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Malinowski N, Morgan MJ, Wylie J, Walsh T, Domingos S, Metcalfe S, Kaksonen AH, Barnhart EP, Mueller R, Peyton BM, Puzon GJ. Prokaryotic microbial ecology as an ecosurveillance tool for eukaryotic pathogen colonisation: Meiothermus and Naegleria fowleri. WATER RESEARCH 2024; 254:121426. [PMID: 38471203 DOI: 10.1016/j.watres.2024.121426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Naegleria fowleri has been detected in drinking water distribution systems (DWDS) in Australia, Pakistan and the United States and is the causative agent of the highly fatal disease primary amoebic meningoencephalitis. Previous small scale field studies have shown that Meiothermus may be a potential biomarker for N. fowleri. However, correlations between predictive biomarkers in small sample sizes often breakdown when applied to larger more representative datasets. This study represents one of the largest and most rigorous temporal investigations of Naegleria fowleri colonisation in an operational DWDS in the world and measured the association of Meiothermus and N. fowleri over a significantly larger space and time in the DWDS. A total of 232 samples were collected from five sites over three-years (2016-2018), which contained 29 positive N. fowleri samples. Two specific operational taxonomic units assigned to M. chliarophilus and M. hypogaeus, were significantly associated with N. fowleri presence. Furthermore, inoculation experiments demonstrated that Meiothermus was required to support N. fowleri growth in field-collected biofilms. This validates Meiothermus as prospective biological tool to aid in the identification and surveillance of N. fowleri colonisable sites.
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Affiliation(s)
- Natalia Malinowski
- CSIRO Environment, Floreat Park, WA, Australia; Water Corporation of Western Australia, Leederville, WA, Australia
| | | | - Jason Wylie
- CSIRO Environment, Floreat Park, WA, Australia
| | - Tom Walsh
- CSIRO Environment, Canberra, ACT, Australia
| | - Sergio Domingos
- Water Corporation of Western Australia, Leederville, WA, Australia
| | | | | | - Elliott P Barnhart
- U.S. Geological Survey, Wyoming-Montana Water Science Center, Helena, Montana (MT), USA
| | - Rebecca Mueller
- Centre for Biofilm Engineering, and Thermal Biology Institute, Montana State University, Bozeman, MT, USA
| | - Brent M Peyton
- Centre for Biofilm Engineering, and Thermal Biology Institute, Montana State University, Bozeman, MT, USA
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2
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Shaukat A, Khaliq N, Riaz R, Munsab R, Ashraf T, Raufi N, Shah H. Noninvasive diagnostic biomarkers, genomic profiling, and advanced microscopic imaging in the early detection and characterization of Naegleria fowleri infections leading to primary amebic meningoencephalitis (PAM). Ann Med Surg (Lond) 2024; 86:2032-2048. [PMID: 38576920 PMCID: PMC10990330 DOI: 10.1097/ms9.0000000000001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
This review delves into the strategies for early detection and characterization of Naegleria fowleri infections leading to primary amoebic meningoencephalitis (PAM). The study provides an in-depth analysis of current diagnostic approaches, including cerebrospinal fluid analysis, brain tissue examination, immunostaining techniques, and culture methods, elucidating their strengths and limitations. It explores the geographical distribution of N. fowleri, with a focus on regions near the equator, and environmental factors contributing to its prevalence. The review emphasizes the crucial role of early detection in PAM management, discussing the benefits of timely identification in treatment, personalized care, and prevention strategies. Genomic profiling techniques, such as conventional PCR, nested PCR, multiplex PCR, and real-time PCR, are thoroughly examined as essential tools for accurate and prompt diagnosis. Additionally, the study explores advanced microscopic imaging techniques to characterize N. fowleri's morphology and behavior at different infection stages, enhancing our understanding of its life cycle and pathogenic mechanisms. In conclusion, this review underscores the potential of these strategies to improve our ability to detect, understand, and combat N. fowleri infections, ultimately leading to better patient outcomes and enhanced public health protection.
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Affiliation(s)
| | - Nawal Khaliq
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rumaisa Riaz
- Dow University of Health Sciences, Karachi, Pakistan
| | - Rabbia Munsab
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Nahid Raufi
- Department of Medicine, Kabul Medical University, Kabul, Afghanistan
| | - Hafsa Shah
- Dow University of Health Sciences, Karachi, Pakistan
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3
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Goudot S, Mathieu L, Herbelin P, Soreau S, Jorand FPA. Growth dynamic of biofilm-associated Naegleria fowleri in freshwater on various materials. Front Microbiol 2024; 15:1369665. [PMID: 38511008 PMCID: PMC10951111 DOI: 10.3389/fmicb.2024.1369665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 03/22/2024] Open
Abstract
In industrial water systems, the occurrence of biofilm-associated pathogenic free-living amoebae (FLA) such as Naegleria fowleri is a potential hygienic problem, and factors associated with its occurrence remain poorly understood. This study aimed to evaluate the impact of four cooling circuit materials on the growth of N. fowleri in a freshwater biofilm formed at 42°C and under a hydrodynamic shear rate of 17 s-1 (laminar flow): polyvinyl chloride, stainless steel, brass, and titanium. Colonization of the freshwater biofilms by N. fowleri was found to be effective on polyvinyl chloride, stainless steel, and titanium. For these three materials, the ratio of (bacterial prey)/(amoeba) was found to control the growth of N. fowleri. All materials taken together, a maximum specific growth rate of 0.18 ± 0.07 h-1 was associated with a generation time of ~4 h. In contrast, no significant colonization of N. fowleri was found on brass. Therefore, the contribution of copper is strongly suspected.
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Affiliation(s)
- Sébastien Goudot
- EDF Recherche et Développement, Laboratoire National d'Hydraulique et Environnement, Chatou, France
- Université de Lorraine, CNRS, LCPME, Nancy, France
| | | | - Pascaline Herbelin
- EDF Recherche et Développement, Laboratoire National d'Hydraulique et Environnement, Chatou, France
| | - Sylvie Soreau
- EDF Recherche et Développement, Laboratoire National d'Hydraulique et Environnement, Chatou, France
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4
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Miko S, Cope JR, Hlavsa MC, Ali IKM, Brown TW, Collins JP, Greeley RD, Kahler AM, Moore KO, Roundtree AV, Roy S, Sanders LL, Shah V, Stuteville HD, Mattioli MC. A Case of Primary Amebic Meningoencephalitis Associated with Surfing at an Artificial Surf Venue: Environmental Investigation. ACS ES&T WATER 2023; 3:1126-1133. [PMID: 37213412 PMCID: PMC10193442 DOI: 10.1021/acsestwater.2c00592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. In September 2018, a 29-year-old man died of PAM after traveling to Texas. We conducted an epidemiologic and environmental investigation to identify the water exposure associated with this PAM case. The patient's most probable water exposure occurred while surfing in an artificial surf venue. The surf venue water was not filtered or recirculated; water disinfection and water quality testing were not documented. N. fowleri and thermophilic amebae were detected in recreational water and sediment samples throughout the facility. Codes and standards for treated recreational water venues open to the public could be developed to address these novel venues. Clinicians and public health officials should also consider novel recreational water venues as a potential exposure for this rare amebic infection.
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Affiliation(s)
- Shanna Miko
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer R. Cope
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Michele C. Hlavsa
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Ibne Karim M. Ali
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Travis W. Brown
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Jennifer P. Collins
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | | | - Amy M. Kahler
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Kathleen O. Moore
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Alexis V. Roundtree
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
- Chenega Enterprise System & Solutions, 609 Independence Parkway Suite 210, Chesapeake, VA 23320
| | - Shantanu Roy
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
| | - Lacey L. Sanders
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Vaidehi Shah
- Waco-McLennan County Public Health District; 225 W Waco Dr, Waco, TX 76707
| | - Haylea D. Stuteville
- Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347
| | - Mia C. Mattioli
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333
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5
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Stahl LM, Olson JB. Investigating the interactive effects of temperature, pH, and salinity on Naegleria fowleri persistence. J Eukaryot Microbiol 2023; 70:e12964. [PMID: 36709487 DOI: 10.1111/jeu.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/14/2022] [Accepted: 01/19/2023] [Indexed: 01/30/2023]
Abstract
Naegleria fowleri causes primary amoebic meningoencephalitis, a deadly infection that occurs when free-living amoebae enter the nose via freshwater and travel to the brain. N. fowleri naturally thrives in freshwater and soil and is thought to be associated with elevated water temperatures. While environmental and laboratory studies have sought to identify what environmental factors influence its presence, many questions remain. This study investigated the interactive effects of temperature, pH, and salinity on N. fowleri in deionized and environmental waters. Three temperatures (15, 25, 35°C), pH values (6.5, 7.5, 8.5), and salinity concentrations (0.5%, 1.5%, 2.5% NaCl) were used to evaluate the growth of N. fowleri via ATP luminescent assays. Results indicated N. fowleri grew best at 25°C, and multiple interactive effects occurred between abiotic factors. Interactions varied slightly by water type but were largely driven by temperature and salinity. Lower temperature increased N. fowleri persistence at higher salinity levels, while low salinity (0.5% NaCl) supported N. fowleri growth at all temperatures. This research provided an experimental approach to assess interactive effects influencing the persistence of N. fowleri. As climate change impacts water temperatures and conditions, understanding the microbial ecology of N. fowleri will be needed minimize pathogen exposure.
