A cluster of Escherichia coli O157: nonmotile infections associated with recreational exposure to lake water

Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis

Recreational water quality guidelines protect the public from health risks associated with water recreation by helping to prevent unacceptable concentrations of pathogenic organisms in ambient water. However, illness risk is associated with both the concentration of pathogens in the water and the degree of contact with those pathogens. Different recreational activities can result in different levels of contact with ambient water containing water-borne pathogens. We conducted a systematic literature review and meta-analysis to evaluate risks of illness associated with different recreational activities and different levels of contact to ambient surface waters. We screened 8,618 potentially relevant studies for quantitative measures of risk using inclusion/exclusion criteria established in advance. We categorized recreational activities as swimming, sports-related contact, minimal contact, and sand contact. We combined relative risks using a random effects meta-analysis for adverse health outcome categories representing gastrointestinal illness, respiratory illness, skin, eye, ear, nose, throat, and cold/flu illness. We identified 92 studies meeting our inclusion criteria. Pooled risk estimates indicate significant elevation of gastrointestinal illness with the recreational activity categories swimming (2.19, 95% CI: 1.82, 2.63) and sports-related contact (2.69, 95% CI: 1.04, 6.92), and nonsignificant elevation of gastrointestinal illness with minimal contact (1.27, 95% CI: 0.74, 2.16). We also found a significant elevation of respiratory illness with swimming (1.78, 95% CI: 1.38, 2.29) and sports-related contact (1.49, 95% CI: 1.00, 2.24), and no elevation of respiratory illness with minimal contact (0.90, 95% CI: 0.71, 1.14). This study suggests that exposures associated with different types of recreational activities are important characteristics of the exposure pathway when assessing illness risk associated with recreation in ambient surface waters.

Occurrence of virulence gene signatures associated with diarrhoeagenic and non-diarrhoeagenic pathovars of Escherichia coli isolates from some selected rivers in South-Western Nigeria

BACKGROUND

Diarrhoeal diseases are attributable to unsafe water stemming from improper sanitation and hygiene and are reportedly responsible for extensive morbidity and mortality particularly among children in developed and developing countries.

METHODS

Water samples from selected rivers in Osun State, South-Western Nigeria were collected and analyzed using standard procedures. Escherichia coli isolates (n=300) were screened for 10 virulence genes using polymerase chain reaction for pathotyping.

RESULTS

While the virulence gene (VG) lt for enterotoxigenic E. coli had the highest prevalence of 45%, the enteropathogenic E. coli genes eae and bfp were detected in 6 and 4% of the isolates respectively. The VGs stx1 and stx2 specific for the enterohemorrhagic E. coli pathotypes were detected in 7 and 1% of the isolates respectively. Also, the VG eagg harboured by enteroaggregative pathotype and diffusely-adherent E. coli VG daaE were detected in 2 and 4% of the isolates respectively and enteroinvasive E. coli VG ipaH was not detected. In addition, the VGs papC for uropathogenic and ibeA for neonatal meningitis were frequently detected in 19 and 3% of isolates respectively.

CONCLUSIONS

These findings reveal the presence of diarrhoeagenic and non-diarrhoeagenic E. coli in the selected rivers and a potential public health risk as the rivers are important resources for domestic, recreational and livelihood usage by their host communities.

A long-term monitoring study of chlorophyll, microbial contaminants, and pesticides in a coastal residential stormwater pond and its adjacent tidal creek

Stormwater ponds are commonly used in residential and commercial areas to control flooding. The accumulation of urban contaminants in stormwater ponds can lead to water-quality problems including nutrient enrichment, chemical contamination, and bacterial contamination. This study presents 5 years of monitoring data assessing water quality of a residential subdivision pond and adjacent tidal creek in coastal South Carolina, USA. The stormwater pond is eutrophic, as described by elevated concentrations of chlorophyll and phosphorus, and experiences periodic cyanobacterial blooms. A maximum monthly average chlorophyll concentration of 318.75 μg/L was measured in the stormwater pond and 227.63 μg/L in the tidal creek. Fecal coliform bacteria (FCB) levels were measured in both the pond and the tidal creek that exceeded health and safety standards for safe recreational use. A maximum monthly average FCB level of 1,247 CFU/100 mL was measured in the stormwater pond and 12,850 CFU/100 mL in the tidal creek. In addition, the presence of antibiotic resistant bacteria and pathogenic bacteria were detected. Low concentrations of herbicides (atrazine and 2,4-D: ), a fungicide (chlorothalonil), and insecticides (pyrethroids and imidacloprid) were measured. Seasonal trends were identified, with the winter months having the lowest concentrations of chlorophyll and FCB. Statistical differences between the stormwater pond and the tidal creek were also noted within seasons. The tidal creek had higher FCB levels than the stormwater pond in the spring and summer, whereas the stormwater pond had higher chlorophyll levels than the tidal creek in the summer and fall seasons. Chlorophyll and FCB levels in the stormwater pond were significantly correlated with monthly average temperature and total rainfall. Pesticide concentrations were also significantly correlated with temperature and rainfall. Pesticide concentrations in the stormwater pond were significantly correlated with pesticide concentrations in the adjacent tidal creek. Chlorophyll and FCB levels in the tidal creek, however, were not significantly correlated with levels in the pond. While stormwater ponds are beneficial in controlling flooding, they may pose environmental and human health risks due to biological and chemical contamination. Management to reduce residential runoff may improve water quality in coastal stormwater ponds and their adjacent estuarine ecosystems.

