A North Carolina teenager's death from a rare 'brain-eating amoeba' infection is drawing fresh attention to the early symptoms of a disease that can initially resemble more common illnesses before rapidly becoming life-threatening.
Moises Ponce Mendoza, 17, died on 31 August after contracting Naegleria fowleri, an amoeba that can cause primary amoebic meningoencephalitis (PAM), a devastating brain infection. North Carolina health officials said a water feature at El Futuro, a community-based organisation in Durham County, was the most likely source of exposure, although investigators could not conclusively establish where Mendoza became infected.
What Happened to Moises Ponce Mendoza?
Mendoza's case illustrates how quickly the infection can escalate.
Investigators said he reportedly had contact with El Futuro's outdoor water feature on 13 August, including splashing water on his face. He developed a severe headache days later and first visited an emergency department on 21 August after experiencing the symptom for two days.
He returned the following day as his condition worsened and was admitted to hospital. Laboratory testing confirmed Naegleria fowleri on 26 August. He died five days later.
Health officials investigated several possible exposure locations. However, evidence ultimately pointed towards El Futuro's water feature as the most likely source. Testing detected Naegleria fowleri DNA in water from its fountain storage tank.
The feature was closed on 28 August and remains closed to the public.
What Are the Early Brain-Eating Amoeba Symptoms?
The early symptoms of Naegleria fowleri infection can be difficult to distinguish from other illnesses, including bacterial meningitis.
According to the US Centers for Disease Control and Prevention (CDC), initial PAM symptoms can include a severe headache, fever, nausea and vomiting. Symptoms usually begin about five days after exposure but can appear anywhere from one to 12 days later.
As the infection progresses, patients can develop a stiff neck, confusion, seizures, hallucinations and coma. The CDC advises seeking medical attention immediately for sudden fever, headache, vomiting or a stiff neck, particularly following recent exposure to warm freshwater.
PAM progresses extremely quickly. Death typically occurs around five days after symptoms begin, although the CDC says it can occur between one and 18 days after symptoms first appear.
How Does Naegleria Fowleri Reach the Brain?
Naegleria fowleri naturally lives in warm freshwater, including lakes, rivers and ponds. Infection occurs when contaminated water enters the nose, allowing the amoeba to travel to the brain.
Importantly, people do not become infected by swallowing contaminated water, and the infection cannot spread from one person to another.
In rare cases, infections have been associated with inadequately chlorinated recreational water or contaminated water used for nasal rinsing.
How Rare Is a Brain-Eating Amoeba Infection?
Despite its severity, Naegleria fowleri infection remains exceptionally rare.
North Carolina health officials said only 167 cases were reported nationwide between 1962 and 2024, with typically fewer than 10 people diagnosed with PAM in the US each year.
The prognosis, however, is extremely poor. The CDC says more than 97 per cent of people who develop PAM have died from the infection, with only four survivors among the 167 US cases recorded between 1962 and 2024.
Health officials say reducing the risk includes preventing warm freshwater from entering the nose, particularly when jumping or diving, and using distilled or properly boiled water for nasal rinsing.