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Affiliation(s)
- Leigha M Stahl
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Julie B Olson
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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6
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Aykur M, Dagci H. Evaluation of molecular characterization and phylogeny for quantification of Acanthamoeba and Naegleria fowleri in various water sources, Turkey. PLoS One 2021; 16:e0256659. [PMID: 34437614 PMCID: PMC8389491 DOI: 10.1371/journal.pone.0256659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Free-living amoeba (FLA) is widely distributed in the natural environment. Since these amoebae are widely found in various waters, they pose an important public health problem. The aim of this study was to detect the presence of Acanthamoeba, B. mandrillaris, and N. fowleri in various water resources by qPCR in Izmir, Turkey. A total of (n = 27) 18.24% Acanthamoeba and (n = 4) 2.7% N. fowleri positives were detected in six different water sources using qPCR with ITS regions (ITS1) specific primers. The resulting concentrations varied in various water samples for Acanthamoeba in the range of 3.2x105-1.4x102 plasmid copies/l and for N. fowleri in the range of 8x103-11x102 plasmid copies/l. The highest concentration of Acanthamoeba and N. fowleri was found in seawater and damp samples respectively. All 27 Acanthamoeba isolates were identified in genotype level based on the 18S rRNA gene as T4 (51.85%), T5 (22.22%), T2 (14.81%) and T15 (11.11%). The four positive N. fowleri isolate was confirmed by sequencing the ITS1, ITS2 and 5.8S rRNA regions using specific primers. Four N. fowleri isolates were genotyped (three isolate as type 2 and one isolate as type 5) and detected for the first time from water sources in Turkey. Acanthamoeba and N. fowleri genotypes found in many natural environments are straightly related to human populations to have pathogenic potentials that may pose a risk to human health. Public health professionals should raise awareness on this issue, and public awareness education should be provided by the assistance of civil authorities. To the best of our knowledge, this is the first study on the quantitative detection and distribution of Acanthamoeba and N. fowleri genotypes in various water sources in Turkey.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpasa University Tokat, Tokat, Turkey
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
- * E-mail:
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
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7
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Herman EK, Greninger A, van der Giezen M, Ginger ML, Ramirez-Macias I, Miller HC, Morgan MJ, Tsaousis AD, Velle K, Vargová R, Záhonová K, Najle SR, MacIntyre G, Muller N, Wittwer M, Zysset-Burri DC, Eliáš M, Slamovits CH, Weirauch MT, Fritz-Laylin L, Marciano-Cabral F, Puzon GJ, Walsh T, Chiu C, Dacks JB. Genomics and transcriptomics yields a system-level view of the biology of the pathogen Naegleria fowleri. BMC Biol 2021; 19:142. [PMID: 34294116 PMCID: PMC8296547 DOI: 10.1186/s12915-021-01078-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The opportunistic pathogen Naegleria fowleri establishes infection in the human brain, killing almost invariably within 2 weeks. The amoeba performs piece-meal ingestion, or trogocytosis, of brain material causing direct tissue damage and massive inflammation. The cellular basis distinguishing N. fowleri from other Naegleria species, which are all non-pathogenic, is not known. Yet, with the geographic range of N. fowleri advancing, potentially due to climate change, understanding how this pathogen invades and kills is both important and timely. RESULTS Here, we report an -omics approach to understanding N. fowleri biology and infection at the system level. We sequenced two new strains of N. fowleri and performed a transcriptomic analysis of low- versus high-pathogenicity N. fowleri cultured in a mouse infection model. Comparative analysis provides an in-depth assessment of encoded protein complement between strains, finding high conservation. Molecular evolutionary analyses of multiple diverse cellular systems demonstrate that the N. fowleri genome encodes a similarly complete cellular repertoire to that found in free-living N. gruberi. From transcriptomics, neither stress responses nor traits conferred from lateral gene transfer are suggested as critical for pathogenicity. By contrast, cellular systems such as proteases, lysosomal machinery, and motility, together with metabolic reprogramming and novel N. fowleri proteins, are all implicated in facilitating pathogenicity within the host. Upregulation in mouse-passaged N. fowleri of genes associated with glutamate metabolism and ammonia transport suggests adaptation to available carbon sources in the central nervous system. CONCLUSIONS In-depth analysis of Naegleria genomes and transcriptomes provides a model of cellular systems involved in opportunistic pathogenicity, uncovering new angles to understanding the biology of a rare but highly fatal pathogen.
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Affiliation(s)
- Emily K Herman
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
| | - Alex Greninger
- Laboratory Medicine and Medicine / Infectious Diseases, UCSF-Abbott Viral Diagnostics and Discovery Center, UCSF Clinical Microbiology Laboratory UCSF School of Medicine, San Francisco, USA
- Department of Laboratory Medicine, University of Washington Medical Center, Montlake, USA
| | - Mark van der Giezen
- Centre for Organelle Research, Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Michael L Ginger
- School of Applied Sciences, Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, UK
| | - Inmaculada Ramirez-Macias
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Cardiology, Hospital Clinico Universitario Virgen de la Arrixaca. Instituto Murciano de Investigación Biosanitaria. Centro de Investigación Biomedica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No.5, Wembley, Western Australia 6913, Australia
- CSIRO, Indian Oceans Marine Research Centre, Environomics Future Science Platform, Crawley, WA, Australia
| | - Matthew J Morgan
- CSIRO Land and Water, Black Mountain Laboratories, Canberra, Australia
| | | | - Katrina Velle
- Department of Biology, University of Massachusetts, Amherst, UK
| | - Romana Vargová
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Kristína Záhonová
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Faculty of Science, Charles University, BIOCEV, Prague, Czech Republic
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Sebastian Rodrigo Najle
- Institut de Biologia Evolutiva (UPF-CSIC), Barcelona, Spain
- Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08003, Barcelona, Catalonia, Spain
| | - Georgina MacIntyre
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Norbert Muller
- Institute of Parasitology, Vetsuisse Faculty Bern, University of Bern, Bern, Switzerland
| | - Mattias Wittwer
- Spiez Laboratory, Federal Office for Civil Protection, Austrasse, Spiez, Switzerland
| | - Denise C Zysset-Burri
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marek Eliáš
- Department of Biology and Ecology, Faculty of Science, University of Ostrava, Ostrava, Czech Republic
| | - Claudio H Slamovits
- Department of Biochemistry and Molecular Biology, Centre for Comparative Genomics and Evolutionary Bioinformatics, Dalhousie University, Halifax, Canada
| | - Matthew T Weirauch
- Center for Autoimmune Genomics and Etiology and Divisions of Biomedical Informatics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | | | - Francine Marciano-Cabral
- Department of Microbiology and Immunology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No.5, Wembley, Western Australia 6913, Australia
| | - Tom Walsh
- CSIRO Land and Water, Black Mountain Laboratories, Canberra, Australia
| | - Charles Chiu
- Laboratory Medicine and Medicine / Infectious Diseases, UCSF-Abbott Viral Diagnostics and Discovery Center, UCSF Clinical Microbiology Laboratory UCSF School of Medicine, San Francisco, USA
| | - Joel B Dacks
- Division of Infectious Disease, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- Institute of Parasitology, Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic.
- Department of Life Sciences, The Natural History Museum, London, UK.
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8
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Masaka E, Reed S, Davidson M, Oosthuizen J. Opportunistic Premise Plumbing Pathogens. A Potential Health Risk in Water Mist Systems Used as a Cooling Intervention. Pathogens 2021; 10:pathogens10040462. [PMID: 33921277 PMCID: PMC8068904 DOI: 10.3390/pathogens10040462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Water mist systems (WMS) are used for evaporative cooling in public areas. The health risks associated with their colonization by opportunistic premise plumbing pathogens (OPPPs) is not well understood. To advance the understanding of the potential health risk of OPPPs in WMS, biofilm, water and bioaerosol samples (n = 90) from ten (10) WMS in Australia were collected and analyzed by culture and polymerase chain reaction (PCR) methods to detect the occurrence of five representative OPPPs: Legionella pneumophila, Pseudomonas aeruginosa, Mycobacterium avium, Naegleria fowleri and Acanthamoeba. P. aeruginosa (44%, n = 90) occurred more frequently in samples, followed by L. pneumophila serogroup (Sg) 2–14 (18%, n = 90) and L. pneumophila Sg 1 (6%, n = 90). A negative correlation between OPPP occurrence and residual free chlorine was observed except with Acanthamoeba, rs (30) = 0.067, p > 0.05. All detected OPPPs were positively correlated with total dissolved solids (TDS) except with Acanthamoeba. Biofilms contained higher concentrations of L. pneumophila Sg 2–14 (1000–3000 CFU/mL) than water samples (0–100 CFU/mL). This study suggests that WMS can be colonized by OPPPs and are a potential health risk if OPPP contaminated aerosols get released into ambient atmospheres.
