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Furst KE, Graham KE, Weisman RJ, Adusei KB. It's getting hot in here: Effects of heat on temperature, disinfection, and opportunistic pathogens in drinking water distribution systems. WATER RESEARCH 2024; 260:121913. [PMID: 38901309 DOI: 10.1016/j.watres.2024.121913] [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: 03/05/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/22/2024]
Abstract
As global temperatures rise with climate change, the negative effects of heat on drinking water distribution systems (DWDS) are of increasing concern. High DWDS temperatures are associated with degradation of water quality through physical, chemical and microbial mechanisms. Perhaps the most pressing concern is proliferation of thermotolerant opportunistic pathogens (OPs) like Legionella pneumophila and Naegleria Fowleri. Many OPs can be controlled in DWDS by residual disinfectants such as chlorine or chloramine, but maintaining protective residuals can be challenging at high temperatures. This critical review evaluates the literature on DWDS temperature, residual disinfectant decay, and OP survival and growth with respect to high temperatures. The findings are synthesized to determine the state of knowledge and future research priorities regarding OP proliferation and control at high DWDS temperatures. Temperatures above 40 °C were reported from multiple DWDS, with a maximum of 52 °C. Substantial diurnal temperature swings from ∼30-50 °C occurred in one DWDS. Many OPs can survive or even replicate at these temperatures. However, most studies focused on just a few OP species, and substantial knowledge gaps remain regarding persistence, infectivity, and shifts in microbial community structure at high temperatures relative to lower water temperatures. Chlorine decay rates substantially increase with temperature in some waters but not in others, for reasons that are not well understood. Decay rates within real DWDS are difficult to accurately characterize, presenting practical limitations for application of temperature-dependent decay models at full scale. Chloramine decay is slower than chlorine except in the presence of nitrifiers, which are especially known to grow in DWDS in warmer seasons and climates, though the high temperature range for nitrification is unknown. Lack of knowledge about DWDS nitrifier communities may hinder development of solutions. Fundamental knowledge gaps remain which prevent understanding even the occurrence of high temperatures in DWDS, much less the overall effect on exposure risk. Potential solutions to minimize DWDS temperatures or mitigate the impacts of heat were identified, many which could be aided by proven models for predicting DWDS temperature. Industry leadership and collaboration is needed to generate practical knowledge for protecting DWDS water quality as temperatures rise.
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Affiliation(s)
- Kirin E Furst
- Department of Civil, Environmental, & Infrastructure Engineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States.
| | - Katherine E Graham
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA 30332, United States
| | - Richard J Weisman
- Department of Civil, Environmental, & Infrastructure Engineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States
| | - Kadmiel B Adusei
- Department of Civil, Environmental, & Infrastructure Engineering, George Mason University, 4400 University Drive, Fairfax, VA 22030, United States
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Chaplin M, Leung K, Szczuka A, Hansen B, Rockey NC, Henderson JB, Wigginton KR. Linear Mixed Model of Virus Disinfection by Free Chlorine to Harmonize Data Collected across Broad Environmental Conditions. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:12260-12271. [PMID: 38923944 PMCID: PMC11238732 DOI: 10.1021/acs.est.4c02885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
Despite the critical importance of virus disinfection by chlorine, our fundamental understanding of the relative susceptibility of different viruses to chlorine and robust quantitative relationships between virus disinfection rate constants and environmental parameters remains limited. We conducted a systematic review of virus inactivation by free chlorine and used the resulting data set to develop a linear mixed model that estimates chlorine inactivation rate constants for viruses based on experimental conditions. 570 data points were collected in our systematic review, representing 82 viruses over a broad range of environmental conditions. The harmonized inactivation rate constants under reference conditions (pH = 7.53, T = 20 °C, [Cl-] < 50 mM) spanned 5 orders of magnitude, ranging from 0.0196 to 1150 L mg-1 min-1, and uncovered important trends between viruses. Whereas common surrogate bacteriophage MS2 does not serve as a conservative chlorine disinfection surrogate for many human viruses, CVB5 was one of the most resistant viruses in the data set. The model quantifies the role of pH, temperature, and chloride levels across viruses, and an online tool allows users to estimate rate constants for viruses and conditions of interest. Results from the model identified potential shortcomings in current U.S. EPA drinking water disinfection requirements.
