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Outbreak of gastroenteritis associated with an interactive water fountain at a beachside park--Florida, 1999.

Since 1989, approximately 170 outbreaks associated with recreational water venues (e.g., swimming pools, waterparks, fountains, hot tubs and spas, lakes, rivers, and oceans) have been reported, with almost half resulting in gastrointestinal illness (1-5). This report summarizes the investigation of an outbreak of gastroenteritis in Florida during 1999. The findings indicated that Shigella sonnei and Cryptosporidium parvum infections caused illness in persons exposed to an "interactive" water fountain at a beachside park.

Adolescent↗

Near drowning in cold water.

Drowning and near drowning is a common cause of accidental death all over the world; specially in road traffic accidents over bridges, swimming pool and boat tragedies. Cold water drowning resulting in hypothermia can lead to instant death before actual drowning. Five cases of near drowning (ND) in cold water, who presented with varied clinical picture like coma with decerebrate rigidity and fixed dilated pupils, hypertension with coma and delayed pulmonary oedema (Secondary drowning) are reported. Energetic management with continuous positive airway pressure was very rewarding in all patients with ND except in one who had transient organic psychosis persisting for two weeks followed by minimal cognitive defect in the form of slow mentation, lack of drive and mild irritability (Bender Gestald Test Score of 53). We have tried to analyse some of the clinical features of ND and the sequel associated with it. The management as well as recent developments in the field are also discussed.

Cold Temperature↗

Efficacy of Australian quarantine procedures against the mosquito Aedes aegypti.

Methods employed by Australian quarantine officers to control Aedes mosquitoes in containers were tested against all stages of Aedes aegypti. Saltwater emersion killed all larvae but not pupae or eggs that were briefly exposed. Swimming pool chlorine, methyl bromide fumigation, and permethrin (2% active ingredient) spray provided 100% mortality of eggs, larvae, and pupae. Aerosol sprays incorporating synthetic pyrethrins are practical and also provide effective control of adults.

Aedes↗

Near drowning in cold water.

Drowning and near drowning is a common cause of accidental death all over the world; specially in road traffic accidents over bridges, swimming pool and boat tragedies. Cold water drowning resulting in hypothermia can lead to instant death before actual drowning. Five cases of near drowning (ND) in cold water, who presented with varied clinical picture like coma with decerebrate rigidity and fixed dilated pupils, hypertension with coma and delayed pulmonary oedema (Secondary drowning) are reported. Energetic management with continuous positive airway pressure was very rewarding in all patients with ND except in one who had transient organic psychosis persisting for two weeks followed by minimal cognitive defect in the form of slow mentation, lack of drive and mild irritability (Bender Gestald Test Score of 53). We have tried to analyse some of the clinical features of ND and the sequel associated with it. The management as well as recent developments in the field are also discussed.

Adult↗

Occurrence of Campylobacter spp. in water in Northern Ireland: implications for public health.

The occurrence of Campylobacter spp was examined in a variety of waters in Northern Ireland. Conventional cultural techniques were employed with 768 water specimens, including drinking waters (tap, spring, bore hole and bottled) and recreational waters (swimming pool, lough, river and sea). Positive waters included 1/11 (9.1%) drinking water from untreated well water, as well as 5/12 (41.7%) untreated surface waters from loughs and 7/8 (87.5%) untreated river waters. Overall, untreated surface waters may represent a source of contamination with Campylobacter spp. in Northern Ireland, where they have a recreational involvement or are used as a drinking source by man or agricultural livestock. Therefore waterborne campylobacteriosis should be considered in patients presenting with acute enteritis and a history of participation in water sports/activities. As faecal coliform organisms have been previously shown to be poor markers of water quality, especially for Campylobacter spp, new criteria should be established to assess the risk of this infection and to evaluate and monitor the quality of water used for recreational purposes.

Bathing Beaches↗

AIDS awareness among undergraduate students, Maharashtra.