Escherichia coli virulence genes profile of surface waters as an indicator of water quality

We compared the presence of 58 known virulence genes (VGs) associated with Escherichia coli strains causing intestinal (InPEC) and extra-intestinal (ExPEC) infections in three estuarine, four brackish and 13 freshwater sites during the dry and wet seasons. The most common VGs observed in water samples during the dry season belonged to ExPEC (traT; 80% and ompA; 70%) whilst east1 (70%) gene was the most common among InPEC. More types of VGs were observed in water samples during wet season and included those found among InPEC (e.g. eaeA; 100%; fyuA, 90%; paa, 65%; cdt, 60%; and stx(2), 60%) and ExPEC (e.g. iroN(E.coli), 90%; iss, 90% and kpsMTII, 80%). Eight VGs were found exclusively in the wet season, of which four were found in all three water types indicating their association with storm-water run off. The number of VGs associated with ExPEC were significantly (P < 0.05) higher in only brackish and estuarine waters during the wet season compared to the dry season. There was no correlation between the number of E. coli and the presence of VGs in any of the water types in both seasons but we found similarities in VG profiles of sites with similar land uses.

Occurrence of diarrheagenic Escherichia coli genes in raw water of water treatment plants

PURPOSE

The high incidences of waterborne diseases are frequently associated with diarrheagenic Escherichia coli (DEC). DEC may pose a health risk to people who contact surface water for recreation or domestic use. However, there is no published report on the monitoring of DEC in drinking water sources in Taiwan. In this study, the occurrence of DEC genes in raw water for water treatment plants in Taiwan was investigated.

METHOD

Raw water samples were taken from water treatment plants adjacent to the Kaoping River in southern Taiwan. Each water sample was treated with membrane filtration followed by DNA extraction from the concentrate and concentrate enrichment, respectively. The target genes for various DEC strains of genes were identified, including enteroaggregative E. coli (EAEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC), enteropathogenic E. coli (EPEC), and enterotoxigenic E. coli (ETEC).

RESULTS

Among 55 water samples analyzed, DEC genes were detected in 16 (29.1%) samples. Strain-specific genes for EAEC, EHEC, EIEC, and EPEC were found in the percentages of 3.6%, 10.9%, 9.1%, and 9.1%, respectively. The specific gene for ETEC is not detected in the study. By looking at the presence/absence of specific genes and water sample characteristics, water temperature was found to differ significantly between samples with and without EHEC gene. In addition, pH levels differed significantly for EHEC and EPEC presence/absence genes, and turbidity was significantly different for water with and without EPEC genes.

CONCLUSION

DEC genes were detected in 29.1% of the raw water samples in the study location. The potential health threat may be increased if the treatment efficiencies are not properly maintained. Routine monitoring of DEC in drinking water sources should be considered.

Shiga toxin: expression, distribution, and its role in the environment

In this review, we highlight recent work that has increased our understanding of the production and distribution of Shiga toxin in the environment. Specifically, we review studies that offer an expanded view of environmental reservoirs for Shiga toxin producing microbes in terrestrial and aquatic ecosystems. We then relate the abundance of Shiga toxin in the environment to work that demonstrates that the genetic mechanisms underlying the production of Shiga toxin genes are modified and embellished beyond the classical microbial gene regulatory paradigms in a manner that apparently "fine tunes" the trigger to modulate the amount of toxin produced. Last, we highlight several recent studies examining microbe/protist interactions that postulate an answer to the outstanding question of why microbes might harbor and express Shiga toxin genes in the environment.

