A child likely died from a rare infection caused by a brain-eating amoeba after swimming in an eastern Nebraska river, health officials said, making it the second such probable death in the Midwest this summer and raising the question of whether climate change is playing a role.

The Douglas County Department of Health based in Omaha, Nebraska, reported Wednesday that doctors believe the child died of primary amebic meningoencephalitis, a usually fatal infection caused by the naegleria fowleri amoeba. Health officials believe the child came into contact with the amoeba on Sunday while swimming in the Elkhorn River just west of Omaha.

Last month, a Missouri resident died of the same infection likely caused by the amoeba at Lake of Three Fires in southwestern Iowa. Iowa officials closed the lake’s beach as a precaution for nearly three weeks.

The Centers for Disease Control and Prevention says naegleria fowleri infections are rare — there are about three cases in the United States every year — but that those infections are overwhelmingly fatal.

The amoeba is typically found in southern states because it thrives in waters that are warmer than 86 degrees Fahrenheit. But infections have migrated north in recent years, including two cases in Minnesota since 2010, Douglas County Health Director Dr. Lindsey Huse noted during a news conference Thursday. However, scientists cannot say with certainty that the Nebraska case is directly attributable to climate change.

Health officials recommend that freshwater swimmers plug their noses, avoid putting their heads underwater and avoid activities such as water skiing and tubing, which could force water into the nose, eyes or mouth. You cannot be infected by drinking contaminated water.

Reporting by Margery A. Beck and Josh Funk for the Associated Press