Tejal Somvanshi
A teenager in central North Carolina is critically ill with a rare brain infection caused by a microscopic amoeba found in warm freshwater. The infection, called primary amebic meningoencephalitis or PAM, began after water entered the teen’s nose during water activities in a freshwater lake or river.
The same parasite, *Naegleria fowleri*, claimed the life of an 8-year-old girl in Louisiana. Lillian Smart from Ruston died over the weekend of August 22–23, just days after being hospitalized. She had likely contracted the infection while swimming in Lake Claiborne in north Louisiana. Her parents, Daniel and Rebecca Smart, had organized a community fundraiser for her eighth birthday on August 21, before her death. Louisiana’s governor, Jeff Landry, said he was “heartbroken” at the loss. This marks Louisiana’s first confirmed case since 2013.
State epidemiologist Dr. Zack Moore explained that while Naegleria fowleri infections are extremely rare, the amoeba is naturally present in warm freshwater across North Carolina and the United States. The infection triggers severe symptoms: intense headache, high fever, nausea, and vomiting, which can progress to a stiff neck, seizures, and coma. Most people with this infection die within roughly five days. The United States typically sees fewer than ten cases each year.
Dr. David Weber from UNC Health emphasized the severity. The organism carries a mortality rate exceeding 95 percent and directly attacks the brain. He noted that the risk of drowning in fresh water is far more common than Naegleria infection, but when infection does occur, it is nearly always fatal.
Debra Moffat, whose six-year-old son Aven died from the infection in 2021, pushed back against calling these cases rare. “I hate the word ‘rare,'” she said.
The amoeba thrives in warm water, surviving at temperatures up to 115 degrees Fahrenheit. It becomes dangerous to swimmers when water exceeds 77 degrees, which is why most infections occur during summer months in the southern United States. The infection cannot spread from person to person. The CDC has detected the organism in warm freshwater lakes, rivers, canals, and ponds throughout the country, though they do not routinely test environmental water samples.
Between 1937 and 2025, roughly 180 confirmed Naegleria infections have been documented in the United States, nearly all of them fatal. Recent cases have appeared in Maryland, Indiana, and Minnesota. Last year, a twelve-year-old boy from South Carolina died from the infection.
The infection occurs when contaminated water forces its way up the nose—typically during diving, jumping, or vigorous water play—rather than through drinking or skin contact. It does not occur in salt water or properly chlorinated pools.
To reduce risk, the CDC recommends using nose clips or holding your nose shut while in water, keeping your head above the surface, and avoiding warm freshwater during hot weather when water levels drop. People should also avoid stirring up sediment on lake or river bottoms and refrain from jumping or diving into warm freshwater.
The North Carolina case and Louisiana’s loss occurred within days of each other. While Naegleria infections remain statistically uncommon across the nation, they remain a serious concern for families and public health officials during warm summer months.
