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PubMed2005

Cryptosporidiosis surveillance--United States 1999-2002.

PROBLEM/CONDITION: Cryptosporidiosis, a gastrointestinal illness, is caused by protozoa of the genus Cryptosporidium. REPORTING PERIOD: 1999-2002. SYSTEM DESCRIPTION: State and two metropolitan health departments voluntarily reported cases of cryptosporidiosis through CDC's National Electronic Telecommunications System for Surveillance. RESULTS: During 1999-2002, the total number of reported cases of cryptosporidiosis increased from 2,769 for 1999 to 3,787 for 2001 and then decreased to 3,016 for 2002. The number of states reporting cryptosporidiosis cases increased from 46 to 50, and the number of states reporting more than four cases per 100,000 population increased from two to five. A greater number of case reports were received for children aged 1-9 years and for adults aged 30-39 years compared with other age groups. Incidence of cryptosporidiosis was particularly high in the upper Midwest and Vermont. Peak onset of illness occurred annually during early summer through early fall. INTERPRETATION: Transmission of cryptosporidiosis occurs throughout the United States, with increased diagnosis or reporting occurring in northern states. However, state incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children. PUBLIC HEALTH ACTION: Cryptosporidiosis surveillance provides data to educate public health practitioners and health-care providers about the epidemiologic characteristics and the disease burden of cryptosporidiosis in the United States. These data are used to improve reporting of cases, plan prevention efforts, and establish research priorities.

Animals↗
PubMed2005

Giardiasis surveillance--United States, 1998-2002.

PROBLEM/CONDITION: Giardiasis, a gastrointestinal illness, is caused by the protozoan parasite Giardia intestinalis. REPORTING PERIOD: 1998-2002. SYSTEM DESCRIPTION: State, commonwealth, territorial, and two metropolitan health departments voluntarily reported cases of giardiasis through CDC's National Electronic Telecommunications System for Surveillance. RESULTS: During 1998-2002, the total number of reported cases of giardiasis decreased from 24,226 for 1998 to 19,708 for 2001 and then increased to 21,300 for 2002. The number of states reporting giardiasis cases increased from 42 to 46; however, the number of states reporting more than 15 cases per 100,000 population decreased from 10 to five. A greater number of case reports were received for children aged 1-9 years and for adults aged 30-39 years compared with other age groups. Incidence of giardiasis was highest in northern states. Peak onset of illness occurred annually during early summer through early fall. INTERPRETATION: The increase observed for 2002 might reflect increased reporting after reporting of giardiasis as a nationally notifiable disease began in 2002. Transmission of giardiasis occurs throughout the United States, with increased diagnosis or reporting occurring in northern states. However, state incidence figures should be compared with caution because individual state surveillance systems have varying capabilities to detect cases. The seasonal peak in age-specific case reports coincides with the summer recreational water season and might reflect increased use of communal swimming venues (e.g., lakes, rivers, swimming pools, and water parks) by young children. PUBLIC HEALTH ACTION: Giardiasis surveillance provides data to educate public health practitioners and health-care providers about the epidemiologic characteristics and the disease burden of giardiasis in the United States. These data are used to improve reporting of cases, plan prevention efforts, and establish research priorities.

Animals↗
PubMed1992

The role of the Singapore Sports Council in coronary artery disease prevention.

The Singapore Sports Council (SSC) is a statutory board (government body) which was set up in 1973. Its main responsibility is to implement the "SPORTS FOR ALL" policy of the Singapore Government. Physical activity has been found to be an important factor in coronary artery disease prevention. It is through its "SPORTS FOR ALL" policy, by promoting physical activity to all Singaporeans, that the SSC helps in coronary artery disease prevention. The SSC promotes physical activities (and sports) by providing facilities, running fitness schemes, organising instructional schemes for sports, sports training schemes and sports activities. The facilities available to the public include swimming pools, stadia with running tracks and playing fields, tennis courts, squash courts and badminton courts. A 1987 national survey showed that 28.3% of the population aged 15 and above engaged in sports one or more times a week. Those who exercised three or more times a week accounted for only 7.9%. The SSC will continue in its efforts to improve this rate of physical activity in the population, with coronary artery disease prevention as one of its main objectives.

