[A pool for therapeutic swimming].
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Exercise Therapy↗
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Uptake of chlorination disinfection by-products; a review and a discussion of its implications for exposure assessment in epidemiological studies.
We have reviewed the relevant issues in the exposure assessment of disinfection by-products (DBPs) of chlorination for epidemiological and health risk assessment. Various DBPs can be detected in drinking water and swimming pools, and the reported levels show a considerable range, but were generally below the current health standard for total trihalomethanes (TTHMs) (100 microg/l). Relatively little information is available on the correlation between the various DBPs in drinking water and in swimming pools. Chloroform was generally, but not always, the most predominant DBP. In epidemiological studies, TTHM levels have been used as an indicator for total DBP load, even though TTHM levels do not always correlate well with individual DPBs. Factors such as residence time, temperature, pH, organic content, including humic and fulvic acid and bromide levels affect the composition and levels of DBPs. Although there are biomarkers of DBPs, mainly for chloroform and more recently for the other volatile trihalomethanes (THMs) and the nonvolatile haloacetic acids (HAAs) such as trichloroacetic acid (TCAA) and dichloroacetic acid (DCAA), they have not been used in epidemiological studies. The THMs have been measured in exhaled breath and serum, while the HAAs have been measured in urine. These biomarkers have been useful to estimate the actual uptake of the DBPs and the relative contribution of various exposure routes. Physiologically based pharmacokinetic (PBPK) models exist for, e.g. chloroform, but their main target organs are the kidney and liver and they have not been used in epidemiological studies. Tap water ingestion, showering, bathing, swimming, boiling water and dishwashing are all activities that have been associated with the uptake of DBPs, and considerable variation in these activities has been observed between people. No studies have reported on the correlation between human uptake of DBPs and water-zone mean estimates, but various studies found a good correlation between THM concentrations in exhaled breath and THM concentrations in water during showering and swimming. In general exposure assessment in epidemiological studies has been limited which complicates the interpretation. These findings have implications for epidemiological studies, particularly with reference to Berkson and classical error type models, study power, attenuation and precision of health-risk estimates and study efficiency. Recommendations are made for further areas of study.
Chlorine Compounds↗
A note on legionellas in whirlpools.
Water samples from 52 whirlpools (jacuzzi), water temperature 35-40 degrees C, and from 50 swimming pools, water temperature 8-30 degrees C, were investigated for the presence of Legionella pneumophila. This was isolated from 11 of 28 whirlpools with free available chlorine less than 0.3 mg/l. No legionellas were detected in 23 whirlpools with free available chlorine over 0.3 mg/l. Legionella pneumophila was found in two swimming pools. The results indicate that 0.3 mg/l of free available chlorine is sufficient to eliminate legionellas from whirlpools.
Legionella↗
[Outbreak of human leptospirosis by recreational activity in the municipality of São José dos Campos, São Paulo. Seroepidemiological study].
An outbreak of human leptospirosis due to recreational activities occurred at São José dos Campos, São Paulo, Brazil in November 1987. It involved a group of persons who had participated in a gathering in a suburb club which had a swimming pool fed with natural water. Epidemiological investigation was carried out and laboratory tests from the patients were done. It was observed that a high prevalence of the pomona serotype (91%) was found in the serological analyses, while the presence of the agent of the infection could not be found in the water club swimming pool.
Agglutination Tests↗
Pontiac fever due to Legionella micdadei from a whirlpool spa: possible role of bacterial endotoxin.
During January 1998, a cluster of illnesses occurred among hotel guests in Wisconsin. Ill persons had been exposed to the hotel's whirlpool spa and swimming pool. Symptoms included headache, fever, chills, myalgia, shortness of breath, and fatigue. A diagnosis of Pontiac fever was made, based on serologic evidence of acute infection with Legionella micdadei. High concentrations of heterotrophic bacteria were recovered from the spa, despite apparently high disinfectant levels. L. micdadei was isolated from the swimming pool filter and water from the spa after heat enrichment but not from pools and spas at nearby hotels. Water from hotel pools and spas was tested to determine endotoxin levels; water from the spa of the implicated hotel contained the highest concentration of endotoxin (14,400 endotoxin units/mL). Additional studies are needed to determine the role of endotoxin from legionellae or other bacteria in the pathogenesis of Pontiac fever.
