Swimming In Fresh Water Research Articles

Genomic Characterization and Antimicrobial Resistance of Four Mcr-1 Escherichia coli Strains Isolated from Human and Environment Sources, Hainan Province, Tropical China

Background: The rapid spread of multidrug-resistant gram-negative bacteria, particularly the increase in carbapenem-resistant strains, has led to a critical level of resistance in clinical settings. Colistin is considered to be the last line of defense against these gram-negative bacteria. Objectives: This study aims to investigate the genetic characteristics and antimicrobial resistance (AMR) patterns of four mcr-1 (mobile colistin resistance) Escherichia coli isolates from various sources in Hainan Province, tropical China, and to determine their genetic relationships with both domestic and global strains. Methods: Samples were collected from swimming pools, marine beaches, and beach personnel in Haikou and Sanya, Hainan Province, China. E. coli isolates were obtained, multilocus sequence typing was performed, and the mcr family resistance genes were amplified by polymerase chain reaction. The mobile sequences, AMR genes, phenotypes, and virulence genotypes of the mcr-1 strains were analyzed. Phylogenetic analyses were conducted to investigate the relationships between the mcr-1E. coli strains and those in the NCBI database. Results: In the current study, the mcr-1 resistance gene was detected in 4 strains, accounting for 2.94% (4/136) of the total. The 4 strains of E. coli were isolated from a freshwater swimming pool, a pool wall, seawater, and a human body. Among the four strains, the minimum inhibitory concentration of polymyxin was 8 mg/L, except for one strain, which showed low-level resistance at 4 mg/L. All four strains showed complete resistance to ampicillin, three were resistant to compound sulfamethoxazole and chloramphenicol, and all strains were sensitive to other common antibiotics. The virulence genes cfaA, cfaB, cfaC, and cfaD/cfaE were detected in all E. coli strains. The insertable sequence IS3 was the most widely distributed type. Three isolates were identified as ST987, whereas the isolate from marine sources was identified as ST24. Comparison of the core genes of the strains indicated that the four strains were closely related to the Chrysomya sp. from Northern Thailand. Conclusions: The four mcr-1 genes can mediate low to medium levels of colistin resistance, facilitating their dissemination within the population and the environment. It is crucial to trace the source of multidrug-resistant bacteria in recreational water, which is in direct contact with humans, and to reduce the risks to human health through effective supervision.

‘You Have To Respect The Water’: Participant Experiences of Appreciating and Managing the Risks Associated with Open Water Swimming – A Rapid Ethnographic Study

Open water swimming (OWS) has rapidly grown in popularity, driven by the purported health benefits of cold-water immersion. A paucity of research remains specifically considering the notable risks inherent in OWS participation, and a lack of qualitative research on freshwater swimming experiences, and safety-related issues therein. This rapid ethnographic study, based at a dedicated OWS lake in the UK, conducted semi-structured interviews with OWS participants (n=17; female=11, male=6). Two core themes emerged: environmental issues impacting OWS experiences and behaviours; and knowledge and education of OWS which highlighted safe/unsafe practices, levels of education for managing risks, personal preparedness, swimming solo/with others, use/non-use of specialised equipment, anxieties relating to participation, and environmental conditions. Findings suggest a lack of safe practice persists pertaining to immersion in cold water environments. Specific strategies are suggested that organisations involved with the promotion of the sport should consider to promote safer and more enjoyable OWS experiences.

One Health Determinants of Escherichia coli Antimicrobial Resistance in Humans in the Community: An Umbrella Review.

To date, the scientific literature on health variables for Escherichia coli antimicrobial resistance (AMR) has been investigated throughout several systematic reviews, often with a focus on only one aspect of the One Health variables: human, animal, or environment. The aim of this umbrella review is to conduct a systematic synthesis of existing evidence on Escherichia coli AMR in humans in the community from a One Health perspective. PubMed, EMBASE, and CINAHL were searched on "antibiotic resistance" and "systematic review" from inception until 25 March 2022 (PROSPERO: CRD42022316431). The methodological quality was assessed, and the importance of identified variables was tabulated across all included reviews. Twenty-three reviews were included in this study, covering 860 primary studies. All reviews were of (critically) low quality. Most reviews focused on humans (20), 3 on animals, and 1 on both human and environmental variables. Antibiotic use, urinary tract infections, diabetes, and international travel were identified as the most important human variables. Poultry farms and swimming in freshwater were identified as potential sources for AMR transmission from the animal and environmental perspectives. This umbrella review highlights a gap in high-quality literature investigating the time between variable exposure, AMR testing, and animal and environmental AMR variables.