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Affiliation(s)
- Mira Chaplin
- Civil
and Environmental Engineering, University
of Michigan, 1351 Beal Ave., Ann Arbor, Michigan 48109-2138, United States
| | - Kaming Leung
- Civil
and Environmental Engineering, University
of Michigan, 1351 Beal Ave., Ann Arbor, Michigan 48109-2138, United States
| | - Aleksandra Szczuka
- Civil
and Environmental Engineering, University
of Michigan, 1351 Beal Ave., Ann Arbor, Michigan 48109-2138, United States
| | - Brianna Hansen
- Civil
and Environmental Engineering, University
of Michigan, 1351 Beal Ave., Ann Arbor, Michigan 48109-2138, United States
| | - Nicole C. Rockey
- Civil
and Environmental Engineering, Duke University, Durham, North Carolina, 27708, United States
| | - James B. Henderson
- Department
of Internal Medicine, University of Michigan
Medical School, NCRC Bldg. 16 #471C, 2800 Plymouth Rd., Ann
Arbor, Michigan 48109-2138, United States
| | - Krista R. Wigginton
- Civil
and Environmental Engineering, University
of Michigan, 1351 Beal Ave., Ann Arbor, Michigan 48109-2138, United States
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Whapham CA, Walker JT. Too much ado about data: Continuous remote monitoring of water temperatures, circulation and throughput can assist in the reduction of hospital-associated waterborne infections. J Hosp Infect 2024:S0195-6701(24)00223-8. [PMID: 38960042 DOI: 10.1016/j.jhin.2024.05.023] [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: 04/01/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND National and international guidance provides advice on maintenance and management of water systems in healthcare buildings, however, healthcare-associated waterborne infections (HAWI) are increasing. This narrative review identifies parameters critical to water quality in healthcare buildings and assesses if remote sensor monitoring can deliver safe water systems thus reducing HAWI. METHOD A narrative review was performed using the following search terms 1) consistent water temperature AND waterborne pathogen control OR nosocomial infection 2) water throughput AND waterborne pathogen control OR nosocomial infection 3) remote monitoring of in-premise water systems AND continuous surveillance for temperature OR throughput OR flow OR use. Databases employed were PubMed, CDSR (Clinical Study Data Request) and DARE (Database of Abstracts of Reviews of Effects) from Jan 2013 - Mar 2024. FINDINGS Single ensuite-patient rooms, expansion of wash-hand basins, widespread glove use, alcohol gel and wipes have increased water system stagnancy resulting in amplification of waterborne pathogens and transmission risk of Legionella, Pseudomonas and Non-Tuberculous Mycobacteria. Manual monitoring does not represent temperatures across large complex water systems. This review deems that multiple point continuous remote sensor monitoring is effective at identifying redundant and low use outlets, hydraulic imbalance and inconsistent temperature delivery across in-premise water systems. CONCLUSION As remote monitoring becomes more common there will be greater recognition of failures in temperature control, hydraulics and balancing in water systems and there remains much to learn as we adopt this developing technology within our hospitals.
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Affiliation(s)
- C A Whapham
- Independent Water Hygiene Consultant, Ludlow UK.
