Water-based diseases

Waterborne diseases are caused by pathogenic microorganisms which are directly transmitted when contaminated fresh water is consumed. Contaminated fresh water, used in the preparation of food, can be the source of foodborne disease through consumption of the same microorganisms. According to the World Health Organization, diarrheal disease accounts for an estimated 4.1% of the total DALY (diability-adjusted life year)  global burden of disease and is responsible for the deaths of 1.8 million people every year. It was estimated that 88% of that burden is attributable to unsafe water supply, sanitation and hygiene, and is mostly concentrated in children in developing countries.[1]

Waterborne disease can be caused by protozoa, viruses, or bacteria, many of which are intestinal parasites.

Even before the establishment of the Germ theory of disease, traditional practices eschewed water in favor of beer, wine and tea. In the camel caravans that crossed Central Asia along the Silk Road, the explorer Owen Lattimore noted "The reason we drank so much tea was because of the bad water. Water alone, unboiled, is never drunk. there is a superstition that it causes blisters on the feet."[2]

Table of Content

Protozoal Infections

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
Amoebiasis (hand-to-mouth)Protozoan (Entamoeba histolytica) (Cyst-like appearance)Sewage, non-treated drinking water, flies in water supplyAbdominal discomfort, fatigue, weight loss, diarrhea, bloating, fever
Balantidiasis, also BalantidosisBalantidum colifeacally contaminated waterDiarrhea or constipation
Cryptosporidiosis (oral)Protozoan (Cryptosporidium parvum)Collects on water filters and membranes that cannot be disinfected, animal manure, seasonal runoff of water.Flu-like symptoms, watery diarrhea, loss of appetite, substantial loss of weight, bloating, increased gas, nausea
CyclosporiasisProtozoan parasite (Cyclospora cayetanensis)Sewage, non-treated drinking watercramps, nausea, vomiting, muscle aches, fever, and fatigue
Giardiasis (oral-fecal) (hand-to-mouth)Protozoan (Giardia lamblia) Most common intestinal parasiteUntreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats create ponds that act as reservoirs for Giardia.Diarrhea, abdominal discomfort, bloating, and flatulence
Meningoencephalitis
(primary amoebic)
Protozoan (Naegleria fowleriwarm stagnant fresh waterolfactory dysfunction, eventually inability to smell and taste, nausea, rigidity of the neck, vomiting, delirium, seizures, and eventually irreversible coma
MicrosporidiosisProtozoan phylum (Microsporidia), but closely related to fungiThe genera of Encephalitozoon intestinalis has been detected in groundwater, the origin of drinking water [3]Diarrhea and wasting in immunocompromised individuals
Toxoplasmosis Protozoan (Toxoplasma gondii)faecally contaminated waterwhen acute: flu-like symptoms, swollen lymph nodes, or muscle aches or pains 

Parasitic Infections (Kingdom Animalia)

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
Schistosomiasis (immersion)Members of the genus SchistosomaFresh water contaminated with certain types of snails that carry schistosomesRash or itchy skin. Fever, chills, cough, and muscle aches
Dracunculiasis (Guinea Worm Disease)Dracunculus medinensisStagnant water containing larvaeAllergic reaction, urticaria rash, nausea, vomiting, diarrhea, asthmatic attack.
TaeniasisTapeworms of the genus TaeniaDrinking water contaminated with eggsIntestinal disturbances, neurologic manifestations, loss of weight, cysticercosis
FasciolopsiasisFasciolopsis buskiDrinking water contaminated with encysted metacercariaGIT disturbance, diarrhea, liver enlargement, cholangitis, cholecystitis, obstructive jaundice.
Hymenolepiasis (Dwarf Tapeworm Infection)Hymenolepis nanaDrinking water contaminated with eggsAbdominal pain, anorexia, itching around the anus, nervous manifestation
Echinococcosis (Hydatid disease)Echinococcus granulosusDrinking water contaminated with feces (usually canid) containing eggsLiver enlargement, hydatid cysts press on bile duct and blood vessels; if cysts rupture they can cause anaphylactic shock
coenurosismulticeps multicepscontaminated drinking water with eggsincreases intacranial tension
AscariasisAscaris lumbricoidesDrinking water contaminated with feces (usually canid) containing eggsMostly, disease is asymptomatic or accompanied by inflammation, fever, and diarrhea. Severe cases involve Löffler's syndrome in lungs, nausea, vomiting, malnutrition, and underdevelopment.
EnterobiasisEnterobius vermicularisDrinking water contaminated with eggsPeri-anal itch, nervous irritability, hyperactivity and insomnia
Disease

Morbidity
 (cases per year)

Mortality
 (deaths per year)

