North Carolina Teen Critically Ill With Rare Brain-Eating Amoeba Infection: What Officials Say About Freshwater Risk

A teenager in central North Carolina is critically ill after developing a rare brain infection caused by Naegleria fowleri, a microscopic amoeba that can live in warm freshwater, state health officials said.

The teenager’s identity and further medical details have not been released. The North Carolina Department of Health and Human Services said the case is still being investigated, including where the exposure occurred.

The infection is known as primary amebic meningoencephalitis (PAM). It is extremely rare in the United States, with fewer than 10 cases typically reported in a year.

How the infection happens

Naegleria fowleri is naturally found in warm freshwater, including lakes, ponds and rivers.

The key risk is not drinking the water.

The amoeba can cause infection when contaminated water enters the nose. From there, it can travel through the nasal passages to the brain and cause PAM. Activities such as diving, jumping into freshwater or water-skiing can increase the chance of water being forced into the nose.

The infection is not spread by swallowing contaminated water, according to North Carolina health officials.

Why the North Carolina case is drawing attention

The case comes only days after an 8-year-old Louisiana girl, Lillian Smart, died after developing the same infection. Health officials and her family said she likely contracted Naegleria fowleri while swimming in a lake.

The two cases do not indicate that the amoeba is spreading from person to person.

Instead, both highlight the risk associated with exposure to warm freshwater during the summer months.

CDC research has found that U.S. PAM cases are generally associated with recreational exposure to warm, untreated freshwater, particularly during summer. Fewer than eight cases are reported annually in the United States in most years.

What symptoms should people watch for?

PAM can progress quickly.

Early symptoms can include severe headache, fever, nausea and vomiting. As the infection progresses, symptoms can include a stiff neck, seizures, confusion and coma.

North Carolina health officials said the disease usually progresses rapidly once symptoms begin and can lead to death within about five days.

Because the illness is so rare, early symptoms can resemble other forms of meningitis, making prompt medical evaluation important when there has been a recent warm-freshwater exposure.

How can swimmers reduce the risk?

North Carolina health officials recommend taking steps to prevent warm freshwater from entering the nose.

People can:

• Use nose clips or hold their nose shut when entering warm freshwater.
• Avoid jumping or diving into warm freshwater.
• Keep their head above water when possible.
• Avoid stirring up sediment in shallow, warm freshwater.
• Exercise additional caution when water temperatures are high and water levels are low.

The CDC similarly recommends avoiding recreational activity in warm freshwater when possible and taking precautions to prevent water from entering the nose.

The source of the North Carolina exposure remains unknown

For now, officials have not identified where the teenager encountered Naegleria fowleri.

That means there is no confirmed lake, river or other body of water associated with the North Carolina case based on the information released so far.

Health officials have also not announced any broader public-health exposure site connected to the patient.

The case remains a reminder that while Naegleria fowleri infections are exceptionally uncommon, warm freshwater can carry a small risk during periods of high temperatures.

Important: A person cannot get PAM simply by swallowing water containing the amoeba, and the infection does not spread between people through ordinary contact.