in the back, slipping into consciousness as relatives transported her to a medical college hospital.

Just days earlier, the patient, who earned her living bottling beverages in a rural area near a city, had experienced nothing more serious than dizziness and high blood pressure. Medical professionals provided medication and discharged her. But her state spiraled with alarming speed: uneasiness gave way to high temperature, fever to severe shivers, and on 5 September, she succumbed.

The cause was Naegleria fowleri – referred to as the brain-destroying organism – an infection commonly ingested through the nose in untreated water and so infrequent that healthcare workers never encounter a case in their lifelong practice.

Within the state in the current period, over 70 people tested positive and a number of lost their lives from the infection. Cases spanned from a baby to an elderly person.

Usually feeding on organisms in non-chlorinated water, this single-cell organism leads to a life-threatening condition, known as primary amoebic meningoencephalitis (PAM). It enters during immersion when bathing and swiftly attacks brain tissue.

This region started identifying cases in the past decade, just one or two a year, and until recently the majority were fatal. A new report has indicated that only 488 occurrences have been recorded globally since the mid-20th century – mostly in the United States, South Asia and Oceania. And 95% of the victims have succumbed from the disease.

However locally, patient outcomes appears to be enhancing: in the previous year there were several dozen cases with a twenty-three percent death rate, and in the present period, nearly 70 instances have been documented with approximately 24.5% fatality. Medical experts say the increase in figures indicates improved diagnosis, due to modern facilities.

"Infections are growing but fatalities are dropping. Proactive diagnosis and early diagnosis have enhanced survival – a method unique to Kerala," said a senior medical doctor.

Timely identification enables personalized care: a combination of medications of antimicrobials and anti-inflammatories targeting the amoeba can save lives.

Scientists have discovered about 400 varieties of free-living amoebae, but only six are recognized to infect humans in people – including Naegleria fowleri and Acanthamoeba, which can infect the brain. In Kerala, medical facilities can now diagnose the multiple key pathogenic types, authorities say.

Kerala's extensive use on natural sources and ponds renders it especially at risk, particularly since a lot of ponds and wells are unsafe. A localized outbreak of infections recently, for example, was tied to people consuming a substance diluted in non-potable water – a dangerous habit that underscores how unsafe water can act as a vehicle for infection.

Kerala has nearly countless water wells and numerous ponds – and many residents draw their daily water from these sources alone. That pervasiveness renders it unfeasible to disinfect wells or ponds as basic "risk factors" – they are the lifeblood of living in the area.

"Some infections have occurred in people bathing in ponds, some from recreational water, and even through ritual cleansing with untreated water which is a custom," explains a prominent epidemiologist.

So health officials have tried to respond at scale: in a mass effort at the last month, 2.7 million water sources were chlorinated.

Authorities have installed sign boards around ponds warning against bathing or swimming and used the health regulations to mandate frequent treatment of recreational water and storage containers. But even with such measures, natural bodies cannot practically be chlorinated – fish would die – and policing all community pond in a region of more than a large population people is impractical.

Experts now emphasize awareness instead of restrictions: residents are encouraged to clean water containers, use treated warm water for nasal ablutions, keep children away from irrigation devices and avoid unsafe water sources. Swimmers are recommended to cover their nasal passages by keeping their heads above water, using equipment and preventing agitating bottom material in standing water.

However, managing risks between alerting the people about real risks – of using non-sterile water – and averting anxiety that could affect daily life is difficult. Various {