Waterborne diseases are caused by pathogenic microorganisms that most commonly are transmitted in contaminated fresh water.

1. Waterborne Pathogens
in Historical and Social
Contexts
Nursing Path
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2. Vibrio cholerae
one of the six waves of cholera
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3. John Snow
Vibrio cholerae
one of the six waves of cholera
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4. John Snow
Vibrio cholerae
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5. Fillipo Pacini
Vibrio cholerae
one of the six waves of cholera
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6. Robert Koch
Nobel Prize (1905)
Vibrio cholerae
one of the six waves of cholera
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7. Vibrio cholerae
Rita Colwell
University of Maryland
discovered O1391/19/2017 7www.drjayeshpatidar.blogspot.in

8. Vibrio cholerae
• Symptoms
– toxins lead to watery diarrhea (rice stools)
– symptoms within hours
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9. Vibrio cholerae
• Symptoms
– toxins lead to watery diarrhea (rice stools)
– symptoms within hours
• Transmission
– contaminated water, food (fish, shellfish), swimming
– feces of asymptomatic and sick human carriers.
– no person-to-person transmission
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10. Vibrio cholerae
• Symptoms
– toxins lead to watery diarrhea (rice stools)
– symptoms within hours
• Transmission
– contaminated water, food (fish, shellfish), swimming
– feces of asymptomatic and sick human carriers.
– no person-to-person transmission
• Infectious Dose (in healthy adults)
– 108-1011 cells (ID50)
– antacids lower ID (= more susceptible to infection)
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11. Vibrio cholerae
• Symptoms
– toxins lead to watery diarrhea (rice stools)
– symptoms within hours
• Transmission
– contaminated water, food (fish, shellfish), swimming
– feces of asymptomatic and sick human carriers.
– no person-to-person transmission
• Infectious Dose (in healthy adults)
– 108-1011 cells (ID50)
– antacids lower ID (= more susceptible to infection)
• Survival Outside Human Hosts
– biofilms
– zooplankton, shellfish
– viable non-culturable state
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12. Vibrio cholerae
• Detection, Monitoring Programs
– Culture:
• Alkaline Peptone Water (for enrichment, 6-8 hrs @ 37oC)
• Thiosulfate Citrate Bile Sucrose Agar (small yellow colonies)
• Kligler Iron Agar (no gas, red slant/yellow butt)
• Leucine Slants (purple slant/purple butt, no gas, no H2S)
• Agglutination test for positive colonies to ID strain
– DNA-based detection
• rfb (O antigen), ctxA,ctxB (cholera toxin)
• Control and Treatment
– Proper water sanitation (chlorination, solar)
– Rehydrate symptomatic individuals
– Antibiotic (tetracycline) treatment
– Vaccine (only moderately effective)
– Exposure to O1 does not protect against O139
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13. Salmonella
• WHO: 1,400,000 instances of salmonellosis in
USA
• Salmonella costs per year
US $3,000,000,000
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14. Salmonella
• WHO: 1,400,000 instances of salmonellosis in USA
• Salmonella costs per year
US $3,000,000,000
• Nomenclature evolves (old, new names co-exist...)
– the latest: S. bongori and S. enterica
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15. Salmonella
• WHO: 1,400,000 instances of salmonellosis in USA
• Salmonella costs per year
US $3,000,000,000
• Nomenclature evolves (old, new names co-exist...)
– the latest: S. bongori and S. enterica
• 2,300 serotypes (S. enterica Typhimurium, etc)
– wide host range (humans, cattle, horses, rodents, cats, dogs,
birds, reptiles)
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16. Salmonella
• WHO: 1,400,000 instances of salmonellosis in USA
• Salmonella costs per year
US $3,000,000,000
• Nomenclature evolves (old, new names co-exist...)
– the latest: S. bongori and S. enterica
• 2,300 serotypes (S. enterica Typhimurium, etc)
– wide host range (humans, cattle, horses, rodents, cats, dogs,
birds, reptiles)
• Multi-drug resistant S.e.Typhimurium DT104
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17. Salmonella
• WHO: 1,400,000 instances of salmonellosis in USA
• Salmonella costs per year
US $3,000,000,000
• 2,300 serotypes (S. enterica Typhimurium, etc)
– wide host range (humans, cattle, horses, rodents, cats, dogs,
birds, reptiles)
• Multi-drug resistant S.e.Typhimurium DT104
• Most common diseases caused by Salmonella:
– gastroenteritis (self-limiting, 2-5 days)
– enteric/typhoid fever (incubation 1-10/7-14 days, lasts 2-3 wks)
– septicemia (incubation12-36 hrs, may lead to chronic infection)
– symptoms and disease manifestation differ in hosts
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18. Daniel Elmer Salmón
(1850-1914)
Salmonella enterica
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19. Mary Mallon
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20. Mary Mallon
237 other “healthy” carriers in NY at the same time
(none of the 237 were ostracized like Mary
Mallon)1/19/2017 20www.drjayeshpatidar.blogspot.in

