On hot summer days, people may often go for a swim in a beautiful lake or river to cool off from the heat. And while heat isn’t always a good friend to the body, another danger might be also lurking in the warm summer waters, making some lakes dangerous to swimmers. Naegleria fowleri is a brain-eating amoeba that thrives in soil and freshwater, and typically enters the body through the nose and travels to the brain, where it can cause a deadly infection called primary amebic meningoencephalitis (PAM). This infection damages brain tissue, and may ultimately prove fatal. As a result, medical experts advise against exposing your nose when swimming in freshwater.

Fortunately, PAM is a very rare infection, with less than 10 cases each year in the United States, according to the Centers for Disease Control and Prevention (CDC). However, survival rates among infected individuals are low, and death may occur within five days after the start of symptoms. Explore spoke exclusively with the Chief Medical Officer of One Oak Medical Group, Dr. Jason Singh, who confirmed the rarity and deadliness of this amoeba.

“I think it’s important to know that Naegleria fowleri is [an] extremely rare (3-8 US cases annually) but almost always fatal brain infection when forced water entry through the nose allows it to migrate along nerves directly into brain tissue,” he explains. “The death comes from hemorrhagic necrosis which is the body’s inflammatory response to it.” Dr. Singh also underscores that keeping water out of your nose is the key to avoiding the infection. “The prevention should focus entirely on avoiding nasal water exposure,” he advises.

Read more: The Lake That Many Call The Most Dangerous In America

Saving yourself from the brain-eating Naegleria

man covering his nose with his hand in the pool - Koldunova_anna/Getty Images

Keeping the water out of your nose remains the major preventive move against Naegleria fowleri. But as Dr. Jason Singh explains, that’s the only way it can enter your system. “One thing to note is that they cannot infect through drinking, skin contact, or vapor inhalation,” he notes.

It’s recommended to wear nose clips or hold your nose if you’re going into a lake or hot spring. It’s also helpful to keep your head above water as much as possible, and avoid stirring up the water, because the organism also lives in soil sediment. As for people who might want to flush their sinuses, it’s also essential to avoid using untreated tap water for your nasal irrigation. You should only use distilled or sterile water, though boiling your water and using it after it cools may also work.

However, despite the fact that those who contract this infection often succumb to it, early treatment might still give them a fighting chance. As Dr Jason Singh reveals, “Early recognition is critical as symptoms (severe headache, high fever, altered smell/taste) begin 1-9 days post-exposure, and while treatment rarely succeeds, early intervention with amphotericin B has saved a few patients.”

More ways to stay cautious during your freshwater adventures

A person’s gloved hand holds a beaker containing liquid above a watery surface - Melnikov Dmitriy/Shutterstock

Before you dive into a lake, experts suggest that you should assume that the water contains the brain-eating amoeba. If the weather has been hot, or the water level is low, it might be safer to engage in alternative water activities, such as kayaking or boating. If you do go into the water, avoid diving or jumping; otherwise, you should just stick to chlorinated pools.

As a general precaution for swimming in freshwater, it may help to avoid touching your nose after swimming until you’ve thoroughly washed your hands with soap or an alcohol-based hand rub. Make sure any kids who have been swimming do the same, since it’s been discovered that most infection cases have occurred among children and especially young boys. “Keep in mind again that the statistical risk remains extraordinarily low for recreational water users who take basic nasal protection precautions, though children and young adults should be especially careful as they represent most cases due to their water activity patterns,” Dr. Jason Singh tells Explore.

It’s worth noting that most casess of this infection are found in the southern U.S., although it’s also been found across Indiana, Iowa, Nebraska, and Minnesota, among other states. It is believed that climate change could be playing a role, as warmer water conditions create more growth opportunities for this brain-ravaging amoeba. This is more reason why everyone needs to stay informed, no matter where you live in the United States.

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