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9
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Stahl LM, Olson JB. Environmental abiotic and biotic factors affecting the distribution and abundance of Naegleria fowleri. FEMS Microbiol Ecol 2020; 97:6006869. [PMID: 33242082 PMCID: PMC8068756 DOI: 10.1093/femsec/fiaa238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Naegleria fowleri is a free-living protozoan that resides in soil and freshwater. Human intranasal amoebae exposure through water or potentially dust particles can culminate in primary amoebic meningoencephalitis, which generally causes death. While many questions remain regarding pathogenesis, the microbial ecology of N. fowleri is even less understood. This review outlines current knowledge of the environmental abiotic and biotic factors that affect the distribution and abundance of N. fowleri. Although the impacts of some abiotic factors remain poorly investigated or inconclusive, N. fowleri appears to have a wide pH range, low salinity tolerance and thermophilic preference. From what is known about biotic factors, the amoebae preferentially feed upon bacteria and are preyed upon by other free-living amoebae. Additional laboratory and environmental studies are needed to fill in knowledge gaps, which are crucial for surveillance and management of N. fowleri in freshwaters. As surface water temperatures increase with climate change, it is likely that this amoeba will pose a greater threat to human health, suggesting that identifying its abiotic and biotic preferences is critical to mitigating this risk.
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Affiliation(s)
- Leigha M Stahl
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Julie B Olson
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL 35487, USA
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10
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Masangkay FR, Milanez GD, Tsiami A, Somsak V, Kotepui M, Tangpong J, Karanis P. First report of Cryptosporidium hominis in a freshwater sponge. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 700:134447. [PMID: 31677419 DOI: 10.1016/j.scitotenv.2019.134447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/12/2019] [Indexed: 06/10/2023]
Abstract
Identification of Cryptosporidium oocyst is essential in ensuring water quality fit for human use, consumption, and recreation. This communication proposes the supplemental analysis of substrate-associated biofilms, in particular, freshwater sponges in improving case finding of waterborne-protozoan pathogens (WBPP) in environmental aquatic samples. In this study, a small portion of a mature freshwater sponge under the Genus Spongilla was subjected to microscopic and molecular analysis to identify the presence of Cryptosporidium. Microscopic screening with modified Kinyoun's staining (MK) and microscopic confirmation using direct antibody fluorescent testing (IFT) returned with Cryptosporidium spp. positive findings. Molecular investigation resulted in the confirmation of Cryptosporidium hominis upon sequencing of PCR products and phylogenetic analysis. This is the first report of a pathogenic protozoan, C. hominis isolated from a freshwater sponge. The results of this study provide evidence of the value of expanding water quality assessment strategies to the analysis of substrate-associated biofilms and sponges in improving case finding of WBPP in natural aquatic environments.
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Affiliation(s)
- Frederick R Masangkay
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand; Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila 1015, Philippines.
| | - Giovanni D Milanez
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand; Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University-Manila, Manila 1015, Philippines
| | - Amalia Tsiami
- London Geller College of Hospitality and Tourism, University of West London, St Mary's Road, Ealing, London W5 5RF, United Kingdom
| | - Voravuth Somsak
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Manas Kotepui
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Jitbanjong Tangpong
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand.
| | - Panagiotis Karanis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; University of Nicosia Medical School, Anatomy Centre, P.O. Box 24005, CY-1700, Nicosia, 2408, Cyprus
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11
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Jahangeer M, Mahmood Z, Munir N, Waraich U, Tahir IM, Akram M, Ali Shah SM, Zulfqar A, Zainab R. Naegleria fowleri: Sources of infection, pathophysiology, diagnosis, and management; a review. Clin Exp Pharmacol Physiol 2019; 47:199-212. [DOI: 10.1111/1440-1681.13192] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/07/2019] [Accepted: 10/12/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Muhammad Jahangeer
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Zahed Mahmood
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Naveed Munir
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
- College of Allied Health Professionals Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | | | - Imtiaz Mahmood Tahir
- College of Allied Health Professionals Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Muhammad Akram
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Syed Muhammad Ali Shah
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
| | - Ayesha Zulfqar
- Department of Biochemistry Government College University Faisalabad Faisalabad Pakistan
| | - Rida Zainab
- Department of Eastern Medicine Directorate of Medical Sciences Government College University Faisalabad Faisalabad Pakistan
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12
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Cope JR, Kahler AM, Causey J, Williams JG, Kihlken J, Benjamin C, Ames AP, Forsman J, Zhu Y, Yoder JS, Seidel CJ, Hill VR. Response and remediation actions following the detection of Naegleria fowleri in two treated drinking water distribution systems, Louisiana, 2013-2014. JOURNAL OF WATER AND HEALTH 2019; 17:777-787. [PMID: 31638028 PMCID: PMC7075671 DOI: 10.2166/wh.2019.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Naegleria fowleri causes the usually fatal disease primary amebic meningoencephalitis (PAM), typically in people who have been swimming in warm, untreated freshwater. Recently, some cases in the United States were associated with exposure to treated drinking water. In 2013, a case of PAM was reported for the first time in association with the exposure to water from a US treated drinking water system colonized with culturable N. fowleri. This system and another were found to have multiple areas with undetectable disinfectant residual levels. In response, the water distribution systems were temporarily converted from chloramine disinfection to chlorine to inactivate N. fowleri and reduced biofilm in the distribution systems. Once >1.0 mg/L free chlorine residual was attained in all systems for 60 days, water testing was performed; N. fowleri was not detected in water samples after the chlorine conversion. This investigation highlights the importance of maintaining adequate residual disinfectant levels in drinking water distribution systems. Water distribution system managers should be knowledgeable about the ecology of their systems, understand potential water quality changes when water temperatures increase, and work to eliminate areas in which biofilm growth may be problematic and affect water quality.
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Affiliation(s)
- Jennifer R Cope
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Amy M Kahler
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Jake Causey
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - John G Williams
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jennifer Kihlken
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Caryn Benjamin
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Amanda P Ames
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Johan Forsman
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Yuanda Zhu
- Louisiana Department of Health, 628 North 4th St, Baton Rouge, LA 70802, USA
| | - Jonathan S Yoder
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
| | - Chad J Seidel
- Corona Environmental Consulting, 1001 Hingham St, Suite 102, Rockland, MA 02370, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA E-mail:
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13
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Yu Z, Miller HC, Puzon GJ, Clowers BH. Application of untargeted metabolomics for the detection of pathogenic Naegleria fowleri in an operational drinking water distribution system. WATER RESEARCH 2018; 145:678-686. [PMID: 30212806 DOI: 10.1016/j.watres.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/23/2018] [Accepted: 09/02/2018] [Indexed: 06/08/2023]
Abstract
Found in drinking water distribution systems (DWDSs), swimming pools, and recreational waters, N. fowleri, is the causative agent of primary amoebic meningoencephalitis (PAM). Although cases of N. fowleri infections are rare, the fatality is comparatively high (>95%) and surveillance is essential to minimize N. fowleri infections. However, conventional N. fowleri detection methods are less satisfying owing to their time-consuming and lab intensive characteristics as well as the lack of the ability to determine viability. As a result, an alternative detection approach capable of determining viability as well as species identification is required to better ensure public health. Based on our previous research focusing on distinguishing laboratory cultured N. fowleri from N. lovaniensis and N. italica, this study applies untargeted metabolomics methods to field samples from operational DWDSs. A list of diagnostic features was found to preliminarily discriminate the N. fowleri positive from N. fowleri negative and N. lovaniensis positive field samples with satisfying predictive accuracy. The results outlined in this manuscript further validate and improve the metabolite-based N. fowleri detection approach, potentially aiding water utilities in the detection and management of N. fowleri in drinking water.
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Affiliation(s)
- Zhihao Yu
- Department of Chemistry, Washington State University, P.O. Box 644630, Pullman, WA, 99164, USA
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia, 6913, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia, 6913, Australia
| | - Brian H Clowers
- Department of Chemistry, Washington State University, P.O. Box 644630, Pullman, WA, 99164, USA.
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14
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Miller HC, Morgan MJ, Walsh T, Wylie JT, Kaksonen AH, Puzon GJ. Preferential feeding in Naegleria fowleri; intracellular bacteria isolated from amoebae in operational drinking water distribution systems. WATER RESEARCH 2018; 141:126-134. [PMID: 29783165 DOI: 10.1016/j.watres.2018.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
The amoeba Naegleria fowleri is the causative agent of the highly fatal disease, primary amoebic meningoencephalitis, and estimated to cause 16 deaths per year in the United States alone. Colonisation of drinking water distribution systems (DWDSs) by the N. fowleri is a significant public health issue. Understanding the factors which enable this pathogen to colonise and thrive in DWDSs is critical for proper management. The microbial ecology within DWDSs may influence the ability of N. fowleri to colonise DWDSs by facilitating the availability of an appropriate food source. Using biofilm samples obtained from operational DWDSs, 16S rRNA amplicon metabarcoding was combined with genus-specific PCR and Sanger sequencing of intracellular associated bacteria from isolated amoeba and their parental biofilms to identify Meiothermus chliarophilus as a potential food source for N. fowleri. Meiothermus was confirmed as a food source for N. fowleri following successful serial culturing of axenic N. fowleri with M. chliarophilus or M. ruber as the sole food source. The ability to identify environmental and ecological conditions favourable to N. fowleri colonisation, including the detection of appropriate food sources such as Meiothermus, could provide water utilities with a predictive tool for managing N. fowleri colonisation within the DWDS.
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Affiliation(s)
- Haylea C Miller
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia; School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Matthew J Morgan
- CSIRO Land and Water, Black Mountain Laboratories, P.O. Box 1700, Canberra, ACT, 2601, Australia
| | - Tom Walsh
- CSIRO Land and Water, Black Mountain Laboratories, P.O. Box 1700, Canberra, ACT, 2601, Australia
| | - Jason T Wylie
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia
| | - Anna H Kaksonen
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia; School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia.
