A North Carolina teenager who died after contracting a rare brain infection caused by a microscopic amoeba was most likely exposed through contact with a water feature at a local community center, according to state health officials.
The teen, identified by his family as 17-year-old Moises Ponce Mendoza, died on Aug. 31, four days after health officials reported he was critically ill and undergoing treatment for the infection. The rare brain infection is caused by Naegleria fowleri, an amoeba that is commonly found in warm freshwater.
An investigation could not conclusively determine where the teen was exposed, according to a report released by the North Carolina Department of Health and Human Services on Sept. 15. But health officials said interviews
and environmental testing indicated that a water feature at El Futuro, a community-based mental health care center in Durham County, was the most likely source.
The water feature was closed on Aug. 28 by the Durham County Department of Health and later tested positive for Naegleria fowleri at the Centers for Disease Control and Prevention. The water feature remains closed to the public, according to health officials.
"NC Department of Health and Human Services and Durham County Public Health informed El Futuro that testing identified the presence of Naegleria fowleri in a water feature at our green space," the mental health care center said in a statement.
"Our hearts are broken for the young boy who lost his life and for his family," the statement continued. "We are committed to supporting his family and our community through this devastating loss. We will continue to fully cooperate with public health officials."
Public health investigation trace possible exposure locations
According to the state health department’s report, investigators interviewed family members to trace possible exposure locations, including sites where he may have been swimming or in contact with warm freshwater.
The family told investigators that the teen had gone swimming with family and friends at an apartment complex pool on Aug. 11 and Aug. 17 and had planned visits to two ponds on Aug. 5 and Aug. 6, though it was unclear whether he actually visited or swam in the ponds, the report states.
During a follow-up interview, family members identified another potential exposure site at El Futuro, where the teen reportedly had contact with a garden water feature on Aug. 13, including splashing water on his face, according to the report.
On Aug. 28, the Durham County Health Department advised El Futuro to close the water feature while investigators examined all potential exposure sites. The water feature was subsequently drained "to ensure it would not be used," the report states.
Health officials described the water feature as an interactive, manmade creek with a recirculating water system, multiple fountains, a play water pump, and a fire hydrant-style fountain. The mental health care center reported that the water feature was maintained through power washing and hand-fed chlorination.
During the inspection, investigators found algal growth throughout the creek as well as organic material and debris surrounding the pump system and covering the filter, according to the report. Testing later detected non-viable Naegleria fowleri DNA in the mental health care center's fountain storage tank water.
"While this investigation does not allow us to conclusively determine the location of exposure, the epidemiologic, laboratory, and environmental findings suggest that the El Futuro water feature was the most likely source," the report states. "The lack of effective disinfection, visible algal growth, and detection of non-viable N. fowleri from the water feature support this conclusion."
What happened to the North Carolina teen?
Health officials said the teen initially went to an emergency room on Aug. 21 with a severe headache that had persisted for two days. He returned the following day as his condition worsened and was admitted to the hospital.
"Upon hospital admission, Naegleria infection was suspected due to reports of freshwater swimming exposure and neurological presentation," the report states. Laboratory testing confirmed it was a Naegleria fowleri infection on Aug. 26, and the teen died on Aug. 31.
The teen's mother, Monica Mendoza, said her son became severely ill after developing intense headaches, according to a GoFundMe page. She said she took her son to the hospital after his symptoms became severe and the family was sent home following a brief examination.
Monica Mendoza took her son to the University of North Carolina Hospital's emergency department the next morning after his symptoms worsened, according to the GoFundMe page. She said her son was placed in a coma as doctors worked to treat the brain infection.
How does the brain-eating amoeba cause infection?
Naegleria fowleri is commonly found in warm freshwater, including lakes, ponds, and rivers. Health officials say it does not cause illness when swallowed.
The danger occurs when contaminated water enters the nose, allowing the amoeba to travel to the brain and cause primary amebic meningoencephalitis, or PAM, an extremely rare but often fatal disease, according to the CDC.
Symptoms typically begin about five days after exposure, though they can appear anywhere from one to 12 days later, according to the North Carolina Department of Health and Human Services. Early symptoms include severe headache, fever, nausea, and vomiting.
Symptoms can quickly worsen, progressing to a stiff neck, seizures, and coma before often leading to death within about five days.
"These rare infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels," the state health department said in a news release. "Naegleria fowleri grows best at higher temperatures up to 115°F."
The CDC says fewer than 10 cases are reported in the United States each year, and more than 97% of people who develop the infection die. Naegleria fowleri infections are "very rare, with only 167 cases reported nationally between 1962 and 2024," according to the state health department.
The North Carolina case follows the death of an 8-year-old girl in Louisiana, who died on Aug. 22 after contracting a Naegleria fowleri infection. State health officials said she may have been exposed while swimming in a Louisiana lake.
Contributing: Anthony Thompson and Melina Khan
This article originally appeared on USA TODAY: Teen's brain-eating amoeba infection likely linked to water feature