Total 313 undergraduate students (132 males and 181 females) of the colleges of Nashik and Talegaon of Maharashtra were surveyed regard awareness about AIDS. Most of the students knew about AIDs and tests available. They were aware that people indulging sexually promiscuous relations are at risk of AIDS. But the fact that it is transmitted by infected blood and from infected mother to child was not widely known, particularly among Arts students. Some misconceptions regarding modes of transmission were observed among few students, like social kissing, sharing utensils/personal items, using common swimming pools and insect bite spread infection. Attitude towards HIV infected/AIDS patients were not sympathetic. Overall knowledge of Science students were better compared to commerce and Arts students. Confusion about mode of transmission and prevention of the disease exist. Scope of health education for these students was well felt.

Acquired Immunodeficiency Syndrome↗

December 2002: 19-year old male with febrile illness after jet ski accident.

The December 2002 COM. A 19-year-old healthy male fell into stagnant water of the intercostal waterway (salt water of South Florida), following a jet ski accident. He sustained minor superficial injuries but engulfed significant quantities of water and sediment. A few days later he developed bifrontal headaches, vomiting, a stiff neck and a temperature of 102 degrees F. A CT scan on admission without contrast was negative. The CSF had markedly elevated white count but bacterial and fungal cultures were negative. He became progressively lethargic. On the fifth day he developed seizure activity. He expired the next day despite antibiotics. Gross examination of the brain at autopsy revealed edema, cerebellar tonsillar herniation and purulent meningitis. Microscopic examination revealed a massive leptomeningeal inflammatory infiltrate composed of neutrophils, lymphocytes, and numerous histiocyte-like cells. The inflammatory infiltrate extended into the cerebral parenchyma in numerous areas also involving the cerebellum, brainstem and ventricular system. Given the exposure to stagnant water (later confirmed to be a man-made fresh water lake), and the numerous histiocytic-like cells, suspicion for an amebic etiology of the disease process was raised and the CDC identified the ameba as Naegleria Fowleri. Infection by Naegleria Fowleri, a free-living ameba, occurs after exposure to polluted water in man-made fresh water lakes, ponds, swimming pools, particularly during the warm weather months when the thermophilic ameba grows well. The pathologic substrate of the infection is an acute hemorrhagic, necrotizing meningo-encephalitis mainly at the base of the brain, brainstem and cerebellum occurring in young, healthy individuals.

Adult↗

NTP Toxicology and Carcinogenesis Studies of Bromodichloromethane (CAS No. 75-27-4) in F344/N Rats and B6C3F1 Mice (Gavage Studies).