Coronary Disease↗
PubMed2005

[Legionella in Trondheim, Norway--determining sources of contagion and tracing risk environments].

BACKGROUND: Legionnaires' disease, most often a serious condition, is a relatively rare disease in Norway although in recent years it has been on the increase. Because of clinical and microbiological diagnostic difficulties, one can assume that the number of new cases reported is significantly too low. MATERIAL AND METHOD: A multidisciplinary team established in the City of Trondheim has two main functions; first, to trace sources of contagion when outbreaks of the disease and detected; second, to carry out routine inspections in order to trace potential environmental sources. RESULTS: Over a four-year period (2001 - 2004), 19 cases of Legionnaires' disease were diagnosed; 17 of these are presumed to have originated locally. This is an incidence rate five times greater than the national average. Legionella pneumophila was discovered in the patients' local environment in 6 cases. Environmental investigations showed that the bacterium was present in three water-cooling towers, one Jacuzzi, one swimming pool, a shower in a factory, and in the hot-water system of a building complex. Most of the discoveries were made in the summer or autumn in several different locations in the city. Legionella pneumophila was found more often with low rather than high bacterial count, contrary to the information given in the Norwegian Legionnaires' disease prevention handbook. INTERPRETATION: Legionella pneumophila is in all likelihood a naturally occurring bacterium in many of the water sources and water supply plants in Trondheim. This requires continual awareness and readiness to tackle the disease. We have seen that a multidisciplinary team is well suited to evaluating high-risk environments, tracing outbreaks and carrying out information tasks targeted both at professionals and the public at large.

Adult↗
PubMedDate not supplied

Disseminated Mycobacterium marinum infection with extensive cutaneous eruption and bacteremia in an immunocompromised patient.

Mycobacterium marinum can cause fish tank granuloma (or swimming pool or aquarium granuloma) in immunocompetent patients. Dissemination of Mycobacterium marinum-infection is a rare condition which occurs mainly in immunocompromised patients and can be life-threatening. We report the case of an 87-year-old woman who was treated with oral corticosteroids for polymyalgia rheumatica for many years and developed erythema nodosum-like lesions on the right forearm and arthritis of the right wrist. By increasing the steroid dosage and adding methotrexate only short-term remission was achieved. Seven months later painful erythematous nodules occurred on all extremities which became necrotic, ulcerative and suppurative. Ziehl-Neelsen staining revealed acid-fast bacilli and Mycobacterium marinum was cultured from skin biopsies, blood, and urine. The critically ill patient was treated with clarithromycin and ethambutol resulting in a dramatic improvement of the general condition. After four months, doxycycline had to be added because of new skin lesions. This case illustrates the impact of Mycobacterium marinum infection in immunocompromised patients.

Aged↗
PubMed2006

[Case of clipping of a ruptured aneurysm of the posterior cerebral artery (P2) via the transchoroidal-fissure approach].

A 59-year-old female was found to be drawn in a swimming pool and transferred to our hospital. The patient was comatose on admission (Hunt & Kosnk: Grade IV). Computed tomography (CT) showed diffuse subarachnoid hemorrhage (SAH) with thick hematoma in the left ambient cistern. Conventional cerebral angiography and 3D-digital subtraction angiography revealed aneurysms (ANs) of the left posterior cerebral artery (P2), and bifurcation of the left internal carotid and posterior communicating arteries (IC-PC). Successful neck clipping was performed the same day through the temporal horn via the insula for ruptured P2 AN, and the non-ruptured IC-PC AN was also obliterated using a pterional approach. Postoperative course was uneventful except for initial disturbance of consciousness and aphasia. The patient was discharged with no neurological deficit 1 month after surgery. This approach may be preferable in cases involving high positioned PCA AN in the ambient cistern, particularly in the acute phase of severe SAH, as the brain is protected from the detrimental effects of strong temporal retraction and a wider working space is provided.