C2 (Clinical Case) Complicated Sinusitis in an Adolescent Swimmer in the COVID-19 Pandemic: An Unexpected Microbial Player

Abstract Introduction/Background There are increasing reports of complicated sinusitis following post-pandemic viral surges. Streptococcus anginosus and Staphylococcus aureus (SA) are common causes. However, unusual pathogens may need to be considered in the face of inadequate therapeutic response. Case Description A previously healthy 13-year-old boy presented with fever, facial pain, and headache two weeks following presumed COVID-19 infection based on exposure history and symptoms. While recovering, he had been swimming daily and recalled inhaling pool water. On examination he was febrile with a tender mid-forehead swelling and left periorbital swelling without features of orbital cellulitis. There was no meningism or focal neurological deficits. Investigations revealed leukocytosis (19.1 x109/L), elevated CRP (156.8 mg/L) and sterile blood cultures. Head imaging confirmed sinusitis complicated by Pott’s puffy tumor, a small subdural empyema and sinus venous thrombosis. Ceftriaxone, metronidazole, and vancomycin were initiated with de-escalation of the latter to cloxacillin after sinus cultures grew methicillin-sensitive SA. Despite broadening to meropenem and vancomycin, he progressed to develop cerebritis. Legionella species identified from intracranial sampling using 16s RNA, allowed targeted therapy with levofloxacin and successful resolution after six weeks of therapy. Discussion The development of this patient’s Pott’s puffy tumor and intracranial complications seemed consistent with post-viral sinusitis in terms of onset and growth of SA. However, his inadequate response to broad-spectrum therapy and sterile cultures from intracranial sampling prompted request for 16sRNA testing. Subsequent disclosure of freshwater swimming exposure with aspiration event raised concerns for water-borne pathogens such as Legionella. The aspiration event occurring in presence of persisting congestion, resulted in Legionella species seeding already inflamed sinuses and further tracking intracranially. Without special cultures required to recover Legionella, this pathogen was initially missed, resulting in disease progression and delayed targeted therapy. Fluroquinolones or macrolides are required for treatment of this pathogen. Conclusion Given that post-viral sinusitis may be anticipated during viral surges, practitioners should consider the role of waterborne pathogens in hosts with significant swimming exposure who worsen on usual therapy. Microbiology and infectious diseases involvement is encouraged to optimize detection and management of waterborne infection. Practitioners are reminded that in the face of therapeutic failure, it is critical to revisit the history for unusual exposures, determine immunocompetence, and explore potential bug-drug mismatch.

When parasites stray from the path: a curious case of ectopic cutaneous Schistosoma haematobium.

This case report highlights an unusual manifestation of schistosomiasis, where a chronic cutaneous lesion was observed much later in the disease course. The diagnosis was made after laboratory investigation of the lesion and urine analysis, revealing the presence of Schistosoma haematobium eggs. The patient had a history of swimming in freshwater during his travel to various regions in South Sudan for work. This report emphasizes the importance of a full travel history and the need for physicians to be vigilant for unusual presentations of infectious diseases. The One Health strategy is found to be useful for the prevention and control of such zoonoses in endemic countries. Further studies are needed to improve our understanding of the disease's pathology.

906 Schistosomiasis: The New ‘Gap Year’ Problem

Abstract Introduction Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population. The patient We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations. Discussion Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel. To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.