Bromodichloromethane (99% pure), one of several trihalomethanes commonly formed after chlorination of water, was selected for study because no carcinogenicity data were available for this compound and because chloroform, a related trihalomethane, had been found to cause tumors in rodents. The general population might be exposed to bromodichloromethane in drinking water supplies, in swimming pools, and in a variety of food substances. Single-administration, 14-day, 13-week, and 2-year studies were conducted in F344/N rats and B6C3F1 mice. The chemical was administered by gavage in corn oil because human exposure is primarily oral. Additional studies were performed to evaluate the potential for genetic damage in bacteria and mammalian cells. Results of the Short-Term Studies: In the single-administration studies, the chemical was administered at doses of 150-2,500 mg/kg per day. All rats and female mice at 1,250 and 2,500 mg/kg and all male mice at 600, 1,250, and 2,500 mg/kg died; 2/5 male rats, 1/5 female rats, and 2/5 female mice at 600 mg/kg died; all animals at lower dose levels survived. In the 14-day studies, rats received doses of 38-600 mg/kg, and mice received doses of 19-300 mg/kg per day. One female rat at 38 mg/kg and one female rat at 600 mg/kg died. Weight loss or decreased weight gain was seen at 300 and 600 mg/kg in male and female rats. All male mice at 150 and 300 mg/kg died, and one female mouse at 300 mg/kg died; no weight effects were observed in surviving mice. Dose-related necropsy findings included reddened renal medullae in male rats at 600 mg/kg and in male mice at 150 and 300 mg/kg. Clinical signs seen in high dose groups after dosing were hyperactivity in rats and lethargy in mice. In the 13-week studies, male and female rats received doses of 19-300 mg/kg per day, male mice received doses of 6.25-100 mg/kg per day, and female mice received doses of 25-400 mg/kg per day. Five of 10 male rats and 2/10 female rats at 300 mg/kg died. None of the mice died. Final body weights of male and female rats at 150 and 300 mg/kg were lower than those of vehicle controls (45%-88% of vehicle control weights); final body weights of male mice at 100 mg/kg and female mice at 400 mg/kg were 92% and 94% of those of the vehicle controls. Centrilobular degeneration in the liver and degeneration and necrosis of the kidney were seen in male rats at 300 mg/kg; centrilobular degeneration was seen in female rats at 300 mg/kg; degeneration andnecrosis of the kidney were seen in male mice at 100 mg/kg, and centrilobular degeneration of the liver was seen in female mice at 200 and 400 mg/kg. Experimental Design of the Two-Year Studies: The 2-year toxicology and carcinogenesis studies of bromodichloromethane were conducted by administering the chemical in corn oil by gavage, 5 days per week for 102 weeks, to groups of 50 male and female rats at doses of 0, 50, or 100 mg/kg per day; to groups of 50 male mice at doses of 0, 25, or 50 mg/kg per day; and to groups of 50 female mice at doses of 0, 75, or 150 mg/kg per day. The study in male rats was restarted because at 10.5 months into the original study, a temperature elevation killed 45/50 vehicle control male rats. Survival and Body Weight in the Two-Year Studies: Final survival of dosed rats was comparable to that of vehicle controls (male: vehicle control, 28/50; low dose, 36/50; high dose, 28/50; female: 34/50; 27/50; 41/50). Mean body weights of high dose male and female rats were decreased during the last 1.5 years of the study; final mean body weights of high dose male and female rats were 88% and 79% of the vehicle control mean weights. Final mean body weights of low dose male and female rats were comparable to those of the vehicle controls. Final survival of dosed male mice was comparable to that of the vehicle controls (34/50; 32/50; 42/50). At week 84, survival of female mice was greater than 50% in all dose groups. After week 84, survival of dosed and vehicle control female mice was reduced (final survival: 26/50; 13/50; 15/50), and this decreased survival was ass6/50; 13/50; 15/50), and this decreased survival was associated with ovarian abscesses (8/50; 19/47; 18/49). The final mean body weight of high dose male mice was 95% that of the vehicle controls; the final mean body weight of low dose male mice was comparable to that of the vehicle controls. Mean body weights of the high dose female mice were decreased during the last 1.5 years of the study; the final mean body weight was 75% that of the vehicle controls. The final mean body weight of the low dose female mice was 91% that of the vehicle controls. Nonneoplastic Effects in the Two-Year Studies: Compound-related nonneoplastic lesions included cytomegaly and tubular cell hyperplasia of the kidney and necrosis and fatty metamorphosis of the liver in male rats; eosinophilic cytoplasmic change, clear cell change, focal cellular change, and fatty metamorphosis of the liver and tubular cell hyperplasia of the kidney in female rats; fatty metamorphosisof the liver, renal cytomegaly, and follicular cell hyperplasia of the thyroid gland in male mice; and follicular cell hyperplasia of the thyroid gland in female mice. Neoplastic Effects in the Two-Year Studies: Bromodichloromethane caused compound-related increases in the incidences of neoplasms of the large intestine and kidney in male and female rats, the kidney in male mice, and the liver in female mice, as shown in the table (see page 5 of the Technical Report). The neoplasms of the large intestine and kidney are uncommon tumors in F344/N rats and B6C3F1 mice. Administration of bromodichloromethane was also associated with a decrease in the tumors of the adrenal glands in male rats, the pituitary and mammary glands in female rats, and the pituitary gland in female mice. Genetic Toxicology: Bromodichloromethane was not mutagenic in Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537 when tested by the preincubational protocol at concentrations up to 1,000 ug/plate with or without metabolic activation. The compound was not mutagenic in the mouse lymphoma L5178Y/TK± assay in the presence of S9 but did induce forward mutations in the system in the presence of metabolic activation from rat liver S9. Cytogenetic tests with Chinese hamster ovary cells demonstrated no induction of chromosomal aberrations orsister chromatid exchanges following treatment with bromodichloromethane in either the presence or absence of metabolic activation. Data Audit: An audit of the experimental data was conducted for the 2-year toxicology and carcinogenesis studies of bromodichloromethane. No discrepancies were found that influenced the final interpretations of the results of these studies. Conclusions: Under the conditions of these 2-year gavage studies, there was clear evidence of carcinogenic activity for male and female F344/N rats and B6C3F1 mice as shown by increased incidences of tubular cell adenomas and adenocarcinomas in the kidney and adenocarcinomas and adenomatous polyps in the large intestine in male and female rats, increased incidences of tubular cell adenomas and adenocarcinomas in the kidney of male mice, and increased incidences of hepatocellular adenomas and carcinomas in female mice. Synonym: dichlorobromoethane