Aneurysm, Ruptured↗
PubMedDate not supplied

Diffusing capacity and spirometry following a 60-minute dive to 4.5 meters.

The purpose of this study was to assess the contribution of SCUBA to the pulmonary effects of diving to 4.5 meters depth in healthy subjects using a randomized crossover control condition. Ten healthy divers performed two 60-minute 'dives' using SCUBA in a swimming pool. The non-immersed 1 ATA SCUBA control exposure took place at ambient pressure in the laboratory. Thirty minutes prior to, and 30 and 90 minutes post-exposure, FVC (forced vital capacity), FEV1.0 (forced expired volume), peak expiratory flow rate (PEFR), diffusing capacity (DL(co)), heart rate (HR) and temperature were measured. No significant differences were noted in HR, temperature or spirometry between the two conditions. A significant reduction in diffusing capacity occurred at 30 and 90 minutes after the pool dive (9.3% and 15.1%, respectively, p < 0.05). There was no concordant change in DL(co) following the non-immersed 1 ATA SCUBA control. Thus, a pool dive to 4.5 meters for 60 minutes causes a decrease in DL(co), without a change in spirometry, while breathing from SCUBA equipment without immersion causes no significant change in lung function.

Adult↗
PubMedDate not supplied

[Hygienic evaluation of the combined effect of portable water chloroform].

The paper considers the significance of complex entrance of chloroform from portable water into the human body (enterally, inhalationally, and through the intact skin). It shows it necessary to toughen the maximum permissible concentration (MPC) of chloroform in the portable drinking, by taking into account of the multiplicity of routes of its action on the population. The authors present the results of their own investigations of the levels of chloroform in the air of bath and shower rooms before and after taking a shower and filling the bath with water, as well as in the airspace layer above the water of an indoor swimming pool, by using chromatographic mass-spectrometry.

Carcinogens↗
PubMed2006

[Free-living amoebae as vehicles of pathogenic bacteria].

The free-living amoebae are ubiquitous organisms. They are found in humid soil and all water reservoirs, i.e. fresh, sea, freezing and hot water. They mainly feed on bacteria. Pathogenic properties of amoebae and the mechanisms underlying pathological changes induced during human infection have not yet been fully elucidated. They are the causative agents of primary amoebic meningo-encephalitis (PAM), granulomatous amebic encephalitis (GAE), a chronic progressive disease of the central nervous system, amebic keratitis (AK), a chronic eye infection; amebic pneumitis (AP), a chronic lung infection, and skin infection. Only a few isolates are strongly and permanently pathogenic to humans. Some isolates lose their pathogenic properties after one passage. It has been assumed that such "temporary", unstable pathogenic properties of the amoebae may be caused by internal factors carried by them. It is generally known that the free-living amoebae may be naturally infected with pathogenic bacteria, which have the ability to survive for a long time and to proliferate in the amoebae cells. The role of the amoeba in the process of maintaining, propagating and transmitting human pathogens has not been well recognized. It has been suggested that some infections can be acquired by inhaling aerosols containing amoebae cells filled with bacteria. The presence of bacteria inside the free-living amoebae possess a great challenge to organisations responsible for testing and inspecting the quality and cleanliness of surface waters, swimming pools and drinking water intakes.

Acanthamoeba↗
PubMed2006

Prevention of unintentional childhood injuries.