Effects of a Combined Disinfection Method on Pseudomonas aeruginosa Biofilm in Freshwater Swimming Pool

Pool water must meet certain chemical and microbiological conditions to ensure high water quality and a safe environment for users. A recreational swimming pool treated with a combined disinfection method (chlorination and UV radiation) was monitored for 18 months. Selected chemical and microbiological parameters of the indoor freshwater pool were analyzed, and the in vivo presence of Pseudomonas aeruginosa biofilm was assessed and further correlated to the type of disinfection. P. aeruginosa isolated from biofilm was further examined to determine the effects of combined disinfection methods on the formation and destruction of mature biofilm in vitro. The in vitro application of the combined disinfection methods led to the inhibition of planktonic P. aeruginosa biofilm formation (68.9% compared to the control group) and were more effective in the partial destruction of mature biofilm than individual disinfection methods (from 25.4 to 26.3%). The obtained results indicate the better microbiological and chemical quality of pool water when combined disinfection was applied. Our results contribute to developing the optimization of pool water disinfection methods and biofilm control.

Freshwater Wild Swimming, Health and Well-Being: Understanding the Importance of Place and Risk

Spending time in or around bodies of water or ‘blue spaces’ can benefit human health and well-being. A growing body of evidence suggests immersion in blue space, e.g., participating in ‘wild’ swimming, can be particularly beneficial for both physical and mental health. To date, wild swimming and health research has primarily focused on the experience of individuals who swim in the sea. Empirical studies of the health-promoting potential of swimming in freshwater environments, such as lochs and lakes, are lacking, despite the popularity of this practice in many countries and the vastly different physical and hydrological properties of freshwater and coastal environments. The aim of this study was to explore the relationship between loch (lake) swimming and health and well-being for adults living in Scotland and determine the importance of perceptions of place and risk in this relationship. Semi-structured interviews were conducted with twelve wild swimmers who regularly swim in lochs in Scotland. Interview data were analysed thematically using Nvivo. The findings suggest loch swimming has a variety of health and well-being benefits that can be categorised over three domains of health: physical, mental and social. Of these domains, mental health benefits e.g., mindfulness promotion, resilience building and increasing one’s ability to listen to their body, were particularly prominent. Our findings also highlight important physical and hydrological characteristics of loch environments, e.g., calm water conditions (relative to the sea), which contribute to positive wild swimming experiences. Finally, the perceived risks of loch swimming and mitigation strategies for these risks are established. Collectively, our findings further support the notion that wild swimming is a unique health-promoting practice. Our findings also highlight differences (in terms of experience and perceived risk) between swimming in freshwater and coastal environments, which can inform public health and water management policy.

The diversity of beta defensins in lungfish (Dipnoi)

Abstract Mucosal surfaces are the first line of defense against pathogens. At these surfaces, mucus containing innate and adaptive immune molecules is constantly secreted to protect the animal host. African lungfish are the extant relatives to all tetrapods and have a dual mode of living, swimming in freshwater during the wet seasons and aestivating during the dry seasons. During terrestrialization, African lungfish produce large amounts of mucus that form a dry cocoon to prevent water loss. We recently reported that the lungfish cocoon acts as a bacterial trapping structure and it is rich in antimicrobial peptides (AMPs), specifically beta defensins (BD). As many AMPs, BDs are small amphipathic molecules and mainly cationic. The goal of this study is to provide a full characterization of BD genes from transcriptomes and genomes of different lungfish species. Using the canonical six cysteine motif from vertebrate BD molecules, we searched for all BD genes Protopterus dolloi transcriptomes, the genomes of P. annectens and Australian lungfish (a non-aestivating lungfish, Neoceratodus forsteri). BLASTs searches identified 9 BD genes in P. dolloi transcriptomes with predicted highly cationic characteristics except for BD-7. Sequence alignment and phylogenetic trees indicate that three P. dolloi BD genes may be an intermediate form of AMP between beta and alpha defensins. Genomic analyses indicate that P. annectens BD genes contain 3 exons and 2 introns similar to all defensin genes. Future studies will determine the tissue distribution and antimicrobial function of Protopterus spp. BD molecules and determine their potential application as alternatives to antibiotics. Supported by National Science Foundation Integral Organismal Systems (IOS) award # 1938816

Schistosomiasis: hazards of freshwater swimming

Schistosomiasis: hazards of freshwater swimming

Diagnosis of Acanthamoeba keratitis in Mashhad, Northeastern Iran: A Gene-Based PCR Assay.