Gene and antigen markers of shiga-toxin producing E. coli from Michigan and Indiana river water: occurrence and relation to recreational water quality criteria

The relation of bacterial pathogen occurrence to fecal indicator bacteria (FIB) concentrations used for recreational water quality criteria (RWQC) is poorly understood. This study determined the occurrence of Shiga-toxin producing Escherichia coli (STEC) markers and their relation to FIB concentrations in Michigan and Indiana river water. Using 67 fecal coliform (FC) bacteria cultures from 41 river sites in multiple watersheds, we evaluated the occurrence of five STEC markers: the Escherichia coli (EC) O157 antigen and gene, and the STEC virulence genes eaeA, stx1, and stx2. Simple isolations from selected FC cultures yielded viable EC O157. By both antigen and gene assays, EC O157 was detected in a greater proportion of samples exceeding rather than meeting FC RWQC (P < 0.05), but was unrelated to EC and enterococci RWQC. The occurrence of all other STEC markers was unrelated to any FIB RWQC. The eaeA, stx2, and stx1 genes were found in 93.3, 13.3, and in 46.7% of samples meeting FC RWQC and in 91.7, 0.0, and 37.5% of samples meeting the EC RWQC. Although not statistically significant, the percentage of samples positive for each STEC marker except stx1 was lower in samples that met, as opposed to exceeded, FIB RWQC. Viable STEC were common members of the FC communities in river water throughout southern Michigan and northern Indiana, regardless of FIB RWQC. Our study indicates that further information on the occurrence of pathogens in recreational waters, and research on alternative indicators of their occurrence, may help inform water-resource management and public health decision-making.

Microbiological quality of finfish and shellfish with special reference to shiga toxin-producing Escherichia coli O157

The objective of this study was to determine the microbiological quality of fish and shellfish from Kolkata, India, with special emphasis on E. coli O157. Fresh and ice-preserved Labeo rohita, Catla catla, Cirrhinus mrigala, Oreochromis mossambica, Heteropneustesfossilis, Clarias batrachus, and Penaeus monodon were examined for total heterotrophic bacteria and coliform loads and presence of E. coli and E. coli serotype O157 by culture method. While the total plate count of bacteria was within acceptable or marginally acceptable limits for most samples, fishes were contaminated with coliforms, including E. coli, indicating poor hygiene and sanitary conditions. Although E. coli O157 could not be detected, a few samples were contaminated with non-O157 serotypes of enterohaemolysin- and Shiga toxin-producing E. coli, raising public health concern.

Water quality and restoration in a coastal subdivision stormwater pond

Stormwater ponds are commonly used in residential and commercial areas to control flooding. The accumulation of urban contaminants in stormwater ponds can lead to a number of water quality problems including high nutrient, chemical contaminant, and bacterial levels. This study examined the interaction between land use and coastal pond water quality in a South Carolina residential subdivision pond. Eutrophic levels of chlorophyll and phosphorus were present in all seasons. Harmful cyanobacterial blooms were prevalent during the summer months. Microcystin toxin and fecal coliform bacteria levels were measured that exceeded health and safety standards. Low concentrations of herbicides (atrazine and 2,4-D) were also detected during summer months. Drainage from the stormwater pond may transport contaminants into the adjacent tidal creek and estuary. A survey of residents within the pond's watershed indicated poor pet waste management and frequent use of fertilizers and pesticides as possible contamination sources. Educational and outreach activities were provided to community members to create an awareness of the water quality conditions in the pond. Pond management strategies were then recommended, and selected mitigation actions were implemented. Water quality problems identified in this study have been observed in other coastal stormwater ponds of varying size and salinity, leading this project to serve as a potential model for coastal stormwater pond management.

Detection of virulence genes in Escherichia coli of an existing metabolic fingerprint database to predict the sources of pathogenic E. coli in surface waters

A collection of 366 Escherichia coli strains from 10 host groups and surface waters were tested for the presence of 15 virulence genes associated with strains causing intestinal and extra-intestinal infections. The virulence genes included eaeA, VT1, 2 and 2e, LT1, ST1 and 2, Einv gene, EAgg gene, CNF1 and 2, papC, O111 and O157 side chain LPS. Of the 262 strains obtained from nine different hosts, 39 (15%) carried one or more of these virulence genes. These included six strains from humans, two from horses, eight from dogs, two from ducks, five from cattle, seven from chickens, four from pigs, two from sheep and three from deer. Of the remaining 104 strains obtained from water samples, 10 (10%) also carried one or more of the tested virulence genes. Of these, six had identical biochemical phenotypes (BPTs) to strains isolated from humans (two strains), dogs (two strains), chickens (one strain) and sheep (one strain) with 4 BPTs also carrying same virulence genes. Our results indicate that the sources of clinically important E. coli strains found in surface waters due to faecal contamination can be predicted by using a combination of biochemical fingerprinting method and the detection of virulence genes. From the public health point of view this information will be of great importance for evaluating the risk associated with public use of the catchment.