| | - J T Walker
- Independent Microbiology Consultant, Walker on Water, Salisbury UK
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LeChevallier MW, Prosser T, Stevens M. Opportunistic Pathogens in Drinking Water Distribution Systems-A Review. Microorganisms 2024; 12:916. [PMID: 38792751 PMCID: PMC11124194 DOI: 10.3390/microorganisms12050916] [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: 04/01/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
In contrast to "frank" pathogens, like Salmonella entrocolitica, Shigella dysenteriae, and Vibrio cholerae, that always have a probability of disease, "opportunistic" pathogens are organisms that cause an infectious disease in a host with a weakened immune system and rarely in a healthy host. Historically, drinking water treatment has focused on control of frank pathogens, particularly those from human or animal sources (like Giardia lamblia, Cryptosporidium parvum, or Hepatitis A virus), but in recent years outbreaks from drinking water have increasingly been due to opportunistic pathogens. Characteristics of opportunistic pathogens that make them problematic for water treatment include: (1) they are normally present in aquatic environments, (2) they grow in biofilms that protect the bacteria from disinfectants, and (3) under appropriate conditions in drinking water systems (e.g., warm water, stagnation, low disinfectant levels, etc.), these bacteria can amplify to levels that can pose a public health risk. The three most common opportunistic pathogens in drinking water systems are Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. This report focuses on these organisms to provide information on their public health risk, occurrence in drinking water systems, susceptibility to various disinfectants, and other operational practices (like flushing and cleaning of pipes and storage tanks). In addition, information is provided on a group of nine other opportunistic pathogens that are less commonly found in drinking water systems, including Aeromonas hydrophila, Klebsiella pneumoniae, Serratia marcescens, Burkholderia pseudomallei, Acinetobacter baumannii, Stenotrophomonas maltophilia, Arcobacter butzleri, and several free-living amoebae including Naegleria fowleri and species of Acanthamoeba. The public health risk for these microbes in drinking water is still unclear, but in most cases, efforts to manage Legionella, mycobacteria, and Pseudomonas risks will also be effective for these other opportunistic pathogens. The approach to managing opportunistic pathogens in drinking water supplies focuses on controlling the growth of these organisms. Many of these microbes are normal inhabitants in biofilms in water, so the attention is less on eliminating these organisms from entering the system and more on managing their occurrence and concentrations in the pipe network. With anticipated warming trends associated with climate change, the factors that drive the growth of opportunistic pathogens in drinking water systems will likely increase. It is important, therefore, to evaluate treatment barriers and management activities for control of opportunistic pathogen risks. Controls for primary treatment, particularly for turbidity management and disinfection, should be reviewed to ensure adequacy for opportunistic pathogen control. However, the major focus for the utility's opportunistic pathogen risk reduction plan is the management of biological activity and biofilms in the distribution system. Factors that influence the growth of microbes (primarily in biofilms) in the distribution system include, temperature, disinfectant type and concentration, nutrient levels (measured as AOC or BDOC), stagnation, flushing of pipes and cleaning of storage tank sediments, and corrosion control. Pressure management and distribution system integrity are also important to the microbial quality of water but are related more to the intrusion of contaminants into the distribution system rather than directly related to microbial growth. Summarizing the identified risk from drinking water, the availability and quality of disinfection data for treatment, and guidelines or standards for control showed that adequate information is best available for management of L. pneumophila. For L. pneumophila, the risk for this organism has been clearly established from drinking water, cases have increased worldwide, and it is one of the most identified causes of drinking water outbreaks. Water management best practices (e.g., maintenance of a disinfectant residual throughout the distribution system, flushing and cleaning of sediments in pipelines and storage tanks, among others) have been shown to be effective for control of L. pneumophila in water supplies. In addition, there are well documented management guidelines available for the control of the organism in drinking water distribution systems. By comparison, management of risks for Mycobacteria from water are less clear than for L. pneumophila. Treatment of M. avium is difficult due to its resistance to disinfection, the tendency to form clumps, and attachment to surfaces in biofilms. Additionally, there are no guidelines for management of M. avium in drinking water, and one risk assessment study suggested a low risk of infection. The role of tap water in the transmission of the other opportunistic pathogens is less clear and, in many cases, actions to manage L. pneumophila (e.g., maintenance of a disinfectant residual, flushing, cleaning of storage tanks, etc.) will also be beneficial in helping to manage these organisms as well.
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Affiliation(s)
| | - Toby Prosser
- Melbourne Water, Melbourne, VIC 3001, Australia; (T.P.); (M.S.)
| | - Melita Stevens
- Melbourne Water, Melbourne, VIC 3001, Australia; (T.P.); (M.S.)
