Sanitary microbiology
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3rd MICROBIOLOGY SEMINAR. Sanitary Microbiology. Current issues facing the developed and developing world. Dr Gavin Collins Microbial Ecology Lab (3783) Environmental Change Institute (5047). Sanitary Microbiology. WATER…. … is responsible for, by some estimates, approximately. 80%.

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Sanitary microbiology

3rd MICROBIOLOGY

SEMINAR

Sanitary Microbiology

Current issues facing the developed and developing world

Dr Gavin Collins

Microbial Ecology Lab (3783)

Environmental Change Institute (5047)


Sanitary microbiology

Sanitary Microbiology

WATER…

… is responsible for,

by some estimates, approximately

80%

of all infectious disease -

not just waterborne diseases,

but any disease

where water plays a role… WATER

ASSOCIATED DISEASES


There are waterborne diseases such as cholera typhoid bacillary dysentery infectious hepatitis

There are waterborne diseases, such as cholera, typhoid, bacillary dysentery, infectious hepatitis;

1

Water-washeddiseases, such as trachoma, scabies, dysentery, louse-borne fever;

2

Water-based diseases, such as schistosomiasis, and Guinea worm;

3

And water-related diseases (involving an insect vector) such as malaria, sleeping sickness, or onchocerciasis.

4


Sanitary microbiology

40% of annual worldwide deaths attributed to these diseases


Sanitary microbiology

H2O can act as a vector for the transmission of bacterial, viral and protozoan agents which cause a variety of diseases (mainly intestinal)

It can also be linked to worm invasions and viral/protozoan diseases transmitted by insects (aquatic hosts or insect breeding in H2O - indirect)

Water-associated diseases can be classified under 4 different categories: -


1 water borne diseases

1. Water-borne diseases

Mainly enteric diseases resulting from the ingestion of faecally-contaminated H2O (man, animal and bird excreta)

In developed countries, classical H2O -borne diseases are mostly low infective dose infections - cholera and typhoid fever (rare), leptospirosis (rare); viral infections; Campylobacter (bacterium) and Giardia and Cryptosporidium (protozoa) infections - becoming more common in Ireland


Sanitary microbiology

In developing countries (or as a result of the breakdown of sanitary services in developed countries - earthquakes, war etc.), a variety of other, high-infective dose diseases can be transmitted via H2O - infectious hepatitis, Vibrio (bacterial) infections; bacillary dysentery; other viral infections etc. (human and/or animal origin

All water borne diseases can also be transmitted by other routes that permit ingestion of faecal matter - e.g. contaminated food


2 water washed diseases

2. Water-washed diseases

  • Diseases linked to H20 scarcity and resultant poor personal hygiene

  • Obviously more common in tropical, 3rd world countries where H2O supplies may be scarce

  • Intestinal and non-intestinal infections

  • Intestinal: Shigella (dysentery); typhoid; cholera; Campylobacter; Giardia; Cryptosporidium; viruses


Sanitary microbiology

  • Non-intestinal: Infections of the skin and mucous membranes - bacterial skin sepsis; scabies; fungal infections such as ring-worm; fungal mouth ulcers etc.


3 water based diseases

3. Water-based diseases

  • Diseases caused by pathogens that have a complex life-cycle which involves an intermediate aquatic host

  • All of these diseases are caused by worms, e.g. Schistosomiasis caused by the Schistosoma worm which uses aquatic snails as an intermediate host, also the Guinea worm (Dracunculus medimensis) which uses a small crustacean as an intermediate host


Sanitary microbiology

Schistosomiasis affects 200 million people worldwide per annum


4 water related diseases

4. Water-related diseases

Diseases caused by pathogens carried by

insects that live near H2O and act as

mechanical vectors

Very difficult to control and diseases are very

severe


Sanitary microbiology

  • Examples:

    • Yellow fever (viral disease) is transmitted by the mosquito Aedes spp.;

    • Dengue (viral) carried by the mosquito Aedes aegypti (breeds in water);

    • Malaria is caused by a protozoan (Plasmodium spp.) and is also spread by a mosquito (Anopheles spp.);

    • Trypanosomiasis (Gambian sleeping sickness) is also caused by a protozoan transmitted by the riverine Tetse fly (Glossina spp.)


Increasing crises worldwide

Increasing Crises Worldwide

Population growth

Pollution

with increased flooding leads to

breakdown of sanitary infrastructure and further spread of disease

Climate change

Engineered systems

(such as water treatment and distribution systems)

Population

susceptibility

(increasing numbers of elderly & immuno-suppressed people)


Sanitary microbiology

Methane (CH4) from anaerobic digestion

Greenhouse effect

Bovine generated CH4

CO2 from industry

ANAEROBIC DIGESTION

Urbanisation

Complex molecules

Globalisation

Simpler molecules

Biogas (CH4 & CO2)

Celtic Tiger

economy

Wealth &

Wastefulness

Kyoto treaty


Sanitary microbiology

The diseases that result from flooding vary according to geographic region.

Typical ones include cholera, typhoid, dengue, Rift Valley fever, malaria, hepatitis A, AGI [acute gastro-intestinal illness], and ARI [acute respiratory illness].

Flooding


Problems involved in getting clean safe water to people in the developing world

Problems involved in getting clean, safe water to people in the developing world

  • Water supplies in communities highly susceptible to municipal, agricultural, and industrial contamination.

  • e.g., in India, huge numbers of people live in slums sited in low-lying points, and at end-of-pipe sites.