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15
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Garner E, McLain J, Bowers J, Engelthaler DM, Edwards MA, Pruden A. Microbial Ecology and Water Chemistry Impact Regrowth of Opportunistic Pathogens in Full-Scale Reclaimed Water Distribution Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:9056-9068. [PMID: 30040385 DOI: 10.1021/acs.est.8b02818] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Need for global water security has spurred growing interest in wastewater reuse to offset demand for municipal water. While reclaimed (i.e., nonpotable) microbial water quality regulations target fecal indicator bacteria, opportunistic pathogens (OPs), which are subject to regrowth in distribution systems and spread via aerosol inhalation and other noningestion routes, may be more relevant. This study compares the occurrences of five OP gene markers ( Acanthamoeba spp., Legionella spp., Mycobacterium spp., Naegleria fowleri, Pseudomonas aeruginosa) in reclaimed versus potable water distribution systems and characterizes factors potentially contributing to their regrowth. Samples were collected over four sampling events at the point of compliance for water exiting treatment plants and at five points of use at four U.S. utilities bearing both reclaimed and potable water distribution systems. Reclaimed water systems harbored unique water chemistry (e.g., elevated nutrients), microbial community composition, and OP occurrence patterns compared to potable systems examined here and reported in the literature. Legionella spp. genes, Mycobacterium spp. genes, and total bacteria, represented by 16S rRNA genes, were more abundant in reclaimed than potable water distribution system samples ( p ≤ 0.0001). This work suggests that further consideration should be given to managing reclaimed water distribution systems with respect to nonpotable exposures to OPs.
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Affiliation(s)
- Emily Garner
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
| | - Jean McLain
- Water Resources Research Center , University of Arizona , Tucson , Arizona 85719 , United States
| | - Jolene Bowers
- Translational Genomics Research Institute , Flagstaff , Arizona 86005 , United States
| | - David M Engelthaler
- Translational Genomics Research Institute , Flagstaff , Arizona 86005 , United States
| | - Marc A Edwards
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
| | - Amy Pruden
- Via Department of Civil and Environmental Engineering , Virginia Tech , Blacksburg , Virginia 24061 , United States
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Miller HC, Wylie JT, Kaksonen AH, Sutton D, Puzon GJ. Competition between Naegleria fowleri and Free Living Amoeba Colonizing Laboratory Scale and Operational Drinking Water Distribution Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:2549-2557. [PMID: 29390181 DOI: 10.1021/acs.est.7b05717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Free living amoebae (FLA), including pathogenic Naegleria fowleri, can colonize and grow within pipe wall biofilms of drinking water distribution systems (DWDSs). Studies on the interactions between various FLA species in biofilms are limited. Understanding the interaction between FLA and the broader biofilm ecology could help better predict DWDS susceptibility to N. fowleri colonization. The aim of this study was to determine if N. fowleri and other FLAs ( Naegleria, Vermamoeba, Willaertia, and Vahlkampfia spp.) cocolonize DWDS biofilm. FLAs commonly isolated from DWDSs ( N. fowleri, V. vermiformis, and N. lovaniensis) were introduced into laboratory-scale biomonitors to determine the impact of these amoebae on N. fowleri's presence and viability. Over 18 months, a single viable amoebae ( N. fowleri, N. lovaniensis, or V. vermiformis) was detected in each biofilm sample, with the exception of N. lovaniensis and N. fowleri, which briefly cocolonized biofilm following their coinoculation. The analysis of biofilm and bulk water samples from operational DWDSs revealed a similar lack of cocolonization with a single FLA detected in 99% ( n = 242) of samples. Interestingly, various Naegleria spp. did colonize the same DWDS locations but at different times. This knowledge furthers the understanding of ecological factors which enable N. fowleri to colonize and survive within operational DWDSs and could aid water utilities to control its occurrence.
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Affiliation(s)
- Haylea C Miller
- CSIRO Land and Water , Private Bag No. 5 , Wembley , Western Australia 6913 , Australia
- School of Biomedical Sciences , University of Western Australia , 35 Stirling Highway , Crawley , Western Australia 6009 , Australia
| | - Jason T Wylie
- CSIRO Land and Water , Private Bag No. 5 , Wembley , Western Australia 6913 , Australia
| | - Anna H Kaksonen
- CSIRO Land and Water , Private Bag No. 5 , Wembley , Western Australia 6913 , Australia
- School of Biomedical Sciences , University of Western Australia , 35 Stirling Highway , Crawley , Western Australia 6009 , Australia
| | - David Sutton
- School of Biomedical Sciences , University of Western Australia , 35 Stirling Highway , Crawley , Western Australia 6009 , Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water , Private Bag No. 5 , Wembley , Western Australia 6913 , Australia
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17
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Waso M, Dobrowsky PH, Hamilton KA, Puzon G, Miller H, Khan W, Ahmed W. Abundance of Naegleria fowleri in roof-harvested rainwater tank samples from two continents. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:5700-5710. [PMID: 29230646 DOI: 10.1007/s11356-017-0870-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 11/28/2017] [Indexed: 05/24/2023]
Abstract
Roof-harvested rainwater (RHRW) has been used as an alternative source of water in water scarce regions of many countries. The microbiological and chemical quality of RHRW has been questioned due to the presence of bacterial and protozoan pathogens. However, information on the occurrence of pathogenic amoeba in RHRW tank samples is needed due to their health risk potential and known associations with opportunistic pathogens. Therefore, this study aims to determine the quantitative occurrence of Naegleria fowleri in RHRW tank samples from Southeast Queensland (SEQ), Australia (AU), and the Kleinmond Housing Scheme located in Kleinmond, South Africa (SA). In all, 134 and 80 RHRW tank samples were collected from SEQ, and the Kleinmond Housing Scheme, Western Cape, SA, respectively. Quantitative PCR (qPCR) assays were used to measure the concentrations of N. fowleri, and culture-based methods were used to measure fecal indicator bacteria (FIB) Escherichia coli (E. coli) and Enterococcus spp. Of the 134 tank water samples tested from AU, 69 and 62.7% were positive for E. coli, and Enterococcus spp., respectively. For the SA tank water samples, FIB analysis was conducted for samples SA-T41 to SA-T80 (n = 40). Of the 40 samples analyzed from SA, 95 and 35% were positive for E. coli and Enterococcus spp., respectively. Of the 134 water samples tested in AU, 15 (11.2%) water samples were positive for N. fowleri, and the concentrations ranged from 1.7 × 102 to 3.6 × 104 gene copies per 100 mL of water. Of the 80 SA tank water samples screened for N. fowleri, 15 (18.8%) tank water samples were positive for N. fowleri and the concentrations ranged from 2.1 × 101 to 7.8 × 104 gene copies per 100 mL of tank water. The prevalence of N. fowleri in RHRW tank samples from AU and SA thus warrants further development of dose-response models for N. fowleri and a quantitative microbial risk assessment (QMRA) to inform and prioritize strategies for reducing associated public health risks.
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Affiliation(s)
- Monique Waso
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Penelope Heather Dobrowsky
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Kerry Ann Hamilton
- Drexel University, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- CSIRO Land and Water, Ecosciences Precinct, 41 Boggo Road, Brisbane, QLD, 4102, Australia
| | - Geoffrey Puzon
- CSIRO Land and Water, Private Bag No.5, Wembley, WA, 6913, Australia
| | - Haylea Miller
- CSIRO Land and Water, Private Bag No.5, Wembley, WA, 6913, Australia
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Warish Ahmed
- CSIRO Land and Water, Ecosciences Precinct, 41 Boggo Road, Brisbane, QLD, 4102, Australia.
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18
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Wang H, Bédard E, Prévost M, Camper AK, Hill VR, Pruden A. Methodological approaches for monitoring opportunistic pathogens in premise plumbing: A review. WATER RESEARCH 2017; 117:68-86. [PMID: 28390237 PMCID: PMC5693313 DOI: 10.1016/j.watres.2017.03.046] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/19/2017] [Accepted: 03/22/2017] [Indexed: 05/06/2023]
Abstract
Opportunistic premise (i.e., building) plumbing pathogens (OPPPs, e.g., Legionella pneumophila, Mycobacterium avium complex, Pseudomonas aeruginosa, Acanthamoeba, and Naegleria fowleri) are a significant and growing source of disease. Because OPPPs establish and grow as part of the native drinking water microbiota, they do not correspond to fecal indicators, presenting a major challenge to standard drinking water monitoring practices. Further, different OPPPs present distinct requirements for sampling, preservation, and analysis, creating an impediment to their parallel detection. The aim of this critical review is to evaluate the state of the science of monitoring OPPPs and identify a path forward for their parallel detection and quantification in a manner commensurate with the need for reliable data that is informative to risk assessment and mitigation. Water and biofilm sampling procedures, as well as factors influencing sample representativeness and detection sensitivity, are critically evaluated with respect to the five representative bacterial and amoebal OPPPs noted above. Available culturing and molecular approaches are discussed in terms of their advantages, limitations, and applicability. Knowledge gaps and research needs towards standardized approaches are identified.