Journal Article↗

[Granulomatous skin disease after an exotic injury].

Piranhas are feared freshwater fishes commonly found in the waters of southern Venezuela to the north of Argentina. At present this species is a favourite domesticated article of our aquarists. The authors describe the histopathologic picture of a cutaneous lesion of the right hand thumb of a 60-year old piranha keeper who was bitten by this predatory fish. A firm node with increasing soreness gradually developed in the area of the lesion, and after 7 months the symptoms of the carpal tunnel syndrome were also present. Granulomatous foci--some sarcoid-like, others with central necrosis--were permeated with fibrinoid substance. Epithelioid granuloma cells with huge incorporated multinuclear elements were covered mainly by T-lymphocytes. Ziehl-Neelsen stain did not prove the presence of diagnostic acid-fast rods. Only in some macrophages rare acid-fast spheric microstructures were present in the cytoplasm. Both the local dermatologic finding and histological examination gave evidence that the skin was infected with atypical mycobacteria--swimming pool granuloma.

Animals↗

Body composition of university students by hydrostatic weighing and skinfold measurement.

The body composition of 124 male and 70 female Tartu University students was measured by three different methods: hydrostatic weighing by maximal expiration, hydrostatic weighing by maximal inspiration and subcutaneous fat thickness measurements. Our results show that the proposed body density measuring method by maximal expiration is simple, reliable and applicable not only in indoor swimming pools but in field conditions as well. The second new hydrostatic weighing apparatus is more comfortable for the subjects where the body density is measured at maximal inspiration. The mean body density of males was somewhat higher when measured by the maximal inspiration (1.066 +/- 0.012 g.ml-1) than when measured by the maximal expiration (1.063 +/- 0.009 g.ml-1, p < 0.05). For females, on the contrary, the maximal expiration method (1.044 +/- 0.010 g.ml-1) yielded a higher body density value than when measured by the maximal inspiration (1.040 +/- 0.011 g.ml-1, p > 0.05). The body fat percentage measured by skinfold thickness correlated significantly with the body fat percentage calculated by body density by maximal expiration (males r = 0.420, females r = 0.531) and inspiration (males r = 0.507, females r = 0.663). We must conclude that the presented two methods of measuring body density offer new possibilities for densitometric analysis without the need for expensive laboratory equipment.

Adult↗

Etiology and differential diagnosis of non-trachomatous follicular conjunctivitis.

The author points out that while previously only follicular conjunctivitis of the inclusion or swimming-pool type, and of the Béal type, was classified as "acute follicular conjunctivitis", it is now necessary to enlarge this group to include at least four other clinical or etiological entities: epidemic keratoconjunctivitis, acute herpetic keratoconjunctivitis, Newcastle disease conjunctivitis, and pharyngoconjunctival fever. The author then defines and describes chronic follicular conjunctivitis, toxic follicular conjunctivitis (molluscum contagiosum) and folliculosis.

