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(NEW YORK) — A North Carolina teenager has died after contracting a rare brain-eating amoeba called Naegleria fowleri that’s found in warm freshwater, state health officials said.

The teenager, whose identity was not released, died on Monday, the North Carolina Department of Health and Human Services said on Tuesday.

“We extend our condolences to the family, friends and community impacted by this loss,” the department said in a statement.

NCDHHS said last Thursday that the teenager was critically ill and that “once symptoms start, the disease progresses rapidly and usually causes death within about five days.”

Naegleria fowleri can be found in warm freshwater including ponds, lakes and rivers, and it grows best in hotter water, state health officials said. NCDHHS said Monday that it’s working with federal and local partners “to investigate all possible sources” of this case.

“The amoeba does not cause illness if swallowed but can be fatal if water with the amoeba in it is forced up the nose into the brain, which can occur by jumping into water, diving, water-skiing or other water activities,” NCDHHS said.

The U.S. usually sees fewer than 10 cases a year of Naegleria fowleri infection, also known as primary amebic meningoencephalitis or PAM, state health officials said.

The first symptoms can be severe headache, nausea, vomiting and fever, and later symptoms include stiff neck, seizures and coma, NCDHHS said.

Another girl, 8-year-old Lillian Smart in Louisiana, died in August from Naegleria fowleri, which she likely contracted while swimming in a lake, her family and state health officials said, according to The Associated Press.

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