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Affiliation(s)
- Hong Wang
- State Key Laboratory of Pollution Control and Resource Reuse, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Emilie Bédard
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Anne K Camper
- Center for Biofilm Engineering and Department of Civil Engineering, Montana State University, Bozeman, MT 59717, USA
| | - Vincent R Hill
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA
| | - Amy Pruden
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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Yu Z, Miller HC, Puzon GJ, Clowers BH. Development of Untargeted Metabolomics Methods for the Rapid Detection of Pathogenic Naegleria fowleri. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:4210-4219. [PMID: 28290675 DOI: 10.1021/acs.est.6b05969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Despite comparatively low levels of infection, primary amoebic meningoencephalitis (PAM) induced by Naegleria fowleri is extremely lethal, with mortality rates above 95%. As a thermophile, this organism is often found in moderate-to-warm climates and has the potential to colonize drinking water distribution systems (DWDSs). Current detection approaches require days to obtain results, whereas swift corrective action can maximize the benefit of public health. Presently, there is little information regarding the underlying in situ metabolism for this amoeba but the potential exists to exploit differentially expressed metabolic signatures as a rapid detection technique. This research outlines the biochemical profiles of selected pathogenic and nonpathogenic Naegleria in vitro using an untargeted metabolomics approach to identify a panel of diagnostically meaningful compounds that may enable rapid detection of viable pathogenic N. fowleri and augment results from traditional monitoring approaches.
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Affiliation(s)
- Zhihao Yu
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
| | - Haylea C Miller
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Centre for Environment and Life Sciences , Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Brian H Clowers
- Department of Chemistry, Washington State University , P.O. Box 644630, Pullman, Washington 99164, United States
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20
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Miller HC, Morgan MJ, Wylie JT, Kaksonen AH, Sutton D, Braun K, Puzon GJ. Elimination of Naegleria fowleri from bulk water and biofilm in an operational drinking water distribution system. WATER RESEARCH 2017; 110:15-26. [PMID: 27974249 DOI: 10.1016/j.watres.2016.11.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/07/2016] [Accepted: 11/25/2016] [Indexed: 06/06/2023]
Abstract
Global incidence of primary amoebic meningoencephalitis cases associated with domestic drinking water is increasing. The need for understanding disinfectant regimes capable of eliminating the causative microorganism, Naegleria fowleri, from bulk water and pipe wall biofilms is critical. This field study demonstrated the successful elimination of N. fowleri from the bulk water and pipe wall biofilm of a persistently colonised operational drinking water distribution system (DWDS), and the prevention of further re-colonisation. A new chlorination unit was installed along the pipe line to boost the free chlorine residual to combat the persistence of N. fowleri. Biofilm and bulk water were monitored prior to and after re-chlorination (RCl), pre-rechlorination (pre-RCl) and post-rechlorination (post-RCl), respectively, for one year. A constant free chlorine concentration of > 1 mg/L resulted in the elimination of N. fowleri from both the bulk water and biofilm at the post-RCl site. Other amoeba species were detected during the first two months of chlorination, but all amoebae were eliminated from both the bulk water and biofilm at post-RCl after 60 days of chlorination with free chlorine concentrations > 1 mg/L. In addition, a dynamic change in the biofilm community composition and a four log reduction in biofilm cell density occurred post-RCl. The pre-RCl site continued to be seasonally colonised by N. fowleri, but the constant free chlorine residual of > 1 mg/L prevented N. fowleri from recolonising the bulk and pipe wall biofilm at the post-RCl site. To our knowledge, this is the first study to demonstrate successful removal of N. fowleri from both the bulk and pipe wall biofilm and prevention of re-colonisation of N. fowleri in an operational DWDS. The findings of this study are of importance to water utilities in addressing the presence of N. fowleri and other amoeba in susceptible DWDSs.
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Affiliation(s)
- Haylea C Miller
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Matthew J Morgan
- CSIRO Land and Water, Black Mountain Laboratories, P.O. Box 1700, Canberra, ACT 2601, Australia
| | - Jason T Wylie
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia
| | - Anna H Kaksonen
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Sutton
- School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Kalan Braun
- Water Corporation of Western Australia, 629 Newcastle Street, Leederville, Western Australia 6007, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water, Private Bag No.5, Wembley, Western Australia 6913, Australia.
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Puzon GJ, Wylie JT, Walsh T, Braun K, Morgan MJ. Comparison of biofilm ecology supporting growth of individual Naegleria species in a drinking water distribution system. FEMS Microbiol Ecol 2017; 93:3044201. [DOI: 10.1093/femsec/fix017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/20/2017] [Indexed: 01/06/2023] Open
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22
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Effectiveness of Devices to Monitor Biofouling and Metals Deposition on Plumbing Materials Exposed to a Full-Scale Drinking Water Distribution System. PLoS One 2017; 12:e0169140. [PMID: 28060947 PMCID: PMC5218461 DOI: 10.1371/journal.pone.0169140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/12/2016] [Indexed: 11/19/2022] Open
Abstract
A Modified Robbins Device (MRD) was installed in a full-scale water distribution system to investigate biofouling and metal depositions on concrete, high-density polyethylene (HDPE) and stainless steel surfaces. Bulk water monitoring and a KIWA monitor (with glass media) were used to offline monitor biofilm development on pipe wall surfaces. Results indicated that adenosine triphosphate (ATP) and metal concentrations on coupons increased with time. However, bacterial diversities decreased. There was a positive correlation between increase of ATP and metal deposition on pipe surfaces of stainless steel and HDPE and no correlation was observed on concrete and glass surfaces. The shared bacterial diversity between bulk water and MRD was less than 20% and the diversity shared between the MRD and KIWA monitor was only 10%. The bacterial diversity on biofilm of plumbing material of MRD however, did not show a significant difference suggesting a lack of influence from plumbing material during early stage of biofilm development.
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23
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Siddiqui R, Ali IKM, Cope JR, Khan NA. Biology and pathogenesis of Naegleria fowleri. Acta Trop 2016; 164:375-394. [PMID: 27616699 DOI: 10.1016/j.actatropica.2016.09.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Naegleria fowleri is a protist pathogen that can cause lethal brain infection. Despite decades of research, the mortality rate related with primary amoebic meningoencephalitis owing to N. fowleri remains more than 90%. The amoebae pass through the nose to enter the central nervous system killing the host within days, making it one of the deadliest opportunistic parasites. Accordingly, we present an up to date review of the biology and pathogenesis of N. fowleri and discuss needs for future research against this fatal infection.
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Dobrowsky PH, Khan S, Cloete TE, Khan W. Molecular detection of Acanthamoeba spp., Naegleria fowleri and Vermamoeba (Hartmannella) vermiformis as vectors for Legionella spp. in untreated and solar pasteurized harvested rainwater. Parasit Vectors 2016; 9:539. [PMID: 27724947 PMCID: PMC5057267 DOI: 10.1186/s13071-016-1829-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/02/2016] [Indexed: 01/01/2023] Open
Abstract
Background Legionella spp. employ multiple strategies to adapt to stressful environments including the proliferation in protective biofilms and the ability to form associations with free-living amoeba (FLA). The aim of the current study was to identify Legionella spp., Acanthamoeba spp., Vermamoeba (Hartmannella) vermiformis and Naegleria fowleri that persist in a harvested rainwater and solar pasteurization treatment system. Methods Pasteurized (45 °C, 65 °C, 68 °C, 74 °C, 84 °C and 93 °C) and unpasteurized tank water samples were screened for Legionella spp. and the heterotrophic plate count was enumerated. Additionally, ethidium monoazide quantitative polymerase chain reaction (EMA-qPCR) was utilized for the quantification of viable Legionella spp., Acanthamoeba spp., V. vermiformis and N. fowleri in pasteurized (68 °C, 74 °C, 84 °C and 93 °C) and unpasteurized tank water samples, respectively. Results Of the 82 Legionella spp. isolated from unpasteurized tank water samples, Legionella longbeachae (35 %) was the most frequently isolated, followed by Legionella norrlandica (27 %) and Legionella rowbothamii (4 %). Additionally, a positive correlation was recorded between the heterotrophic plate count vs. the number of Legionella spp. detected (ρ = 0.710, P = 0.048) and the heterotrophic plate count vs. the number of Legionella spp. isolated (ρ = 0.779, P = 0.0028) from the tank water samples collected. Solar pasteurization was effective in reducing the gene copies of viable V. vermiformis (3-log) and N. fowleri (5-log) to below the lower limit of detection at temperatures of 68–93 °C and 74–93 °C, respectively. Conversely, while the gene copies of viable Legionella and Acanthamoeba were significantly reduced by 2-logs (P = 0.0024) and 1-log (P = 0.0015) overall, respectively, both organisms were still detected after pasteurization at 93 °C. Conclusions Results from this study indicate that Acanthamoeba spp. primarily acts as the vector and aids in the survival of Legionella spp. in the solar pasteurized rainwater as both organisms were detected and were viable at high temperatures (68–93 °C).
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Affiliation(s)
- Penelope H Dobrowsky
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Sehaam Khan
- Faculty of Health and Applied Sciences, Namibia University of Science and Technology, 13 Storch Street, Private Bag 13388, Windhoek, Namibia
| | - Thomas E Cloete
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa
| | - Wesaal Khan
- Department of Microbiology, Faculty of Science, Stellenbosch University, Private Bag X1, Stellenbosch, 7602, South Africa.