1,500,000,000100,000
Schistosomiasis200,000,000200,000

Bacterial Infections

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
BotulismClostridium botulinumBacteria can enter a wound from contaminated water sources. Can enter the gastrointestinal tract by consuming contaminated drinking water or (more commonly) foodDry mouth, blurred and/or double vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea. Death is usually caused by respiratory failure.
CampylobacteriosisMost commonly caused by Campylobacter jejuniDrinking water contaminated with fecesProduces dysentery like symptoms along with a high fever. Usually lasts 2–10 days.
CholeraSpread by the bacterium Vibrio choleraeDrinking water contaminated with the bacteriumIn severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhoea, nausea, cramps, nosebleed, rapid pulse, vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours.
E. coli InfectionCertain strains of Escherichia coli (commonly E. coli)Water contaminated with the bacteriaMostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness.
M. marinum infectionMycobacterium marinumNaturally occurs in water, most cases from exposure in swimming pools or more frequently aquariums; rare infection since it mostly infects immunocompromised individualsSymptoms include lesions typically located on the elbows, knees, and feet (from swimming pools) or lesions on the hands (aquariums). Lesions may be painless or painful.
DysenteryCaused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriaeWater contaminated with the bacteriumFrequent passage of feces with blood and/or mucus and in some cases vomiting of blood.
Legionellosis (two distinct forms: Legionnaires’ disease and Pontiac fever)Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila)Contaminated water: the organism thrives in warm aquatic environments.Pontiac fever produces milder symptoms resembling acute influenza without pneumonia. Legionnaires’ disease has severe symptoms such as fever, chills, pneumonia (with cough that sometimes produces sputum), ataxia, anorexia, muscle aches, malaise and occasionally diarrhea and vomiting
LeptospirosisCaused by bacterium of genus LeptospiraWater contaminated by the animal urine carrying the bacteriaBegins with flu-like symptoms then resolves. The second phase then occurs involving meningitis, liver damage (causes jaundice), and renal failure
Otitis Externa (swimmer’s ear)Caused by a number of bacterial and fungal species.Swimming in water contaminated by the responsible pathogensEar canal swells causing pain and tenderness to the touch
SalmonellosisCaused by many bacteria of genus SalmonellaDrinking water contaminated with the bacteria. More common as a food borne illness.Symptoms include diarrhea, fever, vomiting, and abdominal cramps
Typhoid feverSalmonella typhiIngestion of water contaminated with feces of an infected personCharacterized by sustained fever up to 40°C (104°F), profuse sweating, diarrhea, less commonly a rash may occur. Symptoms progress to delirium and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death.
Vibrio IllnessVibrio vulnificus, Vibrio alginolyticus, and Vibrio parahaemolyticusCan enter wounds from contaminated water. Also got by drinking contaminated water or eating undercooked oysters.Symptoms include explosive, watery diarrhea, nausea, vomiting, abdominal cramps, and occasionally fever.

Viral Infections

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
Adenovirus infectionAdenovirusManifests itself in improperly treated waterSymptoms include common cold symptoms, pneumonia, croup, and bronchitis
GastroenteritisAstrovirus, Calicivirus, Enteric Adenovirus, and ParvovirusManifests itself in improperly treated waterSymptoms include diarrhea, nausea, vomiting, fever, malaise, and abdominal pain
SARS (Severe Acute Respiratory Syndrome)CoronavirusManifests itself in improperly treated waterSymptoms include fever, myalgia, lethargy, gastrointestinal symptoms, cough, and sore throat
Hepatitis AHepatitis A virus (HAV)Can manifest itself in water (and food)Symptoms are only acute (no chronic stage to the virus) and include Fatigue, fever, abdominal pain, nausea, diarrhea, weight loss, itching, jaundice and depression.
Poliomyelitis (Polio)PoliovirusEnters water through the feces of infected individuals90-95% of patients show no symptoms, 4-8% have minor symptoms (comparatively) with delirium, headache, fever, and occasional seizures, and spastic paralysis, 1% have symptoms of non-paralytic aseptic meningitis. The rest have serious symptoms resulting in paralysis or death
Polyomavirus infectionTwo of Polyomavirus: JC virus and BK virusVery widespread, can manifest itself in water, 80% of the population has antibodies to PolyomavirusBK virus produces a mild respiratory infection and can infect the kidneys of immunosuppressed transplant patients. JC virus infects the respiratory system, kidneys or can cause progressive multifocal leukoencephalopathy in the brain (which is fatal).

References

  1. ^ WHO | Burden of disease and cost-effectiveness estimates
  2. ^ Lattimore, "The caravan routes of inner Asia," The Geographical Journal 72.6 (1928:500), quoted in Frances Wood, The Silk Road: two thousand years in the heart of Asia 2002:19.
  3. ^ a b Nwachcuku N, Gerba CP (June 2004). "Emerging waterborne pathogens: can we kill them all?". Curr Opin Biotechnol. 15 (3): 175–80. PMID 15193323. http://env1.gist.ac.kr/~aeml/paper/papers(pdf)/27-waterborne_pathogens.pdf
  4. ^ Dziuban EJ, Liang JL, Craun GF, Hill V, Yu PA, et al (22 December 2006). "Surveillance for Waterborne Disease and Outbreaks Associated with Recreational Water — United States, 2003–2004". MMWR Surveill Summ. 55 (12): 1–30. PMID 17183230. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5512a1.htm
  5. ^ Petrini B (October 2006). "Mycobacterium marinum: ubiquitous agent of waterborne granulomatous skin infections". Eur J Clin Microbiol Infect Dis. 25 (10): 609–13. PMID 17047903. http://www.springerlink.com/content/7r65j4n6v54772h4/
  6. ^ Nwachuku N, Gerba CP, Oswald A, Mashadi FD (September 2005). "Comparative inactivation of Adenovirus serotypes by UV light disinfection". Appl Environ Microbiol. 71 (9): 5633–6. PMID 16151167. PMC 1214670. http://aem.asm.org/cgi/reprint/71/9/5633.pdf

Further Reading

Dirk van der Kooij and Paul W.J.J. van der Wielen (2012) Microbial Growth in Drinking Water Distribution Systems: Problems, Causes, Prevention and Research Needs, IWA Publishing.

Can you suggest any further reading materials related to this article? Feel free to add them here.

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