A North Carolina teenager died from a Naegleria fowleri infection, and state health officials say the most likely source was not a lake or a river — it was a water feature at a community center in Durham.
The case has renewed attention on a question public health agencies track every summer: which states actually record the most infections from the so-called brain-eating amoeba, and whether that map is starting to shift.
Naegleria fowleri is a single-celled organism found in warm freshwater. It enters the body through the nose, typically when someone swims or dunks their head in warm water. It cannot be spread from person to person and is not contracted by drinking contaminated water.
Infections are exceedingly rare. But when the amoeba reaches the brain, it causes primary amebic meningoencephalitis, or PAM, which is almost always fatal. Symptoms can look like ordinary meningitis at first — headache, fever, nausea, stiff neck — and typically appear within about five days of exposure.
That rarity is exactly why the geographic pattern matters. Historically, the largest share of U.S. cases has been recorded in warm-weather states, with Texas and Florida consistently at or near the top of the count. Other states with multiple documented cases include Arizona, California, Arkansas, Louisiana, Oklahoma, and South Carolina.
The Durham case stands out for its setting. Community center splash pads and decorative fountains recirculate warm water, which can create conditions the amoeba favors if the water is not properly treated and monitored. Health officials have been explicit that they have identified the water feature as the likely source, not a confirmed one, and that the investigation is ongoing.
A separate question is what the case count looks like over time. Cases in northern states that once seemed anomalous have drawn attention from researchers studying how warming freshwater bodies may be expanding the organism's range. Health agencies stress that the overall risk to any individual remains very low.
The CDC advises people to avoid nasal contact with warm untreated freshwater, to hold the nose shut or use nose clips when jumping into warm lakes and rivers, and to avoid digging in or stirring up sediment in shallow warm water.
What the state-by-state map shows for the current year — and where the newest cluster of cases sits — is still being tallied.