TNWW: Understanding Waterborne Diseases

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Waterborne illnesses are a significant health concern, transmitted through contaminated drinking water and contact with water sources. Before swimming in a new area, one should check to make sure that the water is safe for themselves, their family, and their pets.

he easiest way to do this is to go to websites that can predict or actively measure amounts of E. coli. The amount of E. coli helps to show how harmful the water is. Websites such as Tennessee Water Watch are a good place to start.

Waterborne diseases can be put into four groups: waterborne illnesses from drinking water, water-washed diseases prevented by proper sanitation, water-based diseases transmitted by contact with water, and water vector diseases spread by vectors like mosquitoes.

Transmitted through drinking water

Water-washed (water-scarce) diseases

These are diseases where the interruption of the transmission is achieved through proper attention to effective sanitation, washing and personal hygiene.

Water-based diseases

These are diseases transmitted by contact with water.

Water vector diseases

 These are diseases transmitted by a vector, for example a mosquito.

Microscopic image of the Vibrio cholerae "comma" bacterium

“Comma” bacterium, is a very common waterborne pathogen. It causes cholera, a disease that can lead to severe diarrhea and dehydration. The seven most common waterborne illnesses include typhoid fever, cholera, giardia, dysentery, E. coli, hepatitis A, and salmonella, all linked to poor hygiene and contaminated water or food.

1. Typhoid fever

    • Spread through contaminated food, unsafe water, poor sanitation
    • Highly contagious
    • Vaccine
Microscopic photo of Salmonella typhi
Image: Dahab Clinic

2. Cholera

    • Spread through contaminated water
    • Causes severe dehydration and diarrhea
Microscopic photo of Cholera bacteria (Vibrio cholerae)
Copyright: Darthmouth College Electron Microscope Facility / These images are in the public domain

3. Giardia

    • Spread through contaminated water 
    • Infection caused by a parasite but typically clears up after a few weeks
    • No vaccine
Microscopic photo of Giardia intestinalis
From Wikimedia Commons

4. Dysentery

    • Intestinal infection
    • Severe diarrhea 
    • Spread through poor hygiene
Inflamed mucosal surface of the rectum interior viewed with a sigmoidoscope in a patient with bacillary dysentery.
Centers for Disease Control and Prevention (CDC) (Image Number: 6660)

5. E. coli

    • Bacteria with many strains
      • Some dangerous and some are even beneficial
    • Animal waste
Microscopic view of E. coli

6. Hepatitis A

    • Liver infection
    • Caused by contaminated food/water or contact with infected people
    • Vaccine
    • Once a person gets this infection, they build an immunity and will likely never become infected again.
Microscopic view of Hepatitis A virus (HAV)
Photo: FDA.gov, Copyright: Science Photo Library

7. Salmonella

    • Food or water contaminated with feces, or undercooked food (eggs)
    • Avoid by cooking food thoroughly
    • Treat it by drinking lots of safe water with electrolytes
Microscopic view of salmonella
Photo: CDC

Additionally, dogs are susceptible to waterborne diseases such as leptospirosis, giardiasis, pythiosis, and protothecosis, with varying prognoses and treatments. Cases of harmful algal blooms and parasite infections both cause dogs to become sick, but harmful algal blooms are more commonly the cause of waterborne illnesses in dogs. Mainly Dogs are susceptible but humans can get these diseases, too.

Leptospirosis- treatable but can be fatal

    • Leptospirosis is caused by bacteria (Leptospira spp.) that have world-wide distribution and can infect any mammal.
    • Dogs contract the disease through contact with infected urine or water, but not all infected dogs become ill.
    • The most common signs reported in dogs are fever, anorexia, vomiting and diarrhea, but signs can vary. Kidney and liver damage have been reported in some dogs.
    • Antibiotic therapy is needed to clear the organism, and supportive care and hospitalization is required in the most severe cases.
    • Prognosis depends on the severity of organ damage and the presence (or absence) of complications. Mortality rates are 20 percent, although some experts report mortality rates as high as 70 percent in the most severely affected individuals.
Infographic from VetSupply

Giardiasis- treatable, good long-term

    • Giardiasis is caused by protozoa (Giardia spp.) with a wide geographic distribution.
    • Diarrhea is the most common clinical sign, but many healthy dogs have giardia organisms in their stools.
    • De-wormers such as fenbendazol, or antibiotic therapy with metronidazole, are used to treat symptomatic dogs, and long-term prognosis is very good.
Infographic from Gardner Animal Care Clinic

Pythiosis- rare but severe

    • Pythiosis is caused by a type of fungus (Pythium insidiosum) that causes very serious and often fatal infections of the skin or intestinal tract.
    • Pythiosis most often is seen in the Gulf Coast states, but it has been recognized in several Northern, Midwestern and Western states.
    • Clinical signs include ulcerated, non-healing skin lesions, weight loss, vomiting, diarrhea and bloody stools.
    • Surgery to remove lesions on the skin and in the bowel is the treatment of choice for this disease, but many times the lesions are too extensive to remove.
    • Oral anti-fungal drugs can be tried in cases where surgery is impossible, but rarely are successful at curing the disease. Fortunately, this infection is rare in the United States

Protothecosis- can be fatal

    • Protothecosis is caused by an algae (Prototheca spp.) found in warm, humid regions such as the Gulf Coast states.
    • Although many dogs come in contact with this organism, illnesses are rare and often associated with immunosuppression.
    • The organism can cause skin lesions as well as central nervous system signs (such as seizures, blindness and incoordination) and diarrhea, vomiting and weight loss if the large intestine is involved.
    • Treatment with antifungal agents has been effective; most dogs with clinical infection succumb to the disease.

With TN Water Watch, we’re dedicated to providing vital information on E. coli, which as an indicator species, helps us to understand the risk of exposure to other microorganisms in the water.

Using this tool to monitor the predictive forecast before you recreate helps ensure that both you and your furry friends can get the latest updates on water quality in your favorite spots.

Before you splash and play, check the water for the day!

Henry is a rising junior at Montgomery Bell Academy who plays lacrosse and helps out with the school’s football team. He is a member of Westminster Presbyterian Church. Henry enjoys the outdoors and recently earned his Eagle Scout. Henry has been working with Harpeth Conservancy for the past two weeks to better understand the importance of rivers and the nature of watersheds.