Animals↗

[Public health requirements in physical therapy].

Physiotherapy involves manifold measures that are partly not clearly separated from other methods of therapy. In most cases the skin or mucosa are not injured so that the danger of infectious complications is relatively low. On the other hand, patients with severe underlying diseases which are problematic from the aspect of hygiene in connection with infections, may have to be treated (for example, intensive-care patients, patients with decubital ulcers etc.) In such patients physiotherapy must comply with hygienic precautions that are employed with other diseases and treatments to prevent the transfer of pathogens. Special rules govern the composition of the water and the servicing of equipment used in hydrotherapy (German DIN standard specification No. 1964). Guidelines for the water used in municipal swimming pools and baths are in preparation. Other rules to be observed concern the recognition, treatment and prevention of nosocomial infections. In addition, every establishment must set up definite rules for regular measures to prevent infections and to monitor these measures, especially with regard to cleaning and disinfecting.

Communicable Disease Control↗

Medical aspects of drowning in children.

Accidental, homicidal and suicidal drowning comprise a special challenge to the clinician and preventive medicine advocate, alike. In South-east Asia and Australasia, accidental immersion accidents rank highly among the causes of preventable child trauma. Bath-tub and bucket drownings affect infants and toddlers under the age of 12 months, and some 10 percent of fatal bucket-tub immersions affecting infants are the result of child abuse. Immersion accidents in the sea have special characteristics, not specifically as a result of differences in water osmolarity, but related to hypothermia, secondary lung complications, and immersion times. Swimming pool drownings are the major cause of preventable death affecting pre-school children in some regions of Australasia. Resuscitation of the near-drowned child is topical because, (a) of controversies about the optimality of mouth-to-nose expired air resuscitation (EAR) in infants under six months of age; (b) of controversies about the degree of brain damage among child survivors following intensive care salvage; and (c) the difficulties of having "every parent a first-aider". A major study of childhood immersions (The Brisbane Drowning Study has shown that of all survivors, some 70 percent will be completely normal, 30 percent will suffer some selective deficit (with wide disparities on sub-scale scores on formal IQ testing), and 3 percent will live in a permanent vegetative state. Vigorous preventative campaigns using the triad of (a) public media education and campaigns, (b) better safety standards and safety devices, and (c) safety legislation, can reduce both the population risk and the individual clinical severity of immersion accidents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Atypical cutaneous mycobacterium diseases. Results of a national survey].

We report the results of a retrospective inquiry concerning atypical cutaneous mycobacterioses in France over the last 5 years. Ninety-two cases were observed, contracted from aquariums (50 p. 100), in swimming pools (4.4 p. 100) and as a result of mesotherapy (15.2 p. 100); 66.3 p. 100 of the patients had no other pathology; 17.4 p. 100 were immunodepressed. Bacteriological examination was positive in 44.7 p. 100 of the cases; swabbing, scratching and punturing were better than biopsy to obtain a bacteriological culture. Mycobacteria were identified in 59.8 p. 100 of the cultures. In order of frequency, the pathogens were Mycobacterium marinum (from aquariums), M. chelonae (from iatrogenic lesions) and M. avium-intracellulare (in immunodepression). M. fortuitum, M. ulcerans, M. flavescens, M. haemophilum and M. kansasii were rare. The formation of epithelial giant-cell granulomas was observed in patients without any other pathology. Non-specific infiltration was found in patients with immunodepression and bacteriological examination was often positive in those with non-specific infiltrates. The treatment of atypical cutaneous mycobacterioses is always difficult; third generation tetracyclines and antibacterial combinations are often prescribed, but the results of in vitro tests are not reproducible in vivo. New antibiotics, such as clarithromycin, quinolones, ansamycin and clofazimine, are currently being tested.

