Microbial contamination of drinking water from risky tubewells situated in different hydrological regions of Bangladesh

This study, conducted in 40 selected upazilas covering four hydrological regions of Bangladesh, aimed at determining the risk of selected shallow tubewells (depth <30m) used for drinking purpose (n = 26,229). This was based on WHO’s sanitary inspection guidelines and identifying the association of sanitary inspection indicators and risk scores with microbiological contamination of shallow tubewells. The main objective of the study was to observe the seasonal and regional differences of microbial contamination and finally reaching a conclusion about safe distance between tubewells and latrines by comparing the contamination of two tubewell categories (category-1: distance ≤10 m from nearest latrine; n = 80 and category 2: distances 11–20 m from nearest latrine; n = 80) in different geographical contexts. About 62% of sampled tubewells were at medium to high risk according to WHO’s sanitary inspection guidelines, while the situation was worst in south-west region. Microbiological contamination was significantly higher in sampled category-1 tubewells compared to category-2 tubewells, while the number of contaminated tubewells and level of contamination was higher during wet season. About 21% (CI₉₅ = 12%–30%), 54% (CI₉₅ = 43%–65%) and 58% (CI₉₅ = 46%–69%) of water samples collected from category-1 tubewells were contaminated by E. coli, FC, and TC respectively during the wet season. The number of category-1 tubewells having E.coli was highest in the north-west (n = 8) and north-central (n = 4) region during wet season and dry season respectively, while the level of E.coli contamination in tubewell water (number of CFU/100 ml of sample) was significantly higher in north-central region. However, the south-west region had the highest number of FC contaminated category-1 tubewells (n = 16 & n = 17; respectively during wet and dry season) and significantly a higher level of TC and FC in sampled Category-1 tubewells than north-west, north-central and south-east region, mainly during wet season. Multivariate regression analysis could identified some sanitary inspection indicators, such as tubewell within <10 m of latrine, platform absent/broken, pollution source (i.e. household’s waste dumping point/poultry/dairy farm) within 10 m of tubewell and unimproved sanitation facility which were significantly associated with presence of microbial contaminants in tubewell water (p < 0.01). A tubewell with high risk level was associated with a higher chance of having FC and TC in tubewell water than a tubewell with a medium risk during wet season, but no such conclusion could be drawn in case of E.coli contamination. Construction of pit latrine in areas with high water table should be highly discouraged. Raised sealed pits or flush/pour flash to septic tank could be installed considering sanitary inspection criteria. Water should be treated before drinking.     

Microbiological quality of water in a city with persistent and recurrent waterborne diseases under tropical sub-rural conditions: The case of Kikwit City,Democratic Republic of the Congo

The availability of safe drinking water in sub-Saharan countries remains a major challenge because poor sanitation has been the cause of various outbreaks of waterborne disease due to the poor microbiological quality of water used for domestic purposes. The faecal indicator bacteria (FIB) used in the present study included Escherichia coli (E. coli) and Enterococcus (ENT). FIB and aerobic mesophilic bacteria (AMB) were quantified during July 2015 (dry season) and November 2015 (rainy season) in order to assess the quality of drinking water from wells (n = 3; P1–P3), and two rivers, the River Lukemi (RLK, n = 3) and River Luini (RLN, n = 2) in the city of Kikwit, which is located in the province of Kwilu in the Democratic Republic of the Congo. Kikwit is well known for its outbreaks of persistent and recurrent waterborne diseases including Entamoeba, Shigella, typhoid fever, cholera, and Ebola Viral Hemorrhagic Fever. Consequently, E. coli, ENT, and AMB were quantified in water samples according to the standard international methods for water quality determination using the membrane filtration method. The FIB characterization was performed for human-specific Bacteroides by PCR using specific primers. The results obtained revealed high FIB concentrations in river samples collected during both seasons. For example, E. coli respectively reached 4.3 × 10⁴ and 9.2 × 10⁴ CFU 100 mL^?1 in the dry season and the wet season. ENT reached 5.3 × 10³ CFU 100 mL^?1 during the dry season and 9.8 × 10³ CFU 100 mL^?1 in the wet season. The pollution was significantly worse in the wet season compared to the dry season. Surprisingly, no faecal contamination was observed in well water samples collected in the dry season while E. coli and ENT were detected in all wells in the wet season with values of 6, 7, and 11 CFU mL^?1 for E. coli in wells P1–P3, respectively and 3, 5, 9 CFU mL^?1for ENT in the same wells. Interestingly, the PCR assays for human-specific Bacteroides HF183/HF134 indicated that 97–100% captured in all analyses of isolated FIB were of human origin. The results indicate that contamination of E. coli, ENT, and AMB in the studied water resources increases during the wet season. This study improves understanding of the microbiological pollution of rivers and wells under tropical conditions and will guide future municipal/local government decisions on improving water quality in this region which is characterised by persistent and recurrent waterborne diseases. Although the epidemiology can be geographically localised, the effects of cross border transmission can be global. Therefore, the research results presented in this article form recommendations to municipalities/local authorities and the approach and procedures can be carried out in a similar environment.     

