Seasonal distribution of potentially pathogenic Acanthamoeba species from drinking water reservoirs in Taiwan

Optimizing disinfectant residual dosage in engineered water systems to minimize the overall health risks of opportunistic pathogens and disinfection by-products

This Discussion argues that municipal water utilities may need to consider the health risks of both opportunistic pathogens (OPs) and disinfection by-products (DBPs) while selecting disinfectant residual dosages or levels in engineered water systems. OPs are natural inhabitants in municipal water systems and the leading cause of drinking-water-related disease outbreaks threatening public health. DBPs in water systems are genotoxic/carcinogenic and also significantly affect public health. Disinfectant residuals (such as free chlorine and chloramine residuals) dictate OP (re)growth and DBP formation in engineered water systems. Therefore, regulating the dosages or levels of disinfectant residuals is effective in controlling OP (re)growth and DBP formation. Existing effects assessing optimal disinfectant residual dosages focus solely on minimizing OP (re)growth or solely on DBP formation. However, selecting disinfectant residual dosages aiming to solely limit the formation of DBPs might compromise OP (re)growth control, and vice versa. An optimal disinfectant residual level for DBP formation control or OP (re)growth control might not be optimal for minimizing the overall or combined health effects of OPs and DBPs in drinking water. To better protect public health, water authorities may need to update the current residual disinfection practice and maintain disinfectant residuals in engineered water systems at an optimal level to minimize the overall health risks of OPs and DBPs.

Hannibal’s Ophthalmia—A New Answer to An Ancient Question

In the spring of 217 bce, shortly after Hannibal’s famous elephantborne crossing of the Alps, the general was afflicted by an acute, painful eye condition that has never been adequately explained and that led to permanent unilateral loss of vision in 1 eye. In modern times, scant attention has been given to understanding this condition. We review the historical and geographic evidence and consider possible infective explanations for Hannibal's condition, including elephant-associated zoonoses. Ultimately, we suggest that a keratitis from waterborne organisms, such as Pseudomonas spp. or Acanthamoeba spp., might provide the best answer to this ancient enigma.

Acanthamoeba spp. in river water samples from the Black Sea region, Turkey

The present study aims to investigate the occurrence of free living amoeba (FLA) in water resources (rivers and tap water) in Samsun in the Black Sea. The presence of Acanthamoeba spp. was confirmed in 98 of 192 water samples collected from 32 sites of Samsun province (Samsun centre, Terme, Carsamba, Tekkekoy, Bafra) by PCR. Acanthamoeba spp. were found in 15/36 river samples from Samsun, in 58/90 from Terme, in 12/30 from Carsamba, in 7/18 from Tekkekoy and in 6/18 from Bafra. No Acanthamoeba species were detected in tap water samples. The highest rate in river waters contaminated with Acanthamoeba species was in Terme followed by Samsun centre (41.7%), Carsamba (40%), Tekkekoy (38.9%) and Bafra districts (33.3%), respectively. The result of the subsequent sequence analysis showed Haplotype I (A. triangularis) in 5%, Haplotype II (A. polyphaga) in 29.6%, Haplotype III (Acanthamoeba spp.) in 62% and Haplotype IV (A. lenticulata) in 3%. The most common genotype was Acanthamoeba T4 (Acanthamoeba spp., A. polyphaga, A. triangularis) and T5 genotype was also found in 3%. The T4 genotype is the most common genotype associated with Acanthamoeba keratitis (AK) worldwide; therefore, humans and animals living in the area are at risk after contact with such waters.

Transmission Modes of Melioidosis in Taiwan

In Taiwan, melioidosis is an emerging disease that suddenly increased in the Er-Ren River Basin, beginning in 2005 and in the Zoynan region during 2008⁻2012, following a typhoon. Additionally, the disease sporadically increased in a geography-dependent manner in 2016. Subcutaneous inoculation, ingestion, and the inhalation of soil or water contaminated with Burkholderia pseudomallei are recognized as the transmission modes of melioidosis. The appearance of environmental B. pseudomallei positivity in northern, central and southern Taiwan is associated with disease prevalence (cases/population: 0.03/100,000 in the northern region, 0.29/100,000 in the central region and 1.98/100,000 in the southern region). However, melioidosis-clustered areas are confined to 5 to 7.5 km² hot spots containing high-density populations, but B. pseudomallei-contaminated environments are located >5 km northwestern of the periphery of these hot spots. The observation that the concentration of B. pseudomallei-specific DNA in aerosols was positively correlated with the incidence of melioidosis and the appearance of a northwesterly wind in a hot spot indicated that airborne transmission had occurred in Taiwan. Moreover, the isolation rate in the superficial layers of a contaminated crop field in the northwest was correlated with PCR positivity in aerosols collected from the southeast over a two-year period. The genotype ST58 was identified by multilocus sequence typing in human and aerosol isolates. The genotype ST1001 has increased in prevalence but has been sporadically distributed elsewhere since 2016. These data indicate the transmission modes and environmental foci that support the dissemination of melioidosis are changing in Taiwan.