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Kunz JM, Lawinger H, Miko S, Gerdes M, Thuneibat M, Hannapel E, Roberts VA. Surveillance of Waterborne Disease Outbreaks Associated with Drinking Water - United States, 2015-2020. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-23. [PMID: 38470836 DOI: 10.15585/mmwr.ss7301a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Problem/Condition Public health agencies in U.S. states, territories, and freely associated states investigate and voluntarily report waterborne disease outbreaks to CDC through the National Outbreak Reporting System (NORS). This report summarizes NORS drinking water outbreak epidemiologic, laboratory, and environmental data, including data for both public and private drinking water systems. The report presents outbreak-contributing factors (i.e., practices and factors that lead to outbreaks) and, for the first time, categorizes outbreaks as biofilm pathogen or enteric illness associated. Period Covered 2015-2020. Description of System CDC launched NORS in 2009 as a web-based platform into which public health departments voluntarily enter outbreak information. Through NORS, CDC collects reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents as well as foodborne and waterborne outbreaks of nonenteric disease. Data provided by NORS users, when known, for drinking water outbreaks include 1) the number of cases, hospitalizations, and deaths; 2) the etiologic agent (confirmed or suspected); 3) the implicated type of water system (e.g., community or individual or private); 4) the setting of exposure (e.g., hospital or health care facility; hotel, motel, lodge, or inn; or private residence); and 5) relevant epidemiologic and environmental data needed to describe the outbreak and characterize contributing factors. Results During 2015-2020, public health officials from 28 states voluntarily reported 214 outbreaks associated with drinking water and 454 contributing factor types. The reported etiologies included 187 (87%) biofilm associated, 24 (11%) enteric illness associated, two (1%) unknown, and one (<1%) chemical or toxin. A total of 172 (80%) outbreaks were linked to water from public water systems, 22 (10%) to unknown water systems, 17 (8%) to individual or private systems, and two (0.9%) to other systems; one (0.5%) system type was not reported. Drinking water-associated outbreaks resulted in at least 2,140 cases of illness, 563 hospitalizations (26% of cases), and 88 deaths (4% of cases). Individual or private water systems were implicated in 944 (43%) cases, 52 (9%) hospitalizations, and 14 (16%) deaths.Enteric illness-associated pathogens were implicated in 1,299 (61%) of all illnesses, and 10 (2%) hospitalizations. No deaths were reported. Among these illnesses, three pathogens (norovirus, Shigella, and Campylobacter) or multiple etiologies including these pathogens resulted in 1,225 (94%) cases. The drinking water source was identified most often (n = 34; 7%) as the contributing factor in enteric disease outbreaks. When water source (e.g., groundwater) was known (n = 14), wells were identified in 13 (93%) of enteric disease outbreaks.Most biofilm-related outbreak reports implicated Legionella (n = 184; 98%); two nontuberculous mycobacteria (NTM) (1%) and one Pseudomonas (0.5%) outbreaks comprised the remaining. Legionella-associated outbreaks generally increased over the study period (14 in 2015, 31 in 2016, 30 in 2017, 34 in 2018, 33 in 2019, and 18 in 2020). The Legionella-associated outbreaks resulted in 786 (37%) of all illnesses, 544 (97%) hospitalizations, and 86 (98%) of all deaths. Legionella also was the outbreak etiology in 160 (92%) public water system outbreaks. Outbreak reports cited the premise or point of use location most frequently as the contributing factor for Legionella and other biofilm-associated pathogen outbreaks (n = 287; 63%). Legionella was reported to NORS in 2015 and 2019 as the cause of three outbreaks in private residences (2). Interpretation The observed range of biofilm and enteric drinking water pathogen contributing factors illustrate the complexity of drinking water-related disease prevention and the need for water source-to-tap prevention strategies. Legionella-associated outbreaks have increased in number over time and were the leading cause of reported drinking water outbreaks, including hospitalizations and deaths. Enteric illness outbreaks primarily linked to wells represented approximately half the cases during this reporting period. This report enhances CDC efforts to estimate the U.S. illness and health care cost impacts of waterborne disease, which revealed that biofilm-related pathogens, NTM, and Legionella have emerged as the predominant causes of hospitalizations and deaths from waterborne- and drinking water-associated disease. Public Health Action Public health departments, regulators, and drinking water partners can use these findings to identify emerging waterborne disease threats, guide outbreak response and prevention programs, and support drinking water regulatory efforts.
