Water-borne Diseases
These diseases are largely caused by pathogenic micro-organisms present in human or animal waste, which find their way into human body, through drinking from a contaminated water supply - faecal-oral route. It can also be spread through other routes, such as via hands, clothes, food, or materials used for cooking, eating or drinking. More rarely, some of these diseases may also enter the body through the eyes, nose or open wounds. These diseases are infectious, which means that they can spread from one person to another. So high standards of hygiene and sanitation are needed to stop the disease from spreading.
The causative agent can be:
(i) Bacteria
(ii) Virus
(iii)Protozoa
(iv) Worms
The diseases can be diarrhoeal or non-diarrhoeal.
Mortality from waterborne diseases exceeds the current mortality rates of all diseases combined. These diseases are extremely harmful not only to a person's health but to their productivity, and to the welfare of the community as a whole.
They:
(i) Lead to severe illness and may be fatal, in the case of a severe attack.
(ii) Lower the body's resistance to infection and disease.
(iii) Lower the body's intake of nourishment, and may lead to malnutrition (especially in children)
(iv) Decrease individual and social productivity.
(v) Hamper children's education.
(vi) Increase health expenditure.
Main Bacterial
Pathogens
Vibrio cholerae
Escherichia coli
Salmonella typhi
Shigella flexneri
Campylobacter pylori
Legionella pneumophila
Leptospira
Diarrheal Diseases
Enteric fever/Gasteroenteritis/typhoid fever- Salmonella
typhi
·
Characterized by
fever and inflammation of intestine, ulcer formation, and other abdominal
symptoms
·
Nonspecific symptoms
- chills, sweats, headache, anorexia, weakness, sore throat, cough
·
The incubation
period - 5 to 21 days.
·
Patients recover
after 2-3 days; disease is limited to the GI tract in most cases
·
Organisms are
excreted in urine and faeces in large numbers during the active phase of the
disease
·
Max survival time 7
days; in natural waters above 150C
·
Lack of adequate
sanitation, major cause of the disease
·
Controlled by
maintaining proper sanitation
Shigellosis
(Bacillary dysentery)
·
Intestinal disease;
most common among young children
·
Shigella species; S.
dysenteriae, S. flexneri, S. boydii, and S. sonnei
·
S. sonnei (developed countries) S. flexneri (developing
countries)
·
S. dysenteriae (most severe infections), S. boydii - not
commonly isolated.
·
The organisms
survive stomach acidity, pass through the small intestine, and adhere to the
mucosal epithelium of the terminal ileum and colon
·
Destruction of the
superficial mucosal layer - mucosal ulceration
·
Classic bacillary
dysentery - characterized by diarrhea
with blood, mucus, and painful abdominal cramping. Abundant neutrophils,
erythrocytes, and mucus are found in the stool
· An exotoxin (Shiga
toxin) with enterotoxic and cytotoxic properties - isolated from S.
dysenteriae; implicated in the development of intestinal lesions
·
Shigella species - remain viable in food and water for as long as
6 months
·
readily killed by
chlorination of water, heat, and chemical agents
·
Infection -
generally self-limited, spread through drinking water contaminated with human
faeces
·
Shigella species carried primarily by humans and are not
disseminated in nature
· Most infections are
passed by the faecal- oral route - Organisms excreted in faeces and
urine; rarely survive more than 10 days outside
Cholera
·
Vibrio cholerae -
ingested in contaminated food or water -
multiply to large numbers on the mucosal surface and produce Cholera enterotoxin
·
The toxin causes hyper
secretion of fluids and electrolytes into the intestinal lumen
·
After several hours
to 3-days incubation, patients experience a sudden onset of severe watery
diarrhea with vomiting and abdominal pain
·
The stool specimens
are colorless and odorless, with mucuos flecks (rice-water stool)
·
Untreated, death
from severe dehydration and loss of minerals.
· Cholera causes extreme fluid loss, so ORS-(Oral Rehydration Solution) replaces lost water and essential salts (like sodium, potassium, chloride) to maintain body function. Begin ORS as soon as symptoms (watery diarrhea, vomiting) appear and drink frequently, especially if vomiting.
(Cholera
ORS is a mix of salts, sugar, and water used to
rapidly replace fluids and electrolytes lost from severe diarrhea and vomiting
caused by cholera, preventing fatal dehydration)
·
Large numbers of
pathogens are excreted during the course of the disease - remain viable in
natural waters till 7 days
·
Chlorination of water
and standard disinfectants are able to destroy the organism easily
Campylobacter
jejuni
·
Also causes diarrhea;
transmitted through faeco-oral route
· Campylobacter jejuni
infection is one of the most commonly identified bacterial causes of acute
gastroenteritis worldwide.
·
In developing
countries, it is an important cause of childhood morbidity caused by diarrheal
illness
·
among the most
common causes of diarrhea in travelers from developed nations
· Local complications
of Campylobacter infections include cholecystitis (gall bladder infection), pancreatitis, peritonitis,
and gastrointestinal hemorrhage
· Extra intestinal
manifestations of Campylobacter infection are quite rare and may include
meningitis, endocarditis, arthritis, osteomyelitis, and neonatal sepsis.
· Serious systemic
illness caused by Campylobacter infection rarely occurs but can lead to sepsis
and death.
Other bacterial diseases - Non-Diarrheal
Legionnaires’ Disease (legionellosis)
·
Legionella pneumophila
·
Severe pneumonia;
considerable morbidity, leading to death unless therapy is initiated
promptly
·
commonly present in
small numbers in natural bodies of water, such as lakes and streams
·
Multiply profusely
in artificial aquatic habitats like air
conditioning, cooling towers and in water systems (e.g., showers, hot tubs)
·
Survive in moist
environments for a long time, at relatively high temperatures, and in the
presence of disinfectants such as chlorine
·
can parasitize
amoebae in the water and replicate in this protected environment
·
Respiratory tract
disease in susceptible people who
inhale infectious aerosols
·
Incubation period of
2 to 10 days; fever, and chills, a dry
non-productive cough, headache
·
Can develop into
multi-organ disease involving the gastrointestinal tract, central nervous
system, liver, and kidneys
·
Maintain free
residual chlorine in cold water supplies
·
Control the
temperature of water (cold water below 200C and hot water above 500C)
Leptospirosis
· Leptospira species; inhabit the kidneys of pet dogs and domestic livestock,
excreted into natural waters in urine
·
enter through the
abraded skin, oral or nasal mucosa, or conjunctiva following contact with
urine-contaminated water by drinking, immersion of hands, or swimming and infected wild life and domestic animals especially
rodents
·
Leptospira
icterhaemorrhagiae - associated with
human disease; Weil’s disease
·
Fever, chills,
headache, GI disturbance, and conjunctival redness
·
In 2 – 7 days, the
patient becomes afebrile
·
After 1 – 3 day, a
recurrence of fever, which persists for only couple of days
·
Jaundice, rash,
hepatosplenomegaly, meningitis, and/or renal damage