Antibodies, Bacterial↗
[Comparative study of experimental pathogenicity of Acanthamoeba strains (author's transl)].
We have tested pathogenicity on mice after the intranasal instillation of 8 Acanthamoeba strains isolated from swimming-pools. The A1 strain of A. culbertsoni has also been tested as pathogenic reference strain. Virulence is measured by determination of D.L. 50 for each strain from the study of the variation of mortality in relation to the inoculated dose. We have established that the most of Acanthamoeba strains (6 on 8) isolated from an external environment (swimming-pools) are able to kill a certain percentage of mice after intranasal instillation. But the potential pathogenicity revealed in this way varies greatly (D.L. 50 included between 4.10(2) and 4.10(5)) from one strain to another. Elsewhere there seems to be no correlation among Acanthamoeba between the observed pathogenicity and the fact that it belongs to a particular species.
Amebiasis↗
A review of toxicology studies on cyanurate and its chlorinated derivatives.
Chlorinated cyanurates are added to swimming pools as disinfectants. In the presence of water, these materials hydrolyze to yield cyanurate and hypochlorous acid. To evaluate the safety of exposure to these materials, a comprehensive testing program was undertaken. This review summarizes the results of acute and subchronic tests on chlorinated isocyanurates. Findings from acute, subchronic, reproduction, metabolism, mutagenicity, and chronic/carcinogenicity tests on cyanurate are also summarized. Results from these tests indicate that chlorinated isocyanurates are safe for use in swimming pools.
Animals↗
Unintentional drownings among New York State residents, 1988-1994.
OBJECTIVE: This study examines situations in which drownings occur (environmental risk factors) and the victims' personal risk factors (age, gender, use of personal flotation device, medical condition, alcohol or drug use) to provide guidance for future drowning prevention efforts. METHODS: The authors investigated 883 non-bathtub drownings among New York State residents for the years 1988 to 1994 using medical examiner, coroner, police, and/or hospital records in addition to death certificate data. RESULTS: Males, children ages 0-4 years, and African American males ages 5-14 years residing in New York State outside New York City experienced the highest rates of drowning. The majority of drownings occurred in a natural body of water for all age groups, with the exception of children ages 0-4 years. Most drownings among children ages 0-4 years occurred in residential swimming pools. The child usually gained access to the pool via inadequate fencing, an open or ineffective gate, or a ladder (to an above-ground pool) left in the "down" position. Less than 10% of victims of watercraft-related drownings were wearing personal flotation devices. Blood alcohol concentration (BAC) tests were positive for 44% of 250 persons 15 years of age and older for whom valid toxicology results were provided; 30% had BACs of 100 mg/dl or more. CONCLUSIONS: Suggested prevention efforts include stricter enforcement of fencing requirements for residential swimming pools and drowning prevention education stressing personal flotation device use while boating and the danger of mixing alcohol and water-related activities.
Accidents↗
Transmission of genital human papillomavirus infections is unlikely through the floor and seats of humid dwellings in countries of high-level hygiene.
To evaluate the transmission of genital human papillomavirus (HPV) through the floor and seats of humid dwellings, samples were collected with a toothbrush from the floor and seat surfaces of humid dwellings; showers, saunas and dressing rooms. The survey included 3 bathing resorts, 1 indoor swimming pool, 2 schools and 2 private homes. Polymerase chain reaction (PCR) was used to amplify the human beta-globin gene and HPV DNA. The results for HPV DNA amplification were confirmed by Southern blot hybridization under low stringency using a probe mixture of HPV types 6, 16, 18 and 31. beta-globin could be amplified only from 3 sample taken from a dressing room of and indoor public swimming pool. No HPV DNA-positive samples were found. These results indicate that transmission of genital HPV infection via floor or seat surfaces in the above dwellings in general or family use is highly unlikely.