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Shcherbakov OV, Aghayan SA, Gevorgyan HS, Abgaryan TA, Gevorgyan RH, Jiménez-Meléndez A, Robertson LJ. Preliminary investigations of parasite contamination of water sources in Armenia. Food Waterborne Parasitol 2024; 34:e00221. [PMID: 38318240 PMCID: PMC10840316 DOI: 10.1016/j.fawpar.2024.e00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
The intestinal protozoan parasites, Cryptosporidium and Giardia, are known to have a global distribution, infecting and causing disease in a range of hosts, including people, livestock, pets, and wildlife. However, data from some regions is very sparse. In Armenia, in the Caucasus region of West Asia, only scanty data are available, with just a few surveys on Cryptosporidium infections in livestock, and no available data on human infections or environmental contamination. As part of implementation of water analysis methods for these parasites in Armenia, 24 raw water samples and two sediment samples were analysed for these parasites using a range of approaches, including modified Ziehl-Neelsen, Lugol stain, immunofluorescent antibody test (IFAT), qPCR and, on sediment samples, immunomagnetic separation and IFAT. Results suggest substantial contamination of raw water sources and indicate the need for further targeted studies using appropriate methods and collecting data on host infections in catchment areas.
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Affiliation(s)
- Oleg V. Shcherbakov
- Scientific Center of Zoology and Hydroecology, NAS RA. 7 P. Sevak str., 0014 Yerevan, Armenia
- Armenian National Agrarian University, 74 Teryan str., 0009 Yerevan, Armenia
| | - Sargis A. Aghayan
- Scientific Center of Zoology and Hydroecology, NAS RA. 7 P. Sevak str., 0014 Yerevan, Armenia
| | - Hasmik Sh. Gevorgyan
- Scientific Center of Zoology and Hydroecology, NAS RA. 7 P. Sevak str., 0014 Yerevan, Armenia
| | - Tigran A. Abgaryan
- Scientific Center of Zoology and Hydroecology, NAS RA. 7 P. Sevak str., 0014 Yerevan, Armenia
| | - Ruzanna H. Gevorgyan
- Scientific Center of Zoology and Hydroecology, NAS RA. 7 P. Sevak str., 0014 Yerevan, Armenia
| | - Alejandro Jiménez-Meléndez
- Parasitology, Norwegian University of Life Sciences (NMBU), Faculty of Veterinary Medicine, P.O. Box 5003, NO-1432 Ås, Norway
| | - Lucy J. Robertson
- Parasitology, Norwegian University of Life Sciences (NMBU), Faculty of Veterinary Medicine, P.O. Box 5003, NO-1432 Ås, Norway
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Lan W, Liu H, Weng R, Zeng Y, Lou J, Xu H, Yu Y, Jiang Y. Microbial community of municipal drinking water in Hangzhou using metagenomic sequencing. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 342:123066. [PMID: 38048871 DOI: 10.1016/j.envpol.2023.123066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
While traditional culture-dependent methods can effectively detect certain microorganisms, the comprehensive composition of the municipal drinking water (DW) microbiome, including bacteria, archaea, and viruses, remains unknown. Metagenomic sequencing has opened the door to accurately determine and analyze the entire microbial community of DW, providing a comprehensive understanding of DW species diversity, especially in the context of public health concerns during the COVID-19 era. In this study, we found that most of the culturable bacteria and some fecal indicator bacteria, such as Escherichia coli and Pseudomonas aeruginosa, were non-culturable using culture-dependent methods in all samples. However, metagenomic analysis showed that the predominant bacterial species in the DW samples belonged to the phyla Proteobacteria and Planctomycetes. Notably, the genus Methylobacterium was the most abundant in all water samples, followed by Sphingomonas, Gemmata, and Azospirilum. While low levels of virulence-associated factors, such as the Esx-5 type VII secretion system (T7SS) and DevR/S, were detected, only the erythromycin resistance gene erm(X), an rRNA methyltransferase, was identified at low abundance in one sample. Hosts corresponding to virulence and resistance genes were identified in some samples, including Mycobacterium spp. Archaeal DNA (Euryarchaeota, Crenarchaeota) was found in trace amounts in some DW samples. Viruses such as rotavirus, coxsackievirus, human enterovirus, and SARS-CoV-2 were negative in all DW samples using colloidal gold and real-time reverse transcription polymerase chain reaction (RT‒PCR) methods. However, DNA encoding a new order of reverse-transcribing viruses (Ortervirales) and Herpesvirales was found in some DW samples. The metabolic pathways of the entire microbial community involve cell‒cell communication and signal secretion, contributing to cooperation between different microbial populations in the water. This study provides insight into the microbial community and metabolic process of DW in Hangzhou, China, utilizing both culture-dependent methods and metagenomic sequencing combined with bioinformatics tools during the COVID-19 pandemic era.
