A central North Carolina teenager is critically ill with a rare infection caused by an amoeba commonly found in warm freshwater, state health officials said Thursday. To protect the family's privacy, no identifying information was released.

The North Carolina Department of Health and Human Services said the teen has an infection caused by Naegleria fowleri, a microscopic organism that can damage the brain. NCHHS did not say where the teen was in the water to encounter the amoeba, but Naegleria fowleri poses a danger to anyone who swims in warm lakes, rivers or ponds.

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"The first thing I would say about Naegleria infections is that they are very uncommon," said Dr. David Weber, an infectious disease specialist at UNC Health. Fewer than 10 cases are typically reported each year in the United States.

Infection can happen when contaminated water is forced up the nose, such as when someone dives or jumps into warm freshwater. The amoeba is not found in salt water or in properly maintained and chlorinated swimming pools or water parks, according to health officials.

“Our hearts go out to this teen’s family, friends and loved ones as they navigate this difficult time,” State Epidemiologist Dr. Zack Moore said.

Although rare, Naegleria infections spread quickly and are often deadly.

"It does carry a very high mortality, meaning over 95%, because it's directly involving the brain, and we don't have very good therapies," Weber said. "It's also difficult to diagnose. We do have molecular tests, but again -- in something that is such a rare disease, it starts with fever and headache and nausea and vomiting -- this is not what would come to the first thing in your mind as the possible cause of those symptoms."

Moore said the latest case of infection should serve as a reminder that the amoeba is found in North Carolina and elsewhere in the United States.

"The risk of drowning is much, much higher than getting a Naegleria infection," Weber said.

Warmer weather means more amoeba in warm, fresh water

Infections are more likely during long stretches of hot weather, when water temperatures rise and water levels fall. The amoeba grows best in warm water and can survive at temperatures as high as 115 degrees.

Weber said, "We may start seeing this in warmer temperatures moving up the coast and into states that are more northern, much like we see the organism Vibrio vulnificus, which is in salt water, can enter through wounds on the arm, has been steadily moving up the coast, starting in Florida and now going as far as New York."

No easy way to warn families when danger is present

In theory, Weber said, the state could monitor the levels of Naegleria fowleri in water. But because it is almost always present in the mud and rare in the water, there is no widespread warning system other than the advice to avoid getting water in your nose when swimming in freshwater ponds or lakes.

"We don't really have a system of really looking for it in the water that would allow us to tell people, much like, you know, Don't go to a beach. We have unsafe beach conditions from fecal coliforms. We really don't monitor for this in ponds and lakes," Weber said.

Health officials emphasize that infections from the amoeba are extremely rare, but Debra Moffat said families who have lost loved ones to PAM take issue with that description.

Moffat's son, Aven, died in 2021 after contracting PAM. He was just 6 years old.

"You can ask anyone who has been affected by this amoeba, and we hate the word 'rare,'" Moffat said. "It's probably the one thing that drives us the most crazy, because it's rare until it happens to you."

Moffat said she believes taking a swim in freshwater is not worth it.

"We put our kids in car seats, and we put them in life jackets when they're on boats," she said. "Swimming in freshwater is a risk that's not necessary."

While treatments and therapies for PAM are limited, Moffat said she remains hopeful and encouraged by ongoing research to better understand the infection.

NCDHHS offered these safety measures for those who want to cool off in lakes or ponds:

  • Prevent water going up your nose by holding your nose shut or use nose clips
    • Keep your head above water when swimming or playing freshwater.
      • Avoid putting your head under water in hot springs and thermal waters.
        • Avoid jumping or diving in warm freshwater during periods of high water temperatures and low water levels.
          • Avoid digging in or stirring up the sediment of lakes, ponds or rivers.