Surveillance of Vittaforma corneae in hot springs by a small-volume procedure

Vittaforma corneae is an obligate intracellular fungus and can cause human ocular microsporidiosis. Although accumulating reports of V. corneae causing keratoconjunctivitis in both healthy and immunocompromised persons have been published, little is known about the organism's occurrence in aquatic environments. Limitations in detection sensitivity have meant a large sampling volume is required to detect the pathogen up to now, which is problematic. A recent study in Taiwan has shown that some individuals suffering from microsporidial keratitis (MK) were infected after exposure to the pathogen at a hot spring. As a consequence of this, a survey and analysis of environmental V. corneae present in hot springs became an urgent need. In this study, sixty water samples from six hot spring recreation areas around Taiwan were analyzed. One liter of water from each sample site was filtered to harvest the fungi. The positive samples were detected using a modified nested PCR approach followed by sequencing using specific SSU rRNA gene primer pairs for V. corneae. In total fifteen V. corneae-like isolates were identified (25.0% of sites). Among them, six isolates, which were collected from recreational areas B, C and D, were highly similar to known V. corneae keratitis strains from Taiwan and other countries. Furthermore, five isolates, which were collected from recreation areas A, C, E and F, were very similar to Vittaforma-like diarrhea strains isolated in Portugal. Cold spring water tubs and public foot bath pools had the highest detection rate (50%), suggesting that hot springs might be contaminated via untreated water sources. Comparing the detection rate across different regions of Taiwan, Taitung, which is in the east of the island, gave the highest positive rate (37.5%). Statistical analysis showed that outdoor/soil exposure and a high heterotrophic plate count (HPC) were risk factors for the occurrence of V. corneae. Our findings provide empirical evidence supporting the need for proper control and regulations at hot spring recreational waters in order to avoid health risks from this pathogen. Finally, we have developed a small volume procedure for detecting V. corneae in water samples and this has proved to be very useful.

Detection of Acanthamoeba spp. in water samples collected from natural water reservoirs, sewages, and pharmaceutical factory drains using LAMP and PCR in China

Various species of amoebas belonging to the genus Acanthamoeba are widely distributed in many parts of the world. Some strains of these protozoans may exist as parasites and pose risks to human health as causative agents of serious human diseases. Currently in China there is a lack of information about the distribution of Acanthamoeba strains in the environment. Accordingly, 261 environmental water samples taken from rivers, sewage, and pharmaceutical factory drains were collected in Qinghai Province, China. The material was filtered and then analysed with both LAMP and PCR assays. Of the samples examined, Acanthamoeba DNA was found in 32 (14.68%) samples with the use of LAMP; in 13 of these samples, DNA from this amoeba was also detected using PCR. Sequencing of selected positive samples confirmed that the PCR products were fragments of the Acanthamoeba 18S rRNA gene and that isolates represent the T4 genotype, known as the most common strain related to AK cases. The results indicate that surface water, as well as water taken from sewage and pharmaceutical drains, may be a source of acanthamoebic strains potentially pathogenic for humans in China. It has been also demonstrated that LAMP assays is more sensitive than PCR and can be regarded as useful tool for screening the environment for Acanthamoeba spp.

Neglected waterborne parasitic protozoa and their detection in water

Outbreak incidents raise the question of whether the less frequent aetiological agents of outbreaks are really less frequent in water. Alternatively, waterborne transmission could be relevant, but the lack of attention and rapid, sensitive methods to recover and detect the exogenous stages in water may keep them under-recognized. High quality information on the prevalence and detection of less frequent waterborne protozoa, such as Cyclospora cayetanensis, Toxoplasma gondii, Isospora belli, Balantidium coli, Blastocystis hominis, Entamoeba histolytica and other free-living amoebae (FLA), are not available. This present paper discusses the detection tools applied for the water surveillance of the neglected waterborne protozoa mentioned above and provides future perspectives.

Isolation of Acanthamoeba spp. from different water sources in Isfahan, central Iran, 2014

Acanthamoeba spp. are free-living amoeba found in a wide variety of natural habitats. The high percentage of the presence of Acanthamoeba in different environmental sources represents a sanitary risk for public health, especially immunocompromised patients and contact lens wearers. Acanthamoeba can cause granulomatous amoebic encephalitis, otitis, lung lesions, and skin infections in individuals with immune deficiencies. In the present study, the status of contamination of water sources in Isfahan, central Iran is analyzed through parasitological method. Totally 93 samples were utilized consisting of 59 samples of tap water and 34 samples of environmental water collected from Isfahan in May and June 2014. After filtering, cultivation was done in non-nutrient agar medium, and then the cultured media were kept at 25-30 °C. The samples were analyzed based on the morphological criteria. Acanthamoeba spp. were found in 25 (73.53 %) out of 34 environmental water samples and 17 (28.8 %) out of 59 tap water. Generally, Acanthamoeba spp. were found in 42 (45.16 %) of the samples. The results of the present study showed that the water contamination with Acanthamoeba spp. in different regions of Isfahan can be a potential infection source for at high risk people. It could be suggested that public education and precaution are quiet necessary.