Livestock ownership and microbial contamination of drinking-water: Evidence from nationally representative household surveys in Ghana,Nepal and Bangladesh

Background

Current priorities for diarrhoeal disease prevention include use of sanitation and safe water. There have been few attempts to quantify the importance of animal faeces in drinking-water contamination, despite the presence of potentially water-borne zoonotic pathogens in animal faeces.

Antimicrobial resistance in community-acquired urinary tract infections in Paris in 2015

Background

Urinary tract infection (UTI) is one of the most frequent community-acquired infection. Escherichia coli resistance has been on the rise since 2000s.

Retrospective analysis of nocardiosis in a general hospital from 1998 to 2017

Objectives

To describe the epidemiological, clinical, microbiological, and therapeutic characteristics of Nocardiosis patients treated in a general hospital.

Salt content of some fast foods in Casablanca,Morocco: Pilot study

Introduction

High salt intake is associated with high blood pressure. This pilot study aimed to measure the salt content of some fast foods in Casablanca, Morocco.

Occurrence of Legionella in UK household showers

Household water systems have been proposed as a source of sporadic, community acquired Legionnaires’ disease. Showers represent a frequently used aerosol generating device in the domestic setting yet little is known about the occurrence of Legionella spp. in these systems. This study has investigated the prevalence of Legionella spp. by culture and qPCR in UK household showers. Ninety nine showers from 82 separate properties in the South of England were sampled. Clinically relevant Legionella spp. were isolated by culture in 8% of shower water samples representing 6% of households. Legionella pneumophila sg1 ST59 was isolated from two showers in one property and air sampling demonstrated its presence in the aerosol state. A further 31% of showers were positive by Legionella spp. qPCR. By multi-variable binomial regression modelling Legionella spp. qPCR positivity was associated with the age of the property (p = 0.02), the age of the shower (p = 0.01) and the frequency of use (p = 0.09). The concentration of Legionella spp. detected by qPCR was shown to decrease with increased frequency of use (p = 0.04) and more frequent showerhead cleaning (p = 0.05). There was no association between Legionella spp. qPCR positivity and the cold water supply or the showerhead material (p = 0.65 and p = 0.71, respectively). Household showers may be important reservoirs of clinically significant Legionella and should be considered in source investigations. Simple public health advice may help to mitigate the risk of Legionella exposure in the domestic shower environment.     

Measurement of volatile organic compounds in bottled and tap waters by purge and trap GC–MS: Are drinking water types different?

Volatile organic compounds (VOCs) including major trihalomethanes (THMs) in bottled and tap waters from Central Missouri were quantified and compared with drinking water guidelines. Tap (n = 34), spring (3 brands, n = 25), purified (8 brands, n = 58), distilled (3 brands, n = 12) and flavored waters (5 brands, n = 34) along with Missouri River water (n = 30), were analyzed by purge and trap gas chromatograph–mass spectrometry (GC–MS) using USEPA method 524.2. The mean recoveries of the internal and surrogates standards were fluorobenzene: 100%, benzene d5-, chloro: 100% and 1,4-dichlorobenzene d4: 96%. Approximately 97% of all drinking water types were found to be safe for human consumption. However, two tap water samples recorded bromodichloromethane concentrations above the 60 μg/L World Health Organization (WHO) limit. Moreover, six tap water samples exceeded both the 80 μg/L USEPA Stage I limit and the 100 μg/L European Community (EC) maximum contaminant concentration (MAC) for total THMs (TTHMs) in drinking water. TTHMs in the water types ranged from 0–322 μg/L (tap), 0.1–0.3 μg/L (spring), 0–7.6 μg/L (purified), 0.1–18.1 μg/L (distilled), and 0–5.7 μg/L (flavored). Kruskal–Wallis Chi square approximation showed significant differences (P < 0.001) in the levels of THMs found in the water types. Principal components (PC1 and PC2) with 97% total variance suggested similarities in most drinking waters except for Boonville and Columbia tap waters. Dendrogram plots of TTHMs and Σ VOCs revealed two principal clusters with Columbia and Boonville tap waters in a different cluster and also distant from other water types.     

Infectious sacroiliitis: Retrospective analysis of 18 case patients

Introduction

Few infectious sacroiliitis reports are available in the literature. There is no standard clinical presentation, and diagnosis and treatments are therefore usually delayed. We aimed to describe this infection.