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Affiliation(s)
- Wei Lan
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, 310016, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Haiyang Liu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, 310016, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Rui Weng
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, 310016, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yaxiong Zeng
- College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 320013, China
| | - Jian Lou
- Yiwu Water Construction Group Co., Ltd., Yiwu, 322000, China
| | - Hongxin Xu
- Yiwu Water Construction Group Co., Ltd., Yiwu, 322000, China
| | - Yunsong Yu
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, 310016, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, 310016, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
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Politi L, Mellou K, Chrysostomou A, Mandilara G, Spiliopoulou I, Theofilou A, Polemis M, Tryfinopoulou K, Sideroglou T. A Community Waterborne Salmonella Bovismorbificans Outbreak in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:167. [PMID: 38397659 PMCID: PMC10887688 DOI: 10.3390/ijerph21020167] [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: 11/16/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND In August 2022, the Hellenic National Public Health Organisation was notified about a gastroenteritis outbreak in town A in Southern Greece. Investigations aimed to identify the source and implement control measures. METHODS Case definition categories were used in a 1:3 case-control study. Cases and controls were interviewed about various exposures. Cases' stool samples were cultured on agar plates and characterised by serotyping, antimicrobial susceptibility testing and Pulse Field Gel Electrophoresis (PFGE). Environmental investigations included tap water sampling for microbiological and chemical analysis in town A and inspection of the water supply system. RESULTS We identified 33 cases (median age: 17 years). Tap water consumption was the only significant risk factor for gastroenteritis (OR = 5.46, 95% CI = 1.02-53.95). Salmonella (S.) Bovismorbificans isolated from eight stool and one tap water samples had identical PFGE profiles. No resistant isolates were identified. Residual chlorine levels were lower than the acceptable limits before and during the outbreak. We advised consumption of bottled water and adherence to strict hand hygiene rules until tap water was declared suitable for drinking. CONCLUSIONS Epidemiological and molecular data revealed a waterborne S. Bovismorbificans outbreak in town A. We recommend local water safety authorities to ensure that residual chlorine levels comply with the legislation towards water safety planning, to mitigate risks.
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Affiliation(s)
- Lida Politi
- Department of Microbial Resistance and Infections in Health Care Settings, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece;
| | - Kassiani Mellou
- Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece
| | - Anthi Chrysostomou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (A.C.); (T.S.)
| | - Georgia Mandilara
- National Reference Centre for Salmonella and Shigella, School of Public Health, University of West Attica, 11521 Athens, Greece;
| | - Ioanna Spiliopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (I.S.); (K.T.)
| | - Antonia Theofilou
- Water Microbiology Laboratory, Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece;
| | - Michalis Polemis
- National Electronic Antimicrobial Resistance Surveillance Network, Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece;
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (I.S.); (K.T.)
| | - Theologia Sideroglou
- Department of Foodborne and Waterborne Diseases, Directorate of Surveillance and Prevention of Infectious Diseases, National Public Health Organization, 15123 Athens, Greece; (A.C.); (T.S.)
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Glauser KG, Kelley RE, Leonard WJ, Hendrix J, Petri S, Tong EI, Chan YL, Lipner EM, Dawrs SN, Honda JR. Common Features of Environmental Mycobacterium chelonae from Colorado Using Partial and Whole Genomic Sequence Analyses. Curr Microbiol 2024; 81:69. [PMID: 38238596 PMCID: PMC10796651 DOI: 10.1007/s00284-023-03589-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024]
Abstract
Nontuberculous mycobacteria (NTM) are environmentally acquired opportunistic pathogens that cause chronic lung disease in susceptible individuals. While presumed to be ubiquitous in built and natural environments, NTM environmental studies are limited. While environmental sampling campaigns have been performed in geographic areas of high NTM disease burden, NTM species diversity is less defined among areas of lower disease burden like Colorado. In Colorado, metals such as molybdenum have been correlated with increased risk for NTM infection, yet environmental NTM species diversity has not yet been widely studied. Based on prior regression modeling, three areas of predicted high, moderate, and low NTM risk were identified for environmental sampling in Colorado. Ice, plumbing biofilms, and sink tap water samples were collected from publicly accessible freshwater sources. All samples were microbiologically cultured and NTM were identified using partial rpoB gene sequencing. From these samples, areas of moderate risk were more likely to be NTM positive. NTM recovery from ice was more common than recovery from plumbing biofilms or tap water. Overall, nine different NTM species were identified, including clinically important Mycobacterium chelonae. MinION technology was used to whole genome sequence and compare mutational differences between six M. chelonae genomes, representing three environmental isolates from this study and three other M. chelonae isolates from other sources. Drug resistance genes and prophages were common findings among environmentally derived M. chelonae, promoting the need for expanded environmental sampling campaigns to improve our current understanding of NTM species abundance while opening new avenues for improved targeted drug therapies.