Background:The genus Acanthamoeba is a free-living opportunistic protozoan parasite, which widely distributed in soil and fresh water. Acanthamoeba keratitis, which causes a sight-threating infection of the cornea, is going to rise in Iran and worldwide. The aim of this study was to compare direct microscopy, culture and PCR for detection of Acanthamoeba spp. in clinical samples and to determine the genotypes of Acanthamoeba spp. by sequencing 18SrRNA gene.Methods:Among patients clinically suspected to AK referred to a tertiary ophthalmology center at Mashhad, northeastern Iran. During 2017-18, twenty corneal scrapes specimens obtained. The samples were divided into three parts, subjected to direct microscopic examination, culture onto non-nutrient agar and PCR technique. Sensitivity, specificity, accuracy and likelihood ratio were evaluated.Results:Among 20 persons clinically suspected to amoebic keratitis, 13(69.2%) patients definitely diagnosed as Acanthamoeba keratitis. Wearing contact lens, eye trauma due to foreign particle and swimming in fresh water were the main predisposing factors. Most of patients suffered from pain and photophobia. Corneal ring infiltration and epithelial defect were common clinical sings. Direct examination had the lowest sensitivity and sensitivity of both Nelson-PCR and JDP-PCR methods were equal and highest. In addition, the results of sequencing identified that all strains belonged to T4 genotype.Conclusion:Amoebic keratitis is a sporadic parasitic keratitis, which is mainly seen in contact lens user in Mashhad. PCR based on 18S ribosomal DNA with JDP primers is a reliable and highly sensitive method for diagnosis of Acanthamoeba keratitis in clinically suspected cases.

Management of Coastal Areas with Sustainable Marine Ecotourism Development in Purworejo Regency, Central Java, Indonesia

The beach is a favorite tourist destination for the Indonesian people. As Indonesia is blessed with many beaches which attracts people to visit. Indonesians usually come to the beach in the holiday to fish, see beautiful scenery, and play around. Central Java Province in Indonesia has a beach cluster situated to the north and south of the Java Island. Jatimalang Beach is the south coast of Java which has excellent natural beauty, which is located in Purworejo Regency. This research is focused on the beach facilities and infrastructures, tourist’s ecotourism awareness, and environmental sustainability management of the Jatimalang Beach Purworejo. The study was carried out in November till December 2019 by using the qualitative research method. Information discovered during fieldwork are used to direct data collection. Qualitative researchers, are closely engaging with the environment being examined. This work was conducted through observations and interviews with tourist at Jatimalang Beach, as well as a literature review. The results showed that the facilities and infrastructure found in Jatimalang Beach were the presence of lifesavers, waste, parking lots, freshwater swimming pools for children, toilets, electrical facilities, and worship places. In addition, tourists are often willing to preserve nature and the sustainability of marine tourism on the Jatimalang Beach, however many of them do not understand the importance of ecotourism and need to be educated again.