Microbial quality of drinking water from microfiltered water dispensers

A comparison was made between the microbial quality of drinking water obtained from Microfiltered Water Dispensers (MWDs) and that of municipal tap water. A total of 233 water samples were analyzed. Escherichia coli (EC), enterococci (ENT), total coliforms (TC), Staphylococcus aureus, Pseudomonas aeruginosa and heterotrophic plate count (HPC) at 22 °C and 37 °C were enumerated. In addition, information was collected about the principal structural and functional characteristics of each MWD in order to study the various factors that might influence the microbial quality of the water.EC and ENT were not detected in any of the samples. TC were never detected in the tap water but were found in 5 samples taken from 5 different MWDs. S. aureus was found in a single sample of microfiltered water. P. aeruginosa was found more frequently and at higher concentrations in the samples collected from MWDs. The mean HPCs at 22 °C and 37 °C were significantly higher in microfiltered water samples compared to those of the tap water.In conclusion, the use of MWDs may increase the number of bacteria originally present in tap water. It is therefore important to monitor the quality of the dispensed water over time, especially if it is destined for vulnerable users.     

Quantifying tap-to-household water quality deterioration in urban communities in Vellore,India: The impact of spatial assumptions

Municipal water sources in India have been found to be highly contaminated, with further water quality deterioration occurring during household storage. Quantifying water quality deterioration requires knowledge about the exact source tap and length of water storage at the household, which is not usually known. This study presents a methodology to link source and household stored water, and explores the effects of spatial assumptions on the association between tap-to-household water quality deterioration and enteric infections in two semi-urban slums of Vellore, India. To determine a possible water source for each household sample, we paired household and tap samples collected on the same day using three spatial approaches implemented in GIS: minimum Euclidean distance; minimum network distance; and inverse network-distance weighted average. Logistic and Poisson regression models were used to determine associations between water quality deterioration and household-level characteristics, and between diarrheal cases and water quality deterioration. On average, 60% of households had higher fecal coliform concentrations in household samples than at source taps. Only the weighted average approach detected a higher risk of water quality deterioration for households that do not purify water and that have animals in the home (RR = 1.50 [1.03, 2.18], p = 0.033); and showed that households with water quality deterioration were more likely to report diarrheal cases (OR = 3.08 [1.21, 8.18], p = 0.02). Studies to assess contamination between source and household are rare due to methodological challenges and high costs associated with collecting paired samples. Our study demonstrated it is possible to derive useful spatial links between samples post hoc; and that the pairing approach affects the conclusions related to associations between enteric infections and water quality deterioration.     

Differences between men and women in substance use: the role of educational level and employment status

Objective

To determine differences between men and women in hazardous drinking, heavy cannabis use and hypnosedative use according to educational level and employment status in the economically active population in Spain.

PRISM study: Comparison of a nystatin-neomycin-polymyxin B combination with miconazole for the empirical treatment of infectious vaginitis

Objective

An empirical treatment of infectious vaginitis is justified because of its multiple etiologies, the frequent uncertainty of clinical diagnosis and limits of microbiological analysis. Our aim was to comparatively investigate nystatin-neomycin-polymyxin B combination (NNP, Polygynax^®) and miconazole.

Genotyping of Enterocytozoon bieneusi (Microsporidia) isolated from various birds in China

Enterocytozoon bieneusi is a common opportunistic pathogen causing diarrhea in humans and animals. However, epidemiological data on E. bieneusi infections in birds are relatively scare worldwide, especially in China. To understand the prevalence and genetic diversity of E. bieneusi in birds and to assess the zoonotic potential of bird-derived E. bieneusi isolates, 194 fecal specimens from Gruidae, Anatidae and Columbidae in Heilongjiang Province, China, were analyzed by PCR and sequencing of the single internal transcribed spacer region of the rRNA gene. The average prevalence of E. bieneusi was 22.2%, with 12.5% for Gruidae, 15.9% for Anatidae and 44.0% for Columbidae. Altogether seven genotypes of E. bieneusi were identified, including four known genotypes—Peru6 (n = 29), BEB6 (n = 5), D (n = 3) and EbpA (n = 1)—and three novel genotypes named CHN-B1 (n = 1), CHN-B2 (n = 3) and CHN-B3 (n = 1). All the known genotypes obtained here were previously detected in humans. All the novel genotypes were clustered into the zoonotic group 1 in phylogenetic analysis. The results indicate that these birds may play a potential role in the transmission of E. bieneusi to humans.     