Sanitary microbiology

CASE STUDY

Hyderabad, India

  • Water has maximum "residence time" in deteriorating distribution systems. Uses antiquated British water treatment technology designed for a much smaller population, only supplies water for 2 hours per day.

The remaining time, 22 hours per day, water sits stagnant in the distribution system. In addition to pathogens in drinking water, slums tend to be sited near standing water.


Sanitary microbiology

Moreover, children routinely play in this water - both fouling it and further exposing themselves to disease.

Standing water is a major problem in malaria and other vector-borne diseases.

Cholera, giardiasis, hepatitis, shigellosis, typhoid, and AGI

Other infections such as legionellosis, cryptosporidiosis, and mycobacterial infections occur, but are seldom diagnosed.


Absence of sanitary infrastructure

Absence of Sanitary Infrastructure

Often in the developing world gastroenteritis and other infections cause unnecessary mortality

  • e.g. Massai in Kenya each year the current infant mortality rate is 20% for children < 5 years old from diarrhoeal infections - Campylobacter/E. coli


Sanitary microbiology

  • Treatment for these infections does not need expensive drugs or antibiotics (self-limiting infections)

  • Needs only water and salt to balance loss - but if available water is contaminated??

  • Diarrhoea kills 15000 < 5 year olds every day, 5.5m/annum

  • Treatable at the cost of <10 cent per child


Sanitary microbiology

HOWEVER, NOT JUST A PROBLEM OF THE DEVELOPING WORLD


Wbd s in a developed world context

WBD’s in a developed world context

  • Growing problem in Ireland primarily due to deterioration of ground and surface water quality

  • Massive volume of wastes produced in intensive agriculture can contaminate a water supply if not managed correctly


Sanitary microbiology

  • General causes of WBDOs include:

1) No treatment

2) Breakthrough at treatment plant

3) No disinfectant residual

4) Direct sewage contamination through pipe

leakage, breakage, back-siphoning, and

cross-connections


Sanitary microbiology

Where the problems arise

Corrosion of pipe networks allowing contamination during distribution

30% of rivers polluted;

50% of group water supplies contaminated with E. coli

formation leads to:

Biofilm

  • biofouling;

  • foul odour, smell, colour, and the general impression of "dirty water”;

  • biocorrosion;

  • survival and proliferation of pathogens; disinfection resistance;

  • transfer of antibiotic and virulence factors


Problems with microbiological monitoring

Problems with Microbiological Monitoring

Current indicator organisms may not be adequate for the following reasons:

The presence of coliforms in water only

reflects sewage contamination - not potential

pathogens like Legionella

Coliform behaviour and die-off is not

comparable to the behaviour of viruses and

protozoa

Die-off rates of faecal coliforms have been

demonstrated to vary enormously


Problems with microbiological methods cont d

Problems with Microbiological Methods (cont’d)

Techniques used to identify indicators rely on growth and culture - many organisms can be viable in the environment but unculturable using current methods(‘Plate-count anomaly’)

Molecular methods based on DNA probes and PCR still not adequate


Challenges for the future controlling legionella and other organisms

Challenges for the future: controlling Legionella and other organisms

Legionella pneumophila an emerging

pathogen - first recognized in the 1970s

Example of how creation of a unique

environment in our water systems that has

lead to a "new" or newly recognized disease.

Incidence of Legionnaires' disease in the U.S.:

approximately 1,000 cases annually

Estimated that over 25,000 cases of the illness

occur each year, causing more than 4,000 deaths.


Sanitary microbiology

Legionella is one of the top three causes of sporadic,

community-acquired pneumonia. Difficult to

distinguish, many cases go unreported.

For growth Legionella requires the following:

stagnation; temps between 20° and 50°C (optimal

growth range is 35° - 46°C);

pH between 5.0 and 8.5;

Microbes incl algae, flavobacteria, and Pseudomonas,

which supply essential nutrients or harbor the

organism (protozoa)


Sanitary microbiology

Optimal conditions created for Legionella

growth in many modern buildings:

Domestic hot-water systems with water

heaters that operate below 60°C; centralized

hot water systems [common in eastern

European countries]

Cooling towers, and fluid coolers that use

evaporation; humidifiers and decorative

fountains that create a water spray; spas

and whirlpools.


Giardia and cryptosporidium

Giardia and Cryptosporidium

Protozoa and common causes of GI infections

Used to be rare in Ireland, incidence now

increasing

Form oocysts as part of the life-cycle

These oocysts are resistant to chlorination

which is the only method used to disinfect

water in Ireland


Sanitary microbiology

No detection methods for these

organisms at the moment

Use of conventional indicators

meaningless

How many of the 350,000 cases of food/water borne illnesses in Ireland last year caused by these organisms??


Conclusions

Conclusions

  • Partial solutions to the problems of maintaining clean safe water for all include:

1. Active surveillance

2. Population surveys

3. Low-cost solutions to treatment

4. Waste-water reclamation


Sanitary microbiology

5.Appropriate valuation of the resource

6.Assessments of impacts of engineered "ecosystems”

7.Monitoring of antibiotic resistance and changing virulence

  • Tighter regulation guided by precautionary principles


Sanitary microbiology

www.nuigalway.ie/microbiology/mel


Further info

Further Info

http://www.doh.ie/

http://www.who.int

http://www.cdc.gov/health/

http://www.cfsan.fda.gov/~mow/intro.html

http://www.epa.ie/

http://www.aem.org


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