1348 The Ketamine Connection: Ulcerative Cystitis and Biliary Dilatation in the Setting of Chronic Ketamine Abuse

INTRODUCTION: Recreational ketamine abuse can present with a unique constellation of symptoms, and limited literature on this topic makes this case a rare learning opportunity. CASE DESCRIPTION/METHODS: A 37-year-old male with diffuse psoriasis and a one-year-history of ketamine inhalation presented to the ER complaining of recurrent episodes of epigastric pain. The pain was described as colicky, non-radiating, and 10/10 in intensity; he related the pain acutely worsened in the 3 days prior to admission. He also had a remote history of cocaine and marijuana abuse. He denied vomiting, diarrhea, melena, dysphagia, odynophagia, fevers, or chills. Physical exam findings were negative for a Murphy's sign. Laboratory studies were significant for eosinophilia and an elevated lipase. A CT of the abdomen revealed hypodensities in the liver parenchyma and dilatation of the intrahepatic biliary ducts, common bile duct, gallbladder, and pancreatic duct. These findings suggested an obstructing stone or mass lesion at the ampulla. Furthermore, a pelvic CT also revealed an asymmetric, markedly thickened anterior urinary bladder wall and bladder dome; these findings were concerning for underlying malignancy of the bladder. A urinalysis revealed elevated white blood cells and red blood cells, but cytology was negative. A re-evaluation of the patient revealed symptoms of difficulty urinating, with sensation of having to push to void and dysuria at the end of micturition. Of note, the patient denied any history of freshwater swimming or exposure to factory chemicals. The patient underwent an EUS, which revealed a dilated common bile duct without stones, an acalculous gallbladder, and a deformed ampulla. A bedside cystoscopy was performed, revealing no tumors or strictures, but revealed a high-riding median lobe of the prostate at the bladder neck. Additionally, the posterior dome showed a thickened, erythematous area, and another rounded area consistent with ulcerative cystitis. Urology scheduled the patient for a repeat cystoscopy with biopsy, but unfortunately he left against medical advice as his pain and other symptoms had resolved. DISCUSSION: Ketamine, known for its hallucinogenic effects, is used recreationally among various populations. Hepatic-dominant metabolization, with urinary (90%) and biliary (10%) excretion leave these organs exposed to ketamine metabolites and their effects. This case emphasizes the importance of drug history in patients presenting with biliary colic and urinary symptomatology.

Attributable sources of community-acquired carriage of Escherichia coli containing β-lactam antibiotic resistance genes: a population-based modelling study

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC), plasmid-mediated AmpC-producing E coli (pAmpC-EC), and other bacteria are resistant to important β-lactam antibiotics. ESBL-EC and pAmpC-EC are increasingly reported in animals, food, the environment, and community-acquired and health-care-associated human infections. These infections are usually preceded by asymptomatic carriage, for which attributions to animal, food, environmental, and human sources remain unquantified. In this population-based modelling study, we collected ESBL and pAmpC gene data on the Netherlands population for 2005-17 from published datasets of gene occurrences in E coli isolates from different sources, and from partners of the ESBL Attribution Consortium and the Dutch National Antimicrobial Surveillance System. Using these data, we applied an established source attribution model based on ESBL-EC and pAmpC-EC prevalence and gene data for humans, including high-risk populations (ie, returning travellers, clinical patients, farmers), farm and companion animals, food, surface freshwater, and wild birds, and human exposure data, to quantify the overall and gene-specific attributable sources of community-acquired ESBL-EC and pAmpC-EC intestinal carriage. We also used a simple transmission model to determine the basic reproduction number (R0) in the open community. We identified 1220 occurrences of ESBL-EC and pAmpC-EC genes in humans, of which 478 were in clinical patients, 454 were from asymptomatic carriers in the open community, 103 were in poultry and pig farmers, and 185 were in people who had travelled out of the region. We also identified 6275 occurrences in non-human sources, including 479 in companion animals, 4026 in farm animals, 66 in wild birds, 1430 from food products, and 274 from surface freshwater. Most community-acquired ESBL-EC and pAmpC-EC carriage was attributed to human-to-human transmission within or between households in the open community (60·1%, 95% credible interval 40·0-73·5), and to secondary transmission from high-risk groups (6·9%, 4·1-9·2). Food accounted for 18·9% (7·0-38·3) of carriage, companion animals for 7·9% (1·4-19·9), farm animals (non-occupational contact) for 3·6% (0·6-9·9), and swimming in freshwater and wild birds (ie, environmental contact) for 2·6% (0·2-8·7). We derived an R0 of 0·63 (95% CI 0·42-0·77) for intracommunity transmission. Although humans are the main source of community-acquired ESBL-EC and pAmpC-EC carriage, the attributable non-human sources underpin the need for longitudinal studies and continuous monitoring, because intracommunity ESBL-EC and pAmpC-EC spread alone is unlikely to be self-maintaining without transmission to and from non-human sources. 1Health4Food, Dutch Ministry of Economic Affairs, and the EU's Horizon-2020 through One-Health European Joint Programme.

Injured coliforms in swimming pools : How big a threat?