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Affiliation(s)
- Kayden G Glauser
- Department of Science, Principles of Experimental Design in Biotechnology, Rock Canyon High School, Littleton, CO, 80124, USA
| | - Reagan E Kelley
- Department of Science, Principles of Experimental Design in Biotechnology, Rock Canyon High School, Littleton, CO, 80124, USA
| | - William J Leonard
- Department of Science, Principles of Experimental Design in Biotechnology, Rock Canyon High School, Littleton, CO, 80124, USA
| | - Jo Hendrix
- Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Suzanne Petri
- Department of Science, Principles of Experimental Design in Biotechnology, Rock Canyon High School, Littleton, CO, 80124, USA
| | - Eric I Tong
- Aina Informatics Network, 'Iolani School, Honolulu, HI, 96826, USA
| | - Yvonne L Chan
- Aina Informatics Network, 'Iolani School, Honolulu, HI, 96826, USA
| | - Ettie M Lipner
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Stephanie N Dawrs
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, 80206, USA
| | - Jennifer R Honda
- Department of Cellular and Molecular Biology, School of Medicine, University of Texas at Tyler Health Science Center, Tyler, TX, 75708, USA.
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10
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Lipner EM, French JP, Mercaldo RA, Nelson S, Zelazny AM, Marshall JE, Strong M, Falkinham JO, Prevots DR. The risk of pulmonary NTM infections and water-quality constituents among persons with cystic fibrosis in the United States, 2010-2019. Environ Epidemiol 2023; 7:e266. [PMID: 37840858 PMCID: PMC10569765 DOI: 10.1097/ee9.0000000000000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/06/2023] [Accepted: 07/17/2023] [Indexed: 10/17/2023] Open
Abstract
Rationale The prevalence of nontuberculous mycobacterial (NTM) pulmonary disease varies geographically in the United States. Previous studies indicate that the presence of certain water-quality constituents in source water increases NTM infection risk. Objective To identify water-quality constituents that influence the risk of NTM pulmonary infection in persons with cystic fibrosis in the United States. Methods We conducted a population-based case-control study using NTM incidence data collected from the Cystic Fibrosis Foundation Patient Registry during 2010-2019. We linked patient zip code to the county and associated patient county of residence with surface water data extracted from the Water Quality Portal. We used logistic regression models to estimate the odds of NTM infection as a function of water-quality constituents. We modeled two outcomes: pulmonary infection due to Mycobacterium avium complex (MAC) and Mycobacterium abscessus species. Results We identified 484 MAC cases, 222 M. abscessus cases and 2816 NTM-negative cystic fibrosis controls resident in 11 states. In multivariable models, we found that for every 1-standardized unit increase in the log concentration of sulfate and vanadium in surface water at the county level, the odds of infection increased by 39% and 21%, respectively, among persons with cystic fibrosis with MAC compared with cystic fibrosis-NTM-negative controls. When modeling M. abscessus as the dependent variable, every 1-standardized unit increase in the log concentration of molybdenum increased the odds of infection by 36%. Conclusions These findings suggest that naturally occurring and anthropogenic water-quality constituents may influence the NTM abundance in water sources that supply municipal water systems, thereby increasing MAC and M. abscessus infection risk.
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Affiliation(s)
- Ettie M. Lipner
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Joshua P. French
- Department of Mathematical and Statistical Sciences, University of Colorado Denver, Denver, Colorado
| | - Rachel A. Mercaldo
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Stephen Nelson
- Department of Geological Sciences, Brigham Young University, Provo, Utah
| | - Adrian M. Zelazny
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Julia E. Marshall
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Michael Strong
- Center for Genes, Environment and Health, National Jewish Health, Denver, Colorado
| | | | - D. Rebecca Prevots
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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