Anti-Bacterial Agents↗

Angel's trumpet (Brugmansia arborea) and mydriasis in a child--a case report.

We report a case of anisocoria in a 6-year old child who felt out of an inflatable swimming pool in the garden. After instillation of pilocarpine 1% the dilated pupil constricted, which is an important clinical sign associated with intracranial trauma. There was evidence of exposure to angel's trumpet (Brugmansia arborea), a plant known to contain anticholinergic substances. As the results of further neurological examination turned out to be normal, we believe the mydriasis was due to an accidental exposure to angel's trumpet. The time lag between exposure and presentation at the emergency room, the probably low volume of the plant extract in the eye and the unpredictable concentration of alkaloids in the plant, can influence and question the reliability of the pilocarpine test in this case.

Accidental Falls↗

Mycoses--prophylaxis and treatment.

An increase in the mycotic infections has been observed in recent decades. It is the effect of the development of industry, large migrations, living in huge aglomerations, usage of the public swimming-pools, wearing impervious clothes and shoes. Systemic diseases: diabetes, obesity, hormonal disorders, immune and food deficiency, AIDS, neoplasms and prescription drugs: antibiotics, corticosteroids and immunosuppressants, cause mycoses. Mycoses belong to chronic diseases, they are difficult to treat and very often recur. A lot of antimycotic drugs are known, but the most effective are azoles and alliloamines. An intensive research is conducted on introduction of new and more effective and cheaper preparations.

Antibiotic Prophylaxis↗

[Detection and identification of Mycobacteria with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) from patients with Mycobacterial skin infections].

OBJECTIVE: To establish a rapid approach to the detection and identification of Mycobacteria from lesions of patients with suspected Mycobacterial infections. METHODS: Specimens were obtained from five patients suspected to have Mycobacterial infections. DNA extracted from clinical samples was amplified by nested PCR. The PCR products were digested with HhaI, MboI, and BstUI restriction enzymes and applied to PAGE. The species of Mycobacteria were determined by restriction fragment length polymorphism (RFLP) analysis. Identification of Mycobacteria culture was also performed in 3 patients. RESULTS: M. marinum was found in two patients diagnosed as swimming pool granuloma. M. tuberculosis was found in one patient diagnosed as infectious skin granuloma. All these 3 Mycobacteria were confirmed by Mycobacteria culture. A strain of M. tuberculosis and a strain of M. fortuitum were detected in remain two patients. CONCLUSION: The results above indicate that PCR-RFLP analysis is rapid and reliable in detection and identification of different Mycobacteria species from skin tissues. Application of this method will be helpful for early diagnosis and treatment of Mycobacteria skin infections.

Bacterial Proteins↗

Why is there and should there be more attention paid to dental erosion?

Fluoride delivered by fluoridation, toothpaste, and mouth rinses, combined with regular preventive professional and personal care, has given us a much better opportunity to keep our teeth for a lifetime. But in contrast to better preventive care, lifestyle changes leading to stress or dietary changes in what and how we drink and eat may adversely affect the esthetics and/or healthy look of our teeth. Surface-enamel wear can be described as the result as well as a chronicle of an individual's life. Components of wear--including abfraction, attrition, abrasion, and erosion--combine to characterize the lifetime of wear. The chemical-erosive-wear component appears to be changing because of modern cultural life choices. A number of literature reports conclude that excessive exposure to various acid sources can contribute to the chemical erosion of tooth surfaces. For example, the hydrochloric acid regurgitated from the stomach, the acid added to swimming pools to combat microbes, the citric and chelating carboxylic acids of fruit and fruit-based beverages, the phosphoric acid of cola beverages, and the acetic acid of vinegars used for salads all can contribute to the chemical erosion of tooth surfaces. While these acid sources have the potential to erode, our saliva and the manner in which we consume these substances can largely modify the erosive action of the acids they contain. With a better understanding of our personal lifestyle choices coupled with the educated guidance of our profession, we can help to reduce the opportunities for erosive wear to occur.

Acetic Acid↗