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Liu S, Gunawan C, Barraud N, Rice SA, Harry EJ, Amal R. Understanding, Monitoring, and Controlling Biofilm Growth in Drinking Water Distribution Systems. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:8954-8976. [PMID: 27479445 DOI: 10.1021/acs.est.6b00835] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In drinking water distribution systems (DWDS), biofilms are the predominant mode of microbial growth, with the presence of extracellular polymeric substance (EPS) protecting the biomass from environmental and shear stresses. Biofilm formation poses a significant problem to the drinking water industry as a potential source of bacterial contamination, including pathogens, and, in many cases, also affecting the taste and odor of drinking water and promoting the corrosion of pipes. This article critically reviews important research findings on biofilm growth in DWDS, examining the factors affecting their formation and characteristics as well as the various technologies to characterize and monitor and, ultimately, to control their growth. Research indicates that temperature fluctuations potentially affect not only the initial bacteria-to-surface attachment but also the growth rates of biofilms. For the latter, the effect is unique for each type of biofilm-forming bacteria; ammonia-oxidizing bacteria, for example, grow more-developed biofilms at a typical summer temperature of 22 °C compared to 12 °C in fall, and the opposite occurs for the pathogenic Vibrio cholerae. Recent investigations have found the formation of thinner yet denser biofilms under high and turbulent flow regimes of drinking water, in comparison to the more porous and loosely attached biofilms at low flow rates. Furthermore, in addition to the rather well-known tendency of significant biofilm growth on corrosion-prone metal pipes, research efforts also found leaching of growth-promoting organic compounds from the increasingly popular use of polymer-based pipes. Knowledge of the unique microbial members of drinking water biofilms and, importantly, the influence of water characteristics and operational conditions on their growth can be applied to optimize various operational parameters to minimize biofilm accumulation. More-detailed characterizations of the biofilm population size and structure are now feasible with fluorescence microscopy (epifluorescence and CLSM imaging with DNA, RNA, EPS, and protein and lipid stains) and electron microscopy imaging (ESEM). Importantly, thorough identification of microbial fingerprints in drinking water biofilms is achievable with DNA sequencing techniques (the 16S rRNA gene-based identification), which have revealed a prevalence of previously undetected bacterial members. Technologies are now moving toward in situ monitoring of biomass growth in distribution networks, including the development of optical fibers capable of differentiating biomass from chemical deposits. Taken together, management of biofilm growth in water distribution systems requires an integrated approach, starting from the treatment of water prior to entering the networks to the potential implementation of "biofilm-limiting" operational conditions and, finally, ending with the careful selection of available technologies for biofilm monitoring and control. For the latter, conventional practices, including chlorine-chloramine disinfection, flushing of DWDS, nutrient removal, and emerging technologies are discussed with their associated challenges.
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Affiliation(s)
| | - Cindy Gunawan
- ithree institute, University of Technology Sydney , Sydney, NSW 2007, Australia
| | - Nicolas Barraud
- Department of Microbiology, Genetics of Biofilms Unit, Institut Pasteur , Paris 75015, France
| | - Scott A Rice
- The Singapore Centre for Environmental Life Sciences Engineering and School of Biological Sciences, Nanyang Technological University , 639798, Singapore
| | - Elizabeth J Harry
- ithree institute, University of Technology Sydney , Sydney, NSW 2007, Australia
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Coupat-Goutaland B, Régoudis E, Besseyrias M, Mularoni A, Binet M, Herbelin P, Pélandakis M. Population Structure in Naegleria fowleri as Revealed by Microsatellite Markers. PLoS One 2016; 11:e0152434. [PMID: 27035434 PMCID: PMC4818093 DOI: 10.1371/journal.pone.0152434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/14/2016] [Indexed: 11/19/2022] Open
Abstract
Naegleria sp. is a free living amoeba belonging to the Heterolobosea class. Over 40 species of Naegleria were identified and recovered worldwide in different habitats such as swimming pools, freshwater lakes, soil or dust. Among them, N. fowleri, is a human pathogen responsible for primary amoeboic meningoencephalitis (PAM). Around 300 cases were reported in 40 years worldwide but PAM is a fatal disease of the central nervous system with only 5% survival of infected patients. Since both pathogenic and non pathogenic species were encountered in the environment, detection and dispersal mode are crucial points in the fight against this pathogenic agent. Previous studies on identification and genotyping of N. fowleri strains were focused on RAPD analysis and on ITS sequencing and identified 5 variants: euro-american, south pacific, widespread, cattenom and chooz. Microsatellites are powerful markers in population genetics with broad spectrum of applications (such as paternity test, fingerprinting, genetic mapping or genetic structure analysis). They are characterized by a high degree of length polymorphism. The aim of this study was to genotype N. fowleri strains using microsatellites markers in order to track this population and to better understand its evolution. Six microsatellite loci and 47 strains from different geographical origins were used for this analysis. The microsatellite markers revealed a level of discrimination higher than any other marker used until now, enabling the identification of seven genetic groups, included in the five main genetic groups based on the previous RAPD and ITS analyses. This analysis also allowed us to go further in identifying private alleles highlighting intra-group variability. A better identification of the N. fowleri isolates could be done with this type of analysis and could allow a better tracking of the clinical and environmental N. fowleri strains.
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Affiliation(s)
- Bénédicte Coupat-Goutaland
- Univ Lyon, Université Lyon 1, CNRS UMR 5240 Microbiology Adaptation and Pathogenesis, Villeurbanne, France
| | - Estelle Régoudis
- Univ Lyon, Université Lyon 1, CNRS UMR 5240 Microbiology Adaptation and Pathogenesis, Villeurbanne, France
| | | | - Angélique Mularoni
- Univ Lyon, Université Lyon 1, ISPB EA 4446 Bioactive Molecules and Medicinal Chemistry, Lyon, France
| | - Marie Binet
- EDF Research and Development, Laboratoire National d’Hydraulique et Environnement, Chatou, France
| | - Pascaline Herbelin
- EDF Research and Development, Laboratoire National d’Hydraulique et Environnement, Chatou, France
| | - Michel Pélandakis
- Univ Lyon, Université Lyon 1, CNRS UMR 5240 Microbiology Adaptation and Pathogenesis, Villeurbanne, France
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Morgan MJ, Halstrom S, Wylie JT, Walsh T, Kaksonen AH, Sutton D, Braun K, Puzon GJ. Characterization of a Drinking Water Distribution Pipeline Terminally Colonized by Naegleria fowleri. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:2890-2898. [PMID: 26853055 DOI: 10.1021/acs.est.5b05657] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Free-living amoebae, such as Naegleria fowleri, Acanthamoeba spp., and Vermamoeba spp., have been identified as organisms of concern due to their role as hosts for pathogenic bacteria and as agents of human disease. In particular, N. fowleri is known to cause the disease primary amoebic meningoencephalitis (PAM) and can be found in drinking water systems in many countries. Understanding the temporal dynamics in relation to environmental and biological factors is vital for developing management tools for mitigating the risks of PAM. Characterizing drinking water systems in Western Australia with a combination of physical, chemical and biological measurements over the course of a year showed a close association of N. fowleri with free chlorine and distance from treatment over the course of a year. This information can be used to help design optimal management strategies for the control of N. fowleri in drinking-water-distribution systems.
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Affiliation(s)
- Matthew J Morgan
- CSIRO Land and Water , Black Mountain Laboratories, P.O. Box 1700, Canberra, ACT, 2601, Australia
| | - Samuel Halstrom
- CSIRO Land and Water , Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia 6913, Australia
- School of Pathology and Laboratory Medicine and Oceans Institute, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Jason T Wylie
- CSIRO Land and Water , Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Tom Walsh
- CSIRO Land and Water , Black Mountain Laboratories, P.O. Box 1700, Canberra, ACT, 2601, Australia
| | - Anna H Kaksonen
- CSIRO Land and Water , Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia 6913, Australia
- School of Pathology and Laboratory Medicine and Oceans Institute, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Sutton
- School of Pathology and Laboratory Medicine and Oceans Institute, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Kalan Braun
- Water Corporation of Western Australia , 629 Newcastle Street, Leederville, Western Australia 6007, Australia
| | - Geoffrey J Puzon
- CSIRO Land and Water , Centre for Environment and Life Sciences, Private Bag No. 5, Wembley, Western Australia 6913, Australia
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Régoudis E, Pélandakis M. Detection of the free living amoeba Naegleria fowleri by using conventional and real-time PCR based on a single copy DNA sequence. Exp Parasitol 2016; 161:35-9. [DOI: 10.1016/j.exppara.2015.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/29/2015] [Accepted: 12/02/2015] [Indexed: 11/27/2022]
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Miller HC, Wylie J, Dejean G, Kaksonen AH, Sutton D, Braun K, Puzon GJ. Reduced Efficiency of Chlorine Disinfection of Naegleria fowleri in a Drinking Water Distribution Biofilm. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:11125-11131. [PMID: 26287820 DOI: 10.1021/acs.est.5b02947] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Naegleria fowleri associated with biofilm and biological demand water (organic matter suspended in water that consumes disinfectants) sourced from operational drinking water distribution systems (DWDSs) had significantly increased resistance to chlorine disinfection. N. fowleri survived intermittent chlorine dosing of 0.6 mg/L for 7 days in a mixed biofilm from field and laboratory-cultured Escherichia coli strains. However, N. fowleri associated with an attached drinking water distribution biofilm survived more than 30 times (20 mg/L for 3 h) the recommended concentration of chlorine for drinking water. N. fowleri showed considerably more resistance to chlorine when associated with a real field biofilm compared to the mixed laboratory biofilm. This increased resistance is likely due to not only the consumption of disinfectants by the biofilm and the reduced disinfectant penetration into the biofilm but also the composition and microbial community of the biofilm itself. The increased diversity of the field biofilm community likely increased N. fowleri's resistance to chlorine disinfection compared to that of the laboratory-cultured biofilm. Previous research has been conducted in only laboratory scale models of DWDSs and laboratory-cultured biofilms. To the best of our knowledge, this is the first study demonstrating how N. fowleri can persist in a field drinking water distribution biofilm despite chlorination.