Injuries are the leading cause of death in children and teenagers in the United States. The leading causes of unintentional injury vary by age and include drowning, poisoning, suffocation, fires, burns, falls, and motor vehicle, bicycle, and pedestrian-related crashes. Most injuries are preventable by modifying the child's environment (e.g., use of stair gates) and having parents engage in safety practices (e.g., keeping matches or lighters out of reach of children). Effective injury prevention methods include the use of childproof caps on medications and household poisons, age-appropriate restraints in motor vehicles (i.e., car seats, booster seats, seat belts), bicycle helmets, and a four-sided fence with a locked gate around residential swimming pools.

Accident Prevention↗
PubMed1991

Waterborne-disease outbreaks, 1989-1990.

For the 2-year period 1989-1990, 16 states reported 26 outbreaks due to water intended for drinking; an estimated total of 4,288 persons became ill in these outbreaks. Giardia lamblia was implicated as the etiologic agent for seven of the 12 outbreaks in which an agent was identified. The outbreaks of giardiasis were all associated with ingestion of unfiltered surface water or surface-influenced groundwater. An outbreak with four deaths was attributed to Escherichia coli O157:H7, the only bacterial pathogen implicated in any of the outbreak investigations. An outbreak of remitting, relapsing diarrhea was associated with cyanobacteria (blue-green algae)-like bodies, whose role in causing diarrheal illness is being studied. Two outbreaks due to hepatitis A and one due to a Norwalk-like agent were associated with use of well water. Eighteen states reported a total of 30 outbreaks due to the use of recreational water, which resulted in illness for an estimated total of 1,062 persons. These 30 reports comprised 13 outbreaks of whirlpool- or hot tub-associated Pseudomonas folliculitis; 13 outbreaks of swimming-associated gastroenteritis, including five outbreaks of shigellosis; one outbreak of hepatitis A associated with a swimming pool; and three cases of primary amebic meningoencephalitis caused by Naegleria. The national surveillance of outbreaks of waterborne diseases, which has proceeded for 2 decades, continues to be a useful means for characterizing the epidemiology of waterborne diseases.

Communicable Diseases↗
PubMedDate not supplied

[Drowning in Jalisco: 1983-1989].

The objective of this work was to identify which preventive factors are involved in drowning. Files of 895 autopsies from 1983 through 1989 by the coroner site office were reviewed. During this seven year period, the annual mortality for drowning was 2.6 per 100,000 population. Males had a higher annual mortality rate (4.2 per 100,000) than females (1.1 per 100,000). The age group between one and four years old had the highest mortality rate (7.6 per 100,000). Deaths tend to cluster around summer. Most of the deaths occurred in house cisterns (19.3%), dams/lakes (16.9%), rivers/canals (14.3%), water wells (12.5%) and swimming pools (10.1%). A third of the deaths occurred at home. The relationship alcohol-drowning starts to stand out in the age group between 10 and 14 years old but get its highest percentage in the age group 35-39 (74%). There are two important findings that is necessary to point out: drowning occurring at home and the relationship between drowning and alcohol ingestion.

Accidents, Home↗
PubMed1991

Unusual presentation of Pseudomonas aeruginosa infections: a review.

Pseudomonas aeruginosa is an opportunistic, gram negative bacillus that causes serious hospital acquired infections. However, it also causes infections with unusual presentations which are acquired in a non-hospital environment. This report will discuss the pathogenesis, clinical manifestations, and therapy of this uncommon infection, such as: 1) Pseudomonas folliculitis: a superficial or deep bacterial infection associated with the use of public hot tubs, whirlpools and swimming pools. 2) Invasive external otitis: an infection that can progress to skull base mostly associated to elderly diabetic patients. It is usually secondary to aural irrigation with contaminated water. 3) Pseudomonas osteomyelitis: an infection usually associated with nail puncture wounds especially if wearing tennis shoes. 4) Toe with infection: mostly associated with individuals using topical antibacterial agents. 5) Green nail syndrome: a non tender paronychia lesion that appears most often in persons whose hands are constantly exposed to water, soaps and detergents or are subject to mechanical trauma. 6) Corneal ulcer keratitis: mostly associated with the use of soft lenses, eye drops, mascara or contaminated whirlpools. This condition may terminate in panophthalmitis. 7) Endocarditis: most commonly associated with intravenous drug addicts.

