A teenager in central North Carolina is critically ill from a rare brain infection caused by an amoeba found in warm freshwater, state health officials confirmed Thursday. The patient's identity has not been released, and officials are still investigating where the exposure occurred.
The North Carolina Department of Health and Human Services (NCDHHS) announced the case, noting that once symptoms begin, the disease progresses rapidly and is usually fatal within about five days. The amoeba, Naegleria fowleri, is found naturally in warm freshwater such as lakes, ponds, and rivers, and can cause primary amebic meningoencephalitis (PAM) when contaminated water enters the nose and travels to the brain. NCDHHS emphasized that swallowing the water does not cause illness; the risk comes from water being forced up the nose during activities like jumping, diving, or water-skiing.
The S. typically sees fewer than 10 cases per year of this infection, according to state health officials. Early symptoms include severe headache, nausea, vomiting, and fever, which can progress to stiff neck, seizures, and coma.
NCDHHS is coordinating with the Centers for Disease Control and Prevention (CDC) and local health departments to investigate all possible sources of the infection. As of Friday afternoon, no public details were available about where the teen may have been exposed or whether that water source is still in use.
The amoeba cannot be eliminated from the natural environment, and testing water for it is not straightforward, officials said. Joe Brown, a researcher at the UNC Gillings School of Global Public Health, explained that current testing methods are complex, expensive, and require sophisticated laboratory equipment. Testing is not part of routine water surveillance, but Brown and colleagues are working on a more accessible option—an inexpensive $20 test that could yield results within a couple of hours. Such a tool, he said, could eventually help researchers and public health agencies identify when and where the amoeba is present, and spot potential hot spots. The research is still in early stages.
Debra Moffat, whose 6-year-old son Aven died from PAM in 2021 after swimming in freshwater on private property, described her family's experience. She said they asked the state to test the water after Aven fell ill, but were told to assume the amoeba was present. Moffat acknowledged that a single test has limitations, as water conditions change with temperature, rainfall, and time, but she stressed that better public awareness is essential. "We feel like we're pretty well-educated people, and we had no idea about this amoeba," she said. "Had we known, I would never have let my child in fresh water."
Brown agreed that education is key to reducing risk, as people can adjust how they interact with warm freshwater. NCDHHS recommends keeping freshwater out of the nose with nose clips or keeping the head above water, avoiding jumping or diving into warm, shallow water during high-temperature, low-water periods, and avoiding stirring up sediment in shallow warm areas.
Moffat emphasized that awareness remains one of the few protective tools families have. "Families have a right to know of the risk that's in freshwater," she said. "You only can do so much with the knowledge that you have."
Earlier this month, an 8-year-old girl in Louisiana, Lillian Smart, died from Naegleria fowleri after likely contracting it while swimming in a lake, according to her family and state health officials, as reported by The Associated Press.