Adolescent↗
Evaluation of dermal and respiratory chloroform exposure in humans.
Chloroform is a known contaminant of chlorinated drinking water and of swimming pool water disinfected with chlorine or one of its derivatives. Few data exist regarding the importance of dermal and inhalation exposure routes to the chloroform body burden resulting from domestic and recreational use of chlorinated water. In our experimental study involving 11 male swimmers, we quantified the body burden resulting from exposure to various concentrations of chloroform in water and air of an indoor swimming pool, during a daily 55-min exercise period. From the first to the sixth exercise period, CHCl3 mean concentration in water was increased from 159 micrograms/l to 553 micrograms/l. Corresponding mean air CHCl3 level ranged from 597 ppb to 1630 ppb. To dissociate the dermal exposure route from that of inhalation, swimmers used scuba tanks during an additional exercise period. Chloroform concentrations were measured in alveolar air before and after each exercise period, as well as after 35 min of physical activity. Chloroform levels in water and air were measured every 10 min. We examined the relationship between alveolar air concentration (a measure of body burden) at 35 and 55 min and environmental chloroform concentrations by using multiple regression models. The natural logarithm of alveolar air concentration was strongly correlated with aqueous chloroform concentration both at 35 (p2 < 0.001, r2 = 0.75) and 55 min (p < 0.001, r2 = 0.86). The relationship with air concentrations was also statistically significant (35 min: p < 0.001, r2 = 0.58, 55 min: p < 0.001, r2 = 0.63).(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Cutaneous↗
[The public health relevance of various microbiologic marker pathogens for assessing bathing water].
Regarding the quality of natural recreational water for bathing purposes, the limit values of E. coli and coliforms, faecal coliforms and totalcoliforms, respectively, laid down by the Council of the European Community, differ considerably from those prescribed by some Land Governments of the Federal Republic of Germany and by the DIN Standard Regulation No. 19643 entitled 'Processing and Disinfection of Water in Swimming Pools and Basins in Public Baths'. It must be concluded by virtue of hygienically plausible considerations, as well as for juridical reasons, that only the limit values of the EC-Code of Practice are authoritative, whereas standards of the DIN 19643, especially in respect of E. coli and coliforms, differing from the limit values of the EC-Code of Practice are not legally binding. Moreover, coliforms are not relevant for controlling swimming pools and basins in public baths. Staphylococcus aureus should therefore be investigated instead whereas other parameters such as E. coli, Pseudomonas aeruginosa, and total colony counts are good markers. However, the standards of these organisms as established by the DIN 19643 are more in line with technical practibility and biased aesthetics instead of the hygienically important prinicple of commensurability.
Bathing Beaches↗
Sporotrichoid presentation of Mycobacterium marinum infection of the upper extremity. A case report.
BACKGROUND: Mycobacterium marinum is a human opportunistic pathogen that is known to inhabit swimming pools, home aquariums, and natural bodies of salt and fresh water. Epidemic cases involving swimming pools are easily recognized, but sporadic cases are frequently misdiagnosed. OBJECTIVE: A 42-year-old male presented with a 2-month history of the appearance of livid, verrucous, painless nodules on his right upper extremity. He had cleaned an aquarium with tropical fish for the past 2 years. METHODS: A histopathological examination suggested a granulomatous inflammation. After incubation on Löwenstein-Jensen medium, Mycobacterium marinum was identified using biochemical methods and the PCR technique. RESULTS: Systemic therapy with rifampicin, ethambutol, and clarithromycin over a period of 6 months led to complete resolution of the skin lesions with some residual scars. CONCLUSION: Knowledge of this condition is very important to avoid unnecessary diagnostic procedures and improper treatment.
Adult↗
First cases of Acanthamoeba keratitis in Slovakia.