21. Salmonella
Most “commonly-used” bioterrorism
agent
1939. Japanese Imperial Army contaminated
rivers on the Manchurian border
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22. Salmonella
Most “commonly-used” bioterrorism agent
1939. Japanese Imperial Army contaminated rivers on
the Manchurian border
1972. “Order of the Rising Sun” obtains S. Typhi to
contaminate water supplies in Midwest
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23. Salmonella
Most “commonly-used” bioterrorism agent
1939. Japanese Imperial Army contaminated rivers on the
Manchurian border
1972. “Order of the Rising Sun” obtains S. Typhi to contaminate
water supplies in Midwest
1984. Rajneesh Cult. Successfully contaminates restaurants in
Dalles, OR in an attempt to thwart local elections
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24. Salmonella
• Transmission
– Human-to-human (S. Typhi)
– Pets (often asymptomatic carriers)
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25. Salmonella
• Transmission
– Human-to-human (S. Typhi)
– Pets (often asymptomatic carriers)
– Contaminated foods, milk, drinking water
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26. Salmonella
• Transmission
– Human-to-human (S. Typhi)
– Pets (often asymptomatic carriers)
– Contaminated foods, milk, drinking water
– Eggs and poultry (S. Enteriditis)
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27. Salmonella
• Transmission
– Human-to-human (S. Typhi)
– Pets (often asymptomatic carriers)
– Contaminated foods, milk, drinking water
– Eggs and poultry (S. Enteriditis)
• Infectious Dose (in healthy adults)
– 20-100 cells …. 1 mln cells
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28. Salmonella
• Transmission
– Human-to-human (S. Typhi)
– Pets (often asymptomatic carriers)
– Contaminated foods, milk, drinking water
– Eggs and poultry (S. Enteriditis)
• Infectious Dose (in healthy adults)
– 20-100 cells …. 1 mln cells
– mice become infected only after normal gut flora is killed!
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29. Escherichia coli
Theodor Escherich
(1857-1911)
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30. Escherichia coli
Lee W. Riley
University of Berkeley
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31. Escherichia coli
• Normal flora of human GI
• Uropathogenic E. coli. 90% of all UTI
• Enterovirulent E. coli serotypes
– Enteroinvasive E. coli (EIEC).
– Enterohemorrhagic E. coli (EHEC=VTEC) O157:H7.
Bloody diarrhea. Hemolytic Uremic Syndrome (HUS).
– Enterotoxigenic E. coli (ETEC). Travelers diarrhea (cholera-
like).
– Enteropathogenic E. coli (EPEC). Diarrhea in newborn
nurseries.
– Enteroaggregative E. coli (EAggEC). Acute and chronic
diarrhea in children
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32. Annual Cost of
Pathogenic E. coli
O157:H7
cases
Non O157:H7
STEC cases
O157:H7 costs Non O157:H7
costs
No medical care 35, 632 17, 816 N/A N/A
Physician visit 24, 983 12, 492 $ 6, 900, 000 $ 3, 400, 000
Hospitalized, survived 1790 895 $ 32, 900, 000 $ 16, 500, 000
Deaths 52 26 $ 1, 500, 000 $800, 000
Chronic illness, HUS 46 23 $ 36, 500, 000 $18, 500, 000
Total 60, 615 30, 308 $659, 000, 000
(includes lost
productivity)
$ 329, 700, 000
(includes lost
productivity)
Source: Economic Research Service, USDA, Oct. 20, 2000.1/19/2017 32www.drjayeshpatidar.blogspot.in

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34. Legionella pneumophila
Bellevue-Stratford Hotel, Philadelphia
10,000-20,000 estimated cases per year
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35. Legionella pneumophila
• Symptoms
– appear within 2-10 days after exposure
– Legionnaire’s disease: pneumonia. Also affects nervous, GI, urinary systems.
Highly fatal.
– Pontiac fever: flu-like, self-limiting, mild non-pneumonic
• Transmission
– no known human-to-human transmission
– inhaling or injecting droplets with bacterial cells
• Survival Outside Human Hosts
– aquatic biofilms
• naturally in hot springs, rivers, etc
• cooling towers, any warm water reservoirs
• hot tubs, AC units (mostly industrial)
– amoebae (symbiont or pathogen)
– Cyanobacteria
– Legionella longbeachea. Potting soil
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36. Legionella pneumophila
• Detection, Monitoring Programs
– Culture: Buffered Charcoal Yeast Extract Agar + L-cysteine +
Fe.
• 5 days @ 37oC
• cannot use carbohydrates
– PCR. Commercial kits available
– Serological methods (most common)
• monoclonal antibodies seem more specific
• no single antiserum is used routinely to ID all Legionella
• Direct fluorescent antibody staining
– rapid (2-4 hrs)
– specific. Rarely cross react with Pseudomonas.
– sensitivity improved by sample quality, # bacteria
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37. Legionella pneumophila
• Control and Prevention
– Legionella are ubiquitous. Monitoring is nearly impossible
– copper-silver ionization for hot water
– super heat/flush cycles (>50-60 oC for >30 min)
– UV
– Hyperchlorination (1-2 ppm residual)
– Monochloramine seems to be more effective than chlorine
• more stable?
• penetrates biofilms?
– personal protection while servicing exposed equipment
– stop smoking!
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38. Thank You
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