A swimming pool is an important leisure facility, but it can harbor injured cells creating potential health hazards. Disinfection of swimming pools can cause bacterial injury, when cells are exposed to a suboptimal concentration of disinfectants. Possible pathogenic bacteria can enter into an injured state, for example, Escherichia coli, Klebsiella spp, and Enterococcus faecalis. Injured bacteria can retain their pathogenicity and virulence and they may recover causing diseases. To assess the presence of injured coliforms in swimming pools based on differential plating media. This study compared the difference in recovery of coliforms between two differential media, one designed for recovery of injured coliforms (HiCrome ECC selective agar and the other is CHROMagar ECC). A total of 120 samples were collected from 10 semi-public swimming pools with sporadic distribution around Alexandria, Egypt, and included in this study. Five pools were used for swim training, 4 were used for both training and recreational swimming and one was used for children only. The recovery medium (HiCrome ECC selective agar) detected 1.47 and 2.54 times total coliforms and E. coli, respectively, as CHROMagar ECC. The compliance of samples per fresh water swimming pool Egyptian standard in total coliforms and E. coli fell from 54.10% when examined by CHROMagar ECC medium to 35% by HiCrome ECC selective medium. The current findings may not be universal to all swimming pools but may be applicable to ones where the physicochemical properties of their water induce coliform injury. Results suggest that the use of media that detect injured yet viable coliforms will give a more sensitive and representative guidance about the quality of examined water and will assist in the treatment and decontamination of swimming pools.

Injured coliforms in swimming pools : How big a threat?

A swimming pool is an important leisure facility, but it can harbor injured cells creating potential health hazards. Disinfection of swimming pools can cause bacterial injury, when cells are exposed to a suboptimal concentration of disinfectants. Possible pathogenic bacteria can enter into an injured state, for example, Escherichia coli, Klebsiella spp, and Enterococcus faecalis. Injured bacteria can retain their pathogenicity and virulence and they may recover causing diseases.To assess the presence of injured coliforms in swimming pools based on differential plating media.This study compared the difference in recovery of coliforms between two differential media, one designed for recovery of injured coliforms (HiCrome ECC selective agar and the other is CHROMagar ECC). A total of 120 samples were collected from 10 semi-public swimming pools with sporadic distribution around Alexandria, Egypt, and included in this study. Five pools were used for swim training, 4 were used for both training and recreational swimming and one was used for children only.The recovery medium (HiCrome ECC selective agar) detected 1.47 and 2.54 times total coliforms and E. coli, respectively, as CHROMagar ECC. The compliance of samples per fresh water swimming pool Egyptian standard in total coliforms and E. coli fell from 54.10% when examined by CHROMagar ECC medium to 35% by HiCrome ECC selective medium.The current findings may not be universal to all swimming pools but may be applicable to ones where the physicochemical properties of their water induce coliform injury. Results suggest that the use of media that detect injured yet viable coliforms will give a more sensitive and representative guidance about the quality of examined water and will assist in the treatment and decontamination of swimming pools.

Assessment of Knowledge of Medical Students on an Important Health Issue Neagleria Flowri Infection at a Medical College of Karachi, Pakistan

Background: Since 2005 Neagleria Flowri infection appeared as a major health issue in Karachi, Pakistan. Most infections were acquired due to swimming in fresh water, ablution with fresh stagnant water. Our objective was to assess the knowledge of medical students regarding this important health issue and to highlight any deficiencies in medical education system. Material and methods: It was a prospective cross sectional study conducted at a medical college of Karachi, Pakistan. The sample size was calculated and sampling technique was randomized stratified sampling. Knowledge of the students was assessed through designed questionnaire. The data was recorded and analyzed on SPSS vs 21. Results: Our study included 250 medical students from five years of medical school. The highest response was recorded from final year regarding type of organism and habitat. Regarding treatment of Naegleria most correct response was from 4th year MBBS. Most final years answered correctly regarding the ablution as risk factor. The knowledge of medical students regarding incubation period of Neagleria was generally low. Conclusion: The knowledge of medical students regarding this significant medical issue appears low. The response of medical students was generally poor regarding treatment of infection, incubation period of infection and earliest presenting symptom of infection. Important measures should be taken to improve the knowledge of medical students regarding this significant health issue.