Corneal Ulcer↗
PubMed1991

[Molecular epidemiological study of molluscum contagiosum].

The agarose gel electrophoretic analysis of molluscum contagiosum virus (MCV) DNA obtained from 92 Japanese patients revealed the presence of four different BamHI cleavage patterns of MCV DNAs, classified as MCV-1,2,3 and 4. MCV-1 was found in 69% of the patients, MCV-2 in 4%, MCV-3 in 25%, and MCV-4 in 2%. Almost all the isolates from children and all female adult cases were infected with either MCV-1 or 3. No obvious clinical differences were seen between these two types. MCV-4 was found in only two adult male cases. The sizes of the lesions induced by MCV-4 appeared to be larger than those of other types. Six sets of siblings were shown to be infected with the same types, whereas two sets were infected with the different types. Some different MCV types were found in the cases attending the same swimming pools.

Adult↗
PubMed1990

[A recto-sigmoid lesion due to trans-anal aspiration. Apropos of a case].

A three year old boy presented a transanal evisceration of the rectum after sitting over a non covered drain site of a swimming pool. Peritonitis led to laparatomy 24 hours later. The high rectum was found to be necrotic and perforated. A protecting sigmoïd loop colostomy was performed with out any rectocolic resection. Five months later, resection of the fibrosed high rectum and end to end anastomosis between sigmoïd and low rectum was done. The colorectal function was quickly restored. Continence is now normal with a follow-up of 18 months. Pathogenesis of transanal suction may be as follows: relaxation of perineal muscles and anal sphincter during sitting position permit transanal evisceration by suction. Such lesions are rare (less than 10 cases reported). The therapeutic choice, between initial reparation and drainage associated, with protecting colostomy is discussed.

Anal Canal↗
PubMed1990

Whirlpool folliculitis: a review of its cause, treatment, and prevention.

Folliculitis caused by Pseudomonas aeruginosa has been increasing due to the popularity of hot tubs, swimming pools, and whirlpools. The follicular pustules and inflammatory papules usually occur after an incubation period of two to four days and improve spontaneously in seven to ten days. Despite the discomforts of the condition, treatment is usually not necessary and may even prolong the infection. Since it is difficult to control the growth of Pseudomonas in hot tubs and whirlpools, attention to water conditions is the best way to prevent this irritating skin condition.

Folliculitis↗
PubMedDate not supplied

[Hygiene problems in spas].

The problems of hygiene to be tackled in spas are governed by Federal German legislation such as the Federal Communicable Diseases Act, the Federal German DIN standard regulation No. 19643, the guidelines for the construction of medical baths and the legal definition of a spa. The article describes the problems of hygiene encountered in respect of the water in swimming pools and in physical exercise basins in spas, as well as the problems of hygiene in other fields with particular reference to microorganisms that are of special importance as far as hygienic aspects are concerned. Reference is made to the trihalogen methanes and to the problems in connection with the employed materials.

Baths↗
PubMed1990

Childhood near-drowning--a 12-year retrospective review.

The epidemiological findings in 107 patients admitted to Red Cross War Memorial Children's Hospital, Cape Town, between 1976 and 1987 with a diagnosis of near-drowning are reported. Of these patients, 77% were less than 5 years of age (ratio of boys to girls 2.1:1) and 46% of accidents occurred in swimming pools, 18% in buckets and only 9% in the sea. The high percentage of bucket near-drownings is unique in published medical reports; this appears prevalent in socially disadvantaged communities. Seventy-six per cent of the children were normal on discharge from hospital, 12% died and 6% had neurological damage. In 6% the final outcome was not known. These results are in keeping with other hospital-based studies. Preventive strategies are discussed and the need for further research highlighted.

Adolescent↗