We present the case report of the first identification of Acanthamoeba as a causative agent of keratitis in the Slovak Republic. For the first time, Acanthamoeba sp. Group III was isolated from a 53-year-old patient with keratitis, which was manifested after an injury of the right eye. A delayed visit to a physician as well as a late diagnosis of the illness led to the advanced stage of eye disease. As the treatment with itraconazol and cornea transplantation showed no result, enucleation of the eye was decided. Acanthamoeba ludgunensis was also the causative agent of keratitis in a 39-year-old patient wearing contact lenses. His complaints occurred a month after bathing in a thermal swimming pool. The symptoms presented in the left eye were those of herpetic keratitis, and led to a cloudy cornea with circular infliltrate and poor vision. A prompt clinical and laboratory diagnosis, along with treatment with propamidine-isetionate resulted in a significant improvement of the eye condition. Contact lenses were probably related to another case of Acanthamoeba keratitis. The patient, a 15-year-old girl, kept wearing contact lenses during bathing in various swimming pools and in the sea; her contact lenses were also regularly washed under tap water. Due to the fact that cysts of Acanthamoeba sp. group II were found in the contact lens solution, this is presumed to be the source of the eye infection.
Acanthamoeba↗
Ten-year study of pediatric drownings and near-drownings in King County, Washington: lessons in injury prevention.
The factors associated with submersion events among less than 20-year-old persons that occurred in King County from 1974 to 1983 were studied to focus prevention efforts. Near-drowning (n = 103) and drowning (n = 96) victims were identified from medical examiners' reports, paramedics' reports, and hospital discharge registers. Annual incidence was 5.5; the mortality rate was 2.6 per 100,000 children. Although preschool-aged children had the largest incidence (12.8), followed by older adolescents (4.9), adolescents had the largest case fatality rate, 77%. Lake and river victims had the largest incidence, mortality, and case fatality rate; swimming pools, the smallest case fatality rate (25%). A total of 89% of all victims had absent or no supervision; victims supervised by lifeguards had a 42% case fatality rate. Prior seizures were part of the history of 7.5% of all victims; 25% of fatal submersions by adolescents were associated with alcohol. Bathtub submersions were associated with child abuse in three of 16 preschool-aged children and epilepsy in four of five older children. Certain age groups and sites combined had the greatest incidence: preschool-aged children in swimming pools, infants in bathtubs, teenagers in lakes and rivers. Incidence decreased in public and semipublic pools coincident with fencing regulations. These findings suggest prevention strategies: extending fencing requirements to private pools, discouraging alcohol consumption during water sports, changing bathing practices of epileptics, and improving lifeguard efficacy.
Adolescent↗
The determinants of prevalence of health complaints among young competitive swimmers.
OBJECTIVES: Chloramines, which are produced by the reaction of chlorine with the organic matter present in indoor pools, are potential airway irritants in swimmers. The objective of this study was to compare the prevalence of health complaints of young swimmers and young indoor soccer players and to evaluate the relationship between chloramine concentrations and the athletes' health complaints. METHODS: Health complaints were first (Part 1) documented by questionnaire in 305 competitive swimmers and 499 indoor soccer players of the Québec City region (Canada). Then, (Part 2) health complaints were documented during five training sessions in 72 competitive swimmers in comparison to 73 soccer players. The chloramines in the swimming pool air and water were measured as well as the peak expiratory flow (PEF) before and after the training session. RESULTS: In Part 1, the swimmers reported more lower (adjusted OR: 1.5; IC95%= 1.0-2.2) and upper respiratory symptoms (adjusted OR: 3.7; IC95%= 2.4-5.8). In Part 2, the swimmers experienced more frequent lower (adjusted OR: 3.5; IC95%= 2.0-6.0) and upper respiratory symptoms (adjusted OR: 3.1; IC95%= 1.8-5.4). Overall, swimmers exposed to the highest levels of chloramines in the air and water had more respiratory complaints. CONCLUSIONS: Swimmers exposed to chlorination by-products in both the water and air of indoor swimming pools experience frequent respiratory symptoms that could potentially be reduced by limiting exposure to these products.
Adolescent↗
Increased sensitization to aeroallergens in competitive swimmers.