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Affiliation(s)
- Haylea C Miller
- Microbiology and Immunology, School of Pathology and Laboratory Medicine, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- Water for a Healthy Country Flagship, Centre for Environment and Life Sciences, CSIRO Land and Water, Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Jason Wylie
- Water for a Healthy Country Flagship, Centre for Environment and Life Sciences, CSIRO Land and Water, Private Bag No. 5, Wembley, Western Australia 6913, Australia
| | - Guillaume Dejean
- Water for a Healthy Country Flagship, Centre for Environment and Life Sciences, CSIRO Land and Water, Private Bag No. 5, Wembley, Western Australia 6913, Australia
- Pierre Gauthier Street, 33320 Eysines, France
| | - Anna H Kaksonen
- Water for a Healthy Country Flagship, Centre for Environment and Life Sciences, CSIRO Land and Water, Private Bag No. 5, Wembley, Western Australia 6913, Australia
- School of Pathology and Laboratory Medicine and Oceans Institute, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - David Sutton
- School of Pathology and Laboratory Medicine and Oceans Institute, University of Western Australia , 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Kalan Braun
- Water Corporation of Western Australia , 629 Newcastle Street, Leederville, Western Australia 6007, Australia
| | - Geoffrey J Puzon
- Water for a Healthy Country Flagship, Centre for Environment and Life Sciences, CSIRO Land and Water, Private Bag No. 5, Wembley, Western Australia 6913, Australia
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Mahittikorn A, Mori H, Popruk S, Roobthaisong A, Sutthikornchai C, Koompapong K, Siri S, Sukthana Y, Nacapunchai D. Development of a rapid, simple method for detecting Naegleria fowleri visually in water samples by loop-mediated isothermal amplification (LAMP). PLoS One 2015; 10:e0120997. [PMID: 25822175 PMCID: PMC4379150 DOI: 10.1371/journal.pone.0120997] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/09/2015] [Indexed: 12/03/2022] Open
Abstract
Naegleria fowleri is the causative agent of the fatal disease primary amebic meningoencephalitis. Detection of N. fowleri using conventional culture and biochemical-based assays is time-consuming and laborious, while molecular techniques, such as PCR, require laboratory skills and expensive equipment. We developed and evaluated a novel loop-mediated isothermal amplification (LAMP) assay targeting the virulence-related gene for N. fowleri. Time to results is about 90 min and amplification products were easily detected visually using hydroxy naphthol blue. The LAMP was highly specific after testing against related microorganisms and able to detect one trophozoite, as determined with spiked water and cerebrospinal fluid samples. The assay was then evaluated with a set of 80 water samples collected during the flooding crisis in Thailand in 2011, and 30 natural water samples from border areas of northern, eastern, western, and southern Thailand. N. fowleri was detected in 13 and 10 samples using LAMP and PCR, respectively, with a Kappa coefficient of 0.855. To the best of our knowledge, this is the first report of a LAMP assay for N. fowleri. Due to its simplicity, speed, and high sensitivity, the LAMP method described here might be useful for quickly detecting and diagnosing N. fowleri in water and clinical samples, particularly in resource-poor settings.
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Affiliation(s)
- Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail: (AM); (DN)
| | - Hirotake Mori
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supaluk Popruk
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Amonrattana Roobthaisong
- Section of Bacterial Pathogenesis, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Microbiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chantira Sutthikornchai
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Khuanchai Koompapong
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sukhontha Siri
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Yaowalark Sukthana
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Duangporn Nacapunchai
- Department of Parasitology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
- * E-mail: (AM); (DN)
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Comparison of real-time PCR methods for the detection of Naegleria fowleri in surface water and sediment. Parasitol Res 2015; 114:1739-46. [PMID: 25855343 DOI: 10.1007/s00436-015-4359-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
Naegleria fowleri is a thermophilic free-living ameba found in freshwater environments worldwide. It is the cause of a rare but potentially fatal disease in humans known as primary amebic meningoencephalitis. Established N. fowleri detection methods rely on conventional culture techniques and morphological examination followed by molecular testing. Multiple alternative real-time PCR assays have been published for rapid detection of Naegleria spp. and N. fowleri. Foursuch assays were evaluated for the detection of N. fowleri from surface water and sediment. The assays were compared for thermodynamic stability, analytical sensitivity and specificity, detection limits, humic acid inhibition effects, and performance with seeded environmental matrices. Twenty-one ameba isolates were included in the DNA panel used for analytical sensitivity and specificity analyses. N. fowleri genotypes I and III were used for method performance testing. Two of the real-time PCR assays were determined to yield similar performance data for specificity and sensitivity for detecting N. fowleri in environmental matrices.
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Bartrand TA, Causey JJ, Clancy JL. Naegleria fowleri:An emerging drinking water pathogen. ACTA ACUST UNITED AC 2014. [DOI: 10.5942/jawwa.2014.106.0140] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
| | - Jonathan Jake Causey
- DHH-OPH Engineering Services, Louisiana Department of Health and Hospitals, Office of Public Health
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Kao PM, Hsu BM, Hsu TK, Chiu YC, Chang CL, Ji WT, Huang SW, Fan CW. Application of TaqMan qPCR for the detection and monitoring of Naegleria species in reservoirs used as a source for drinking water. Parasitol Res 2014; 113:3765-71. [PMID: 25079704 DOI: 10.1007/s00436-014-4042-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
Abstract
Naegleria spp. can be found in the natural aquatic environments. Naegleria fowleri can cause fatal infections in the central nervous system in humans and animals, and the most important source of infection is through direct water contact. In this study, PCR of 5.8S ribosomal RNA (rRNA) gene and internal transcribed spacer (ITS) region was performed in order to identify Naegleria isolates and quantify the Naegleria spp. by TaqMan real-time quantitative PCR in reservoir water samples. The occurrence of Naegleria spp. was investigated in 57 water samples from reservoirs with culture and PCR positive in 2 of them (3.5%), respectively. The total detection rate was 7.0% (4/ 57) for Naegleria spp. The identified species included Naegleria spp., Naegleria canariensis, and Naegleria clarki. N. fowleri was not found in Taiwan's reservoirs used for drinking purposes. The concentrations of Naegleria spp. in detected positive reservoir water samples were in the range of 599 and 3.1 × 10(3) cells/L. The presence or absence of Naegleria spp. within the reservoir water samples showed significant difference with the levels of water temperature. The presence of Naegleria spp. in reservoirs considered a potential public health threat if pathogenic species exist in reservoirs.
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Affiliation(s)
- Po-Min Kao
- Department of Earth and Environmental Sciences, National Chung Cheng University, No.168, Sec. 1, University Rd., Minhsiung Township, Chiayi, 621, Taiwan, Republic of China
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Goudot S, Herbelin P, Mathieu L, Soreau S, Banas S, Jorand F. Biocidal efficacy of monochloramine against planktonic and biofilm-associated Naegleria fowleri
cells. J Appl Microbiol 2014; 116:1055-65. [DOI: 10.1111/jam.12429] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/17/2013] [Accepted: 12/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- S. Goudot
- EDF Recherche et Développement; Laboratoire National d'Hydraulique et Environnement; Chatou Cedex France
- Université de Lorraine; LCPME; UMR 7564 CNRS - UL; Institut Jean Barriol; Villers-lès-Nancy France
- CNRS; LCPME; UMR 7564 CNRS - UL; Villers-lès-Nancy France
| | - P. Herbelin
- EDF Recherche et Développement; Laboratoire National d'Hydraulique et Environnement; Chatou Cedex France
| | - L. Mathieu
- CNRS; LCPME; UMR 7564 CNRS - UL; Villers-lès-Nancy France
- Ecole Pratique des Hautes Etudes (EPHE); LCPME; UMR 7564 CNRS-UL; Vandoeuvre-lès-Nancy France
| | - S. Soreau
- EDF Recherche et Développement; Laboratoire National d'Hydraulique et Environnement; Chatou Cedex France
| | - S. Banas
- Université de Lorraine; LCPME; UMR 7564 CNRS - UL; Institut Jean Barriol; Villers-lès-Nancy France
- CNRS; LCPME; UMR 7564 CNRS - UL; Villers-lès-Nancy France
| | - F.P.A. Jorand
- Université de Lorraine; LCPME; UMR 7564 CNRS - UL; Institut Jean Barriol; Villers-lès-Nancy France
- CNRS; LCPME; UMR 7564 CNRS - UL; Villers-lès-Nancy France
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Improved Method for the Detection and Quantification of Naegleria fowleri in Water and Sediment Using Immunomagnetic Separation and Real-Time PCR. J Parasitol Res 2013; 2013:608367. [PMID: 24228172 PMCID: PMC3818898 DOI: 10.1155/2013/608367] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/26/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022] Open
Abstract
Primary amebic meningoencephalitis (PAM) is a rare and typically fatal infection caused by the thermophilic free-living ameba, Naegleria fowleri. In 2010, the first confirmed case of PAM acquired in Minnesota highlighted the need for improved detection and quantification methods in order to study the changing ecology of N. fowleri and to evaluate potential risk factors for increased exposure. An immunomagnetic separation (IMS) procedure and real-time PCR TaqMan assay were developed to recover and quantify N. fowleri in water and sediment samples. When one liter of lake water was seeded with N. fowleri strain CDC:V212, the method had an average recovery of 46% and detection limit of 14 amebas per liter of water. The method was then applied to sediment and water samples with unknown N. fowleri concentrations, resulting in positive direct detections by real-time PCR in 3 out of 16 samples and confirmation of N. fowleri culture in 6 of 16 samples. This study has resulted in a new method for detection and quantification of N. fowleri in water and sediment that should be a useful tool to facilitate studies of the physical, chemical, and biological factors associated with the presence and dynamics of N. fowleri in environmental systems.