Uropathogenic Escherichia coli are less likely than paired fecal E. coli to have CRISPR loci

CRISPRs (Clustered Regularly Interspaced Short Palindromic Repeats) are short fragments of DNA that act as an adaptive immune system protecting bacteria against invasion by phages, plasmids or other forms of foreign DNA. Bacteria without a CRISPR locus may more readily adapt to environmental changes by acquiring foreign genetic material. Uropathogenic Escherichia coli (UPEC) live in a number of environments suggesting an ability to rapidly adapt to new environments. If UPEC are more adaptive than commensal E. coli we would expect that UPEC would have fewer CRISPR loci, and – if loci are present – that they would harbor fewer spacers than CRISPR loci in fecal E. coli. We tested this in vivo by comparing the number of CRISPR loci and spacers, and sensitivity to antibiotics (resistance is often obtained via plasmids) among 81 pairs of UPEC and fecal E. coli isolated from women with urinary tract infection. Each pair included one uropathogen and one commensal (fecal) sample from the same female patient.Fecal isolates had more repeats (p = 0.009) and more unique spacers (p < 0.0001) at four CRISPR loci than uropathogens. By contrast, uropathogens were more likely than fecal E. coli to be resistant to ampicillin, cefazolin and trimethoprim/sulfamethoxazole. However, no consistent association between CRISPRs and antibiotic resistance was identified. To our knowledge, this is the first study to compare fecal E. coli and pathogenic E. coli from the same individuals, and to test the association of CRISPR loci with antibiotic resistance. Our results suggest that the absence of CRISPR loci may make UPEC more susceptible to infection by phages or plasmids and allow them to adapt more quickly to various environments.     

Use,microbiological effectiveness and health impact of a household water filter intervention in rural Rwanda—A matched cohort study

Unsafe drinking water is a substantial health risk contributing to child diarrhoea. We investigated impacts of a program that provided a water filter to households in rural Rwandan villages. We assessed drinking water quality and reported diarrhoea 12–24 months after intervention delivery among 269 households in the poorest tertile with a child under 5 from 9 intervention villages and 9 matched control villages. We also documented filter coverage and use. In Round 1 (12–18 months after delivery), 97.4% of intervention households reported receiving the filter, 84.5% were working, and 86.0% of working filters contained water. Sensors confirmed half of households with working filters filled them at least once every other day on average. Coverage and usage was similar in Round 2 (19–24 months after delivery). The odds of detecting faecal indicator bacteria in drinking water were 78% lower in the intervention arm than the control arm (odds ratio (OR) 0.22, 95% credible interval (CrI) 0.10–0.39, p < 0.001). The intervention arm also had 50% lower odds of reported diarrhoea among children <5 than the control arm (OR = 0.50, 95% CrI 0.23–0.90, p = 0.03). The protective effect of the filter is also suggested by reduced odds of reported diarrhoea-related visits to community health workers or clinics, although these did not reach statistical significance.     

Adecuación del tratamiento de la osteoporosis en prevención primaria. Estudio cuantitativo y cualitativo

Objective

Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74 years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists.

Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study

Background

In France, the most severe bone and joint infections (BJI), called “complex” (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification.

Chronic PM2.5 exposure and risk of infant bronchiolitis and otitis media clinical encounters

Chronic particulate matter less than 2.5 μm in diameter (PM_2.5) exposure can leave infants more susceptible to illness. Our objective is to estimate associations of the chronic PM_2.5 exposure with infant bronchiolitis and otitis media (OM) clinical encounters. We obtained all first time bronchiolitis (n = 18,029) and OM (n = 40,042) clinical encounters among children less than 12 and 36 months of age, respectively, diagnosed from 2001 to 2009 and two controls per case matched on birthdate and gestational age from the Pregnancy to Early Life Longitudinal data linkage system in Massachusetts. We applied conditional logistic regression to estimate odds ratios (OR) and confidence intervals (CI) per 2-μg/m³ increase in lifetime average satellite based PM_2.5 exposure_. Effect modification was assessed by age, gestational age, frequency of clinical encounter, and income. We examined associations between residential distance to roadways, traffic density, and infant bronchiolitis and OM risk. PM_2.5 was not associated with infant bronchiolitis (OR = 1.02, 95% CI = 1.00, 1.04) and inversely associated with OM (OR = 0.97, 95% CI = 0.95, 0.99). There was no evidence of effect modification. Compared to infants living near low traffic density, infants residing in high traffic density had elevated risk of bronchiolitis (OR = 1.23, 95% CI = 1.14, 1.31) but not OM (OR = 0.98, 95% CI = 0.93, 1.02) clinical encounter. We did not find strong evidence to support an association between early-life long-term PM_2.5 exposure and infant bronchiolitis or OM. Bronchiolitis risk was increased among infants living near high traffic density.