Chlorine is used to disinfect swimming pools or as a constituent of other disinfection reagents. Pulmonary diseases are occasionally observed after exposure to chlorine. In 14 competitive swimmers and in 14 matched control subjects, we searched for clinically manifest allergies, subclinical sensitization to aeroallergens, imbalance of the cellular immune system, and bronchial hyperresponsiveness. Conjunctival or respiratory symptoms were found in 11 swimmers (2 cases of conjunctivitis, 4 rhinitis, 2 rhinoconjunctivitis, 1 laryngitis, and 2 bronchitis) and in 3 controls. Sensitization to aeroallergens was confirmed in 9 swimmers by skin test and in 11 swimmers by radioallergosorbent test (RAST), compared to findings in 4 and 5 controls, respectively. An altered cellular immune system, (i.e., imbalance in T-cell system, B-cell system, or natural killer cells) was detected in 7 swimmers and only 2 controls. Bronchial hyperresponsiveness to methacholine was seen in 11 swimmers and 5 controls. This higher incidence of allergic diseases and subclinical sensitization to aeroallergens, disorders of the cellular immune system, and bronchial hyperresponsiveness in competitive swimmers compared with control subjects could be due to repeated exposure to chlorine in swimming pools.
Adolescent↗
[Bathing caps and germ shedding of human scalp hair].
With three groups of 30 test subjects each, having short, medium-long and long hair, as well as with a model test using a woman's wig it was possible to show that by wearing bathing caps the transfer of germs from the scalp hairs to the swimming-pool water can be reduced considerably, either by the isolation of the hairs from water when snugly fitting water-tight bathing caps are used, or by a reduction of the germ-carrying hair surface rinsed by the water, which is always the case, even when using water-permeable caps. The effect is the greater, the larger the natural hair surface is. The rule that persons with long hair of either sex should wear bathing caps proves again justified although the prescriptive use of bathing caps by "the long-haired" earlier was based on other concepts. The population of germs settling on bathing caps does not in the least reach the germ counts discharged into the swimming-pool water when no headgear is used. Nevertheless, the issue of disposable bathing caps, which is occasionally practised, must be welcomed for reasons of hygiene. The use of bathing caps not only diminishes the discharge of colony forming units (CFU) but also prevents the indicators of pollution, pathological and occasionally pathological germs being washed into the water from the hair. Reference is also made to the possibility that a snugly fitting bathing cap protects the swimmer against the risk of contracting otitis.
Bacteria↗
KILLING OF CHLORINE-RESISTANT BACTERIA BY CHLORINE-BROMINE SOLUTIONS.
The disinfective power of chlorine, bromine, and mixtures of chlorine and bromine at different ratios was compared. The influence of pH was also studied. The experiments were carried out in "purified" water and in natural waters of swimming pools, river, and sea. In the presence of high amounts of nitrogenous growth-promoting material (at neutral pH), bromine was more effective than chlorine; in waters containing low amounts of nitrogenous growth-promoting material, chlorine was found superior. Mixtures of chlorine and bromine at various ratios were found to increase in effectiveness inversely to the percentage of hypobromite generated, down to 10 or 5%. Such effectiveness was found at pH levels of 5.4 to 8.6 in both purified and natural water containing high and low amounts of nitrogenous growth-promoting material. Therefore, the above mixtures seem of practical value for the disinfection of various natural waters. Escherichia coli isolated in the presence of chlorine, either from swimming pools or after deliberate exposure to the halogen, were shown to be chlorine-resistant mutants. Their resistance was maintained for at least nine passages in the absence of the disinfectant, which accounts for the number of passages tested. Chlorine-resistant mutants were not affected by bromine alone but did show a marked sensitivity to low concentrations of bromine active in the presence of chlorine. This was achieved by admixing small amounts of bromide to hypochlorite. A hypothetical model is presented to explain the synergistic sequential block by the two disinfectants. Some chlorine-resistant mutants were found to have changed into relatively slow-growing organisms with a changed phase-sensitivity pattern.
Bromides↗