Occurrence of Escherichia coli O157:H7 and other enterohemorrhagic Escherichia coli in the environment

Enterohemorrhagic Escherichia coli (EHEC) (O157 and other serotypes) are zoonotic pathogens linked with severe human illnesses. The main virulence factors of EHEC are the Shiga toxins, among others. Most of the genes coding for these toxins are bacteriophage-encoded. Although ruminants are recognized as their main natural reservoir, water has also been documented as a way of transmission of EHEC. E. coli O157:H7 and other EHEC may contaminate waters (recreational, drinking or irrigation waters) through feces from humans and other animals. Indeed, the occurrence of EHEC carrying the stx2 gene in raw municipal sewage and animal wastewater from several origins has been widely documented. However, the evaluation of the persistence of naturally occurring EHEC in the environment is still difficult due to methodological problems. Methods proposed for the detection and isolation of stx-encoding bacteria, ranging from the classic culture-based methods to molecular approaches, and their application in the environment, are discussed here. Most virulence factors associated with these strains are linked to either plasmids or phages, and consequently they are likely to be subject to horizontal gene transfer between species or serotypes. Moreover, the presence of infectious stx-phages isolated as free particles in the environment and their high persistence in water systems suggest that they may contribute to the spread of stx genes, as they are directly involved in the emergence of new pathogenic strains, which might have important health consequences.

Occurrence of genes associated with enterotoxigenic and enterohemorrhagic Escherichia coli in agricultural waste lagoons

The prevalence among all Escherichia coli bacteria of the LTIIa toxin gene and STII toxin gene, both associated with enterotoxigenic E. coli, and of three genes (stxI, stxII, and eaeA) associated with enterohemorrhagic E. coli was determined in farm waste disposal systems seasonally for 1 year. Single- and nested-PCR results for the number of E. coli isolates carrying each toxin gene trait were compared with a five-replicate most-probable-number (MPN) method. The STII and LTIIa toxin genes were present continuously at all farms and downstream waters that were tested. Nested-MPN-PCR manifested sensitivity increased over that of single-MPN-PCR by a factor of 32 for LTIIa, 10 for STII, and 2 for the stxI, stxII, and eaeA genes. The geometric mean prevalence of each toxin gene within the E. coli community in waste disposal site waters after nested MPN-PCR was 1:8.5 E. coli isolates (1:8.5 E. coli) for the LTIIa toxin gene and 1:4 E. coli for the STII toxin gene. The geometric mean prevalence for the simultaneous occurrence of toxin genes stxI, stxII, and eaeA, was 1:182 E. coli. These findings based on total population analysis suggest that prevalence rates for these genes are higher than previously reported in studies based on surveys of single isolates. With a population-based approach, the frequency of each toxin gene at the corresponding disposal sites and the endemic nature of diseases on farms can be easily assessed, allowing farmers and public health officials to evaluate the risk of infection to animals or humans.

Rectoanal mucosal swab culture is more sensitive than fecal culture and distinguishes Escherichia coli O157:H7-colonized cattle and those transiently shedding the same organism

Enrichment and direct (nonenrichment) rectoanal mucosal swab (RAMS) culture techniques were developed and compared to traditional fecal culture for the detection of Escherichia coli O157:H7 in experimentally infected and naturally infected cattle. Holstein steers (n = 16) orally dosed with E. coli O157:H7 were sampled after bacterial colonization starting 15 days postinoculation. Enrichment RAMS cultures (70.31% positive) were more sensitive than enrichment fecal cultures with 10 g of feces (46.88% positive) at detecting E. coli O157:H7 (P < 0.01). Holstein bull calves (n = 15) were experimentally exposed to E. coli O157:H7 by penning them with E. coli O157:H7-positive calves. Prior to bacterial colonization (1 to 14 days postexposure), enriched fecal cultures were more sensitive at detecting E. coli O157:H7 than enriched RAMS cultures (P < 0.01). However, after colonization (40 or more days postexposure), the opposite was true and RAMS culture was more sensitive than fecal culture (P < 0.05). Among naturally infected heifers, enriched RAMS or fecal cultures were equally sensitive (P = 0.5), but direct RAMS cultures were more sensitive than either direct or enriched fecal cultures at detecting E. coli O157:H7 (P < 0.01), with 25 of 144, 4 of 144, and 10 of 108 samples, respectively, being culture positive. For both experimentally and naturally infected cattle, RAMS culture predicted the duration of infection. Cattle transiently shedding E. coli O157:H7 for <1 week were positive by fecal culture only and not by RAMS culture, whereas colonized animals (which were culture positive for an average of 26 days) were positive early on by RAMS culture. RAMS culture more directly measured the relationship between cattle and E. coli O157:H7 infection than fecal culture.