A Central North Carolina teenager is critically ill with a rare brain infection caused by an amoeba typically found in warm freshwater. The case was announced Thursday, but as of Friday afternoon, there were still no public answers about where the teen may have been exposed or whether that water is still being used.

WRAL asked the North Carolina Department of Health and Human Services where the teen may have been exposed, whether the suspected water source is still being used and what the state is doing to educate families about the risk.

“NCDHHS is coordinating closely with our federal partners at the CDC as well as our local health departments to investigate all possible sources of this Naegleria fowleri case,” the agency said in a statement Friday.

Naegleria fowleri is a microscopic organism found naturally in warm freshwater, including lakes, ponds and rivers. It can cause primary amebic meningoencephalitis, or PAM, when water containing the amoeba enters the nose and travels to the brain. The infection progresses rapidly and is usually fatal.

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The amoeba cannot be eliminated from the natural environment, according to DHHS. And testing a body of water is not as simple as determining whether it is safe or unsafe.

Joe Brown, a researcher at the UNC Gillings School of Global Public Health, said current testing methods are complex, expensive and require sophisticated laboratory equipment. Testing for the organism is not currently part of routine water surveillance.

Brown and other researchers are working on a faster, cheaper option.

“We would like to see an inexpensive $20 test for Naegleria fowleri that can be completed in a couple of hours,” Brown told WRAL in an interview Friday.

Such a test could eventually help researchers and public health agencies better understand when and where the amoeba is present and identify potential hot spots or spikes in concentration, Brown said. The research is still in its early stages.

For Debra Moffat, the limitations of testing became clear after her 6-year-old son, Aven, died from PAM in 2021 after swimming in freshwater on private property.

Moffat told WRAL Friday that her family asked the state to test the water after Aven became sick. She said the state instead told the family to assume Naegleria fowleri could be present in freshwater.

But Moffat also recognizes the limitations of a single test. Water conditions can change with temperature, rainfall and time, meaning a sample taken one day may not reflect the risk later.

That is why she says prevention also requires better public awareness.

“We feel like we’re pretty well-educated people, and we had no idea about this amoeba,” Moffat said. “Had we known, I would never have let my child in fresh water.”

Brown agreed that education is an important part of reducing risk because people can change how they interact with warm freshwater.

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DHHS recommends that swimmers:

  • Keep freshwater out of the nose by using nose clips or keeping their heads above water.
  • Avoid jumping or diving into warm freshwater during periods of high water temperatures and low water levels.
  • Avoid stirring up sediment in shallow, warm freshwater.

People do not become infected by swallowing water containing Naegleria fowleri. The risk occurs when contaminated water enters the nose.

Since Aven’s death, his family has created Amazing Aven’s Quest for Amoeba Awareness. Moffat said the nonprofit has raised more than $1.2 million for education, research, earlier diagnosis and potential treatments.

Now, with another North Carolina family facing the same rare infection, Moffat says awareness remains one of the few tools families have.

“Families have a right to know of the risk that’s in freshwater,” Moffat said. “You only can do so much with the knowledge that you have.”