Summer Recreational Water Tourism: A Deadly Human Encounter with Naegleria fowleri

This paper reports about a pathogenic free-living organism that’s affecting the quality of recreational waters in the three states. Naegleria fowleri, multiplies in fresh water during warm seasons which coincides with peak outdoor tourism activities. The deadly organism is acquired while swimming, during which it easily enters the nostrils and reaches the brain. If the recreational water supply of a destination were to be compromised, the whole tourism cycle may be at risk. Swimming in freshwater and untreated pools increases the threat. There are no established standards for controlling the occurrence of Naegleria fowleri in fresh water. The ideal method of preventing infection is by refraining from engaging in recreational activities in fresh bodies of water during summer months.

Use of Aminocaproic Acid in Combination With Extracorporeal Membrane Oxygenation in a Case of Leptospirosis Pulmonary Hemorrhage Syndrome

A 32-year-old man presented with a 10-day history of fever, chills, nausea, vomiting, myalgia, nonproductive cough, and worsening dyspnea after freshwater swimming in the Caribbean 1 week prior to presentation. Shortly after arrival at the hospital, the patient developed severe respiratory distress with massive hemoptysis. Based on serologic workup, he was diagnosed with leptospirosis pulmonary hemorrhage syndrome leading to diffuse alveolar hemorrhage, severe hypoxemic respiratory failure, and multiorgan failure. He received appropriate antibiotic coverage along with hemodynamic support with norepinephrine and vasopressin, mechanical ventilation, and renal replacement therapy in an intensive care unit. Introduction of extracorporeal membrane oxygenation was initiated to provide lung-protective ventilation supporting the recovery of his pulmonary function. Aminocaproic acid was used to stop and prevent further alveolar hemorrhage. He fully recovered thereafter; however, it is uncertain whether it was the use of aminocaproic acid that led to the resolution of his disease.

Outbreak of urogenital schistosomiasis in Corsica (France): an epidemiological case study

Schistosomiasis is a snail-borne parasitic disease endemic in several tropical and subtropical countries. However, in the summer of 2013, an unexpected outbreak of urogenital schistosomiasis occurred in Corsica, with more than 120 local people or tourists infected. We used a multidisciplinary approach to investigate the epidemiology of urogenital schistosomiasis in Corsica, aiming to elucidate the origin of the outbreak. We did parasitological and malacological surveys at nine potential sites of infection. With the snails found, we carried out snail-parasite compatibility experiments by exposing snails to schistosome larvae recovered from the urine of a locally infected Corsican patient. Genetic analysis of both mitochondrial (cox1) and nuclear (internal transcribed spacer) DNA data from the Schistosoma eggs or miracidia recovered from the infected patients was conducted to elucidate the epidemiology of this outbreak. We identified two main infection foci along the Cavu River, with many Bulinus truncatus snails found in both locations. Of the 3544 snails recovered across all sites, none were naturally infected, but laboratory-based experimental infections confirmed their compatibility with the schistosomes isolated from patients. Molecular characterisation of 73 eggs or miracidia isolated from 12 patients showed infection with Schistosoma haematobium, S haematobium-Schistosoma bovis hybrids, and S bovis. Further sequence data analysis also showed that the Corsican schistosomes were closely related to those from Senegal in west Africa. The freshwater swimming pools of the Cavu River harbour many B truncatus snails, which are capable of transmitting S haematobium-group schistosomes. Our molecular data suggest that the parasites were imported into Corsica by individuals infected in west Africa, specifically Senegal. Hybridisation between S haematobium and the cattle schistosome S bovis had a putative role in this outbreak, showing how easily and rapidly urogenital schistosomiasis can be introduced and spread into novel areas where Bulinus snails are endemic, and how hybridisation could increase the colonisation potential of schistosomes. Furthermore our results show the potential risk of schistosomiasis outbreaks in other European areas, warranting close monitoring and surveillance of all potential transmission foci. WHO, ANSES, RICET, and the Ministry of Health and Consumption.