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Kao PM, Tung MC, Hsu BM, Chou MY, Yang HW, She CY, Shen SM. Quantitative detection and identification of Naegleria spp. in various environmental water samples using real-time quantitative PCR assay. Parasitol Res 2013; 112:1467-74. [PMID: 23430358 DOI: 10.1007/s00436-013-3290-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
Naegleria spp. is a free-living amoeba that can be found in various aquatic environments. There are some Naegleria spp. that can cause fatal infections in animals and humans, and the most important source of infection is through direct water contact. In this study, a real-time quantitative PCR was developed to detect and quantify the Naegleria spp. in various environmental water samples. The water samples were taken from rivershed, water treatment plants, and thermal spring recreation areas. The total detection rate was 4.0% (7/176) for Naegleria spp. The percentages of samples containing Naegleria spp. from river water, raw drinking water, and thermal spring water were 0% (0/100), 10.7% (3/28) and 8.3% (4/48), respectively. The concentration of Naegleria spp. in detected positive raw drinking water and thermal spring water samples was in the range of 3.9-12.6 and 1.1-24.2 cells/L, respectively. The identified species included Naegleria australiensis, Naegleria lovaniensis, and Naegleria spitzbergeniensis. The presence of Naegleria spp. in various aquatic environments is considered a potential public health threat.
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Affiliation(s)
- Po-Min Kao
- Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, Republic of China
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Goudot S, Herbelin P, Mathieu L, Soreau S, Banas S, Jorand F. Growth dynamic of Naegleria fowleri in a microbial freshwater biofilm. WATER RESEARCH 2012; 46:3958-3966. [PMID: 22695355 DOI: 10.1016/j.watres.2012.05.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/12/2012] [Accepted: 05/15/2012] [Indexed: 06/01/2023]
Abstract
The presence of pathogenic free-living amoebae (FLA) such as Naegleria fowleri in freshwater environments is a potential public health risk. Although its occurrence in various water sources has been well reported, its presence and associated factors in biofilm remain unknown. In this study, the density of N. fowleri in biofilms spontaneously growing on glass slides fed by raw freshwater were followed at 32 °C and 42 °C for 45 days. The biofilms were collected with their substrata and characterized for their structure, numbered for their bacterial density, thermophilic free-living amoebae, and pathogenic N. fowleri. The cell density of N. fowleri within the biofilms was significantly affected both by the temperature and the nutrient level (bacteria/amoeba ratio). At 32 °C, the density remained constantly low (1-10 N. fowleri/cm(2)) indicating that the amoebae were in a survival state, whereas at 42 °C the density reached 30-900 N. fowleri/cm(2) indicating an active growth phase. The nutrient level, as well, strongly affected the apparent specific growth rate (μ) of N. fowleri in the range of 0.03-0.23 h(-1). At 42 °C a hyperbolic relationship was found between μ and the bacteria/amoeba ratio. A ratio of 10(6) to 10(7) bacteria/amoeba was needed to approach the apparent μ(max) value (0.23 h(-1)). Data analysis also showed that a threshold for the nutrient level of close to 10(4) bacteria/amoeba is needed to detect the growth of N. fowleri in freshwater biofilm. This study emphasizes the important role of the temperature and bacteria as prey to promote not only the growth of N. fowleri, but also its survival.
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Affiliation(s)
- Sébastien Goudot
- EDF Research and Development, Laboratoire National d'Hydraulique et Environnement, 6 Quai Watier, F-78401 Chatou Cedex, France
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Ahmad AF, Lonnen J, Andrew PW, Kilvington S. Development of a rapid DNA extraction method and one-step nested PCR for the detection of Naegleria fowleri from the environment. WATER RESEARCH 2011; 45:5211-5217. [PMID: 21855956 DOI: 10.1016/j.watres.2011.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 07/18/2011] [Accepted: 07/19/2011] [Indexed: 05/31/2023]
Abstract
Naegleria fowleri is a small free-living amoebo-flagellate found in natural and manmade thermal aquatic habitats worldwide. The organism is pathogenic to man causing fatal primary amoebic meningoencephalitis (PAM). Infection typically results from bathing in contaminated water and is usually fatal. It is, therefore, important to identify sites containing N. fowleri in the interests of preventive public health microbiology. Culture of environmental material is the conventional method for the isolation of N. fowleri but requires several days incubation and subsequent biochemical or molecular tests to confirm identification. Here, a nested one-step PCR test, in conjunction with a direct DNA extraction from water or sediment material, was developed for the rapid and reliable detection of N. fowleri from the environment. Here, the assay detected N, fowleri in 18/109 river water samples associated with a nuclear power plant in South West France and 0/10 from a similar site in the UK. Although culture of samples yielded numerous thermophilic free-living amoebae, none were N. fowleri or other thermophilic Naegleria spp. The availability of a rapid, reliable and sensitive one-step nested PCR method for the direct detection of N. fowleri from the environment may aid ecological studies and enable intervention to prevent PAM cases.
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Affiliation(s)
- Arine Fadzlun Ahmad
- Department of Infection, Immunity & Inflammation, University of Leicester, Medical Sciences Building, PO Box 138, University Road, Leicester LE1 9HN, UK
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Thomas JM, Ashbolt NJ. Do free-living amoebae in treated drinking water systems present an emerging health risk? ENVIRONMENTAL SCIENCE & TECHNOLOGY 2011; 45:860-9. [PMID: 21194220 DOI: 10.1021/es102876y] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
There is an expanding body of evidence that free-living amoebae (FLA) increase both the numbers and virulence of water-based, human-pathogenic, amoeba-resisting microorganisms (ARM). Legionella spp., Mycobacterium spp., and other opportunistic human pathogens are known to be both ARM and also the etiologic agents of potentially fatal human lung infections. However, comparatively little is known about the FLA that may facilitate ARM growth in drinking water. This review examines the available literature on FLA in treated drinking water systems; in total 26 studies from 18 different countries. FLA were reported to breakthrough the water treatment barrier and enter distribution systems, in addition to the expected post-treatment system ingress. Once in the distribution system there is evidence of FLA colonization and regrowth especially in reservoirs and in-premise plumbing storage tanks. At the point of use the average FLA detection rate was 45% but highly variable (n = 16, σ = 31) due to both differences in both assay methods and the type of water systems examined. This review reveals that FLA are consistently detected in treated drinking water systems around the world and present a yet unquantified emerging health risk. However, more research is urgently required before accurate risks assessments can be undertaken to assess the impacts on human health, in households and institutions, due to exposure to FLA facilitated pathogenic ARM.
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Affiliation(s)
- Jacqueline M Thomas
- Water Research Centre, School of Civil and Environmental Engineering, The University of New South Wales, NSW 2052 Australia.
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Stockman LJ, Wright CJ, Visvesvara GS, Fields BS, Beach MJ. Prevalence of Acanthamoeba spp. and other free-living amoebae in household water, Ohio, USA--1990-1992. Parasitol Res 2010; 108:621-7. [PMID: 20978791 DOI: 10.1007/s00436-010-2120-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Accepted: 09/24/2010] [Indexed: 11/26/2022]
Abstract
Knowledge of the prevalence of free-living amoebae (FLA) in US household water can provide a focus for prevention of amoeba-associated illnesses. Household water samples from two Ohio counties, collected and examined for amoebae during 1990-1992, were used to describe the prevalence of Acanthamoeba and other FLA in a household setting. Amoebae were isolated and identified by morphologic features. A total of 2,454 samples from 467 households were examined. Amoebae were found in water samples of 371 (79%) households. Sites most likely to contain amoeba were shower heads (52%) and kitchen sprayers (50%). Species of Hartmannella, Acanthamoeba, or Vahlkampfia were most common. Detection was higher in biofilm swab samples than in water samples. Detection of FLA and Acanthamoeba, at 79% and 51%, respectively, exceed estimates that have been published in previous surveys of household sources. We believe FLA are commonplace inhabitants of household water in this sample as they are in the environment.
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Affiliation(s)
- Lauren J Stockman
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE Mailstop A-34, Atlanta, GA, USA
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Barratt JLN, Harkness J, Marriott D, Ellis JT, Stark D. Importance of nonenteric protozoan infections in immunocompromised people. Clin Microbiol Rev 2010; 23:795-836. [PMID: 20930074 PMCID: PMC2952979 DOI: 10.1128/cmr.00001-10] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.
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Affiliation(s)
- J L N Barratt
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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