7- PATHOLOGIE LIÉE À L'ENVIRONNEMENT

Appleton CC, Bailey IW : Canoeists and waterborne diseases in South Africa. S Afr Med J 1990 Sep 15;78(6):323-326

Department of Zoology and Entomology, University of Natal, Pietermaritzburg.

The prevalence of urinary schistosomiasis (Schistosoma haematobium) in canoeists in South Africa was estimated from examinations of urine samples taken from participants in the 1988 and 1989 Duzi Canoe Marathons on the Umsinduzi/Umgeni river in Natal. As an indicator of water quality during races, water samples were taken from the river for bacteriological analysis. Resultsshowed a very low prevalence of S. haematobium and possible reasons for this are offered. Faecal coliform levels in the river water were unacceptably high during the races.

MEDLINE - PMID: 2118684, UI: 90371390

CDC : Outbreak of Leptospirosis Among White-Water Rafters —Costa Rica, 1996.Morbidity and Mortality weekly Report;U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Health Service; June 27, 1997 / Vol. 46 / No. 25

Epidemics of pulmonary blastomycosis have rarely been reported. The following epidemic occurred in a Minnesota family and several of their acquaintances after a canoeing trip in northwestern Wisconsin. The common exposure area wasmost likely a campsite, located along the upper reaches of the Namekagon River. The Namekagon River Valley is a known endemic area of Namekagon fever (blastomycosis) in dogs. Approximately one month after returning home, five of the eight members of the group had positive direct microscopic examinations and cultures of Blastomyces dermatitidis from their sputa, as well as abnormalities on their chest roentgenograms. Among these five patients, four were symptomatic, with fever, cough, and pleuritic chest pain. Of the three others, one had pleuritic chest pain with a transient lung infiltrate, the second was asymptomatic with a transient lung infiltrate, and the third was asymptomatic with a normal chest roentgenogram. Results of acute serologic tests (complement fixation and immunodiffusion) were negative in all five patients evaluated. None of the patients received antifungal therapy. Follow-up five years after the epidemic revealed that all eight were in excellent health, and none had evidence of continuing pulmonary or extrapulmonary disease.

MEDLINE - PMID: 6488903, UI: 85026339

Il existe peu de données quantitatives sur le rapport entre la qualité de l'eau et les taux d'incidence de maladies après des activités de loisirs en eau douce. Nous avons mené une étude par cohorte prospective afin de mesurer les effets sur la santé de la pratique du canoë-kayak en eau vive et en slalom sur deux canaux présentant des degrés différents de contamination microbienne.Le site A, alimenté par un cours d'eau de plaine, a révélé de fortes concentrations d'entérovirus (moyenne arithmétique 198 pfu par 10 litres) et des concentrations modérées de coliformes fécaux (moyenne géométrique 285/dl) ; sur le site B, provenant d'une retenue d'eau sur les hauteurs, tous les échantillons étaient dépourvus d'entérovirus et la moyenne géométrique de concentration de coliformes fécaux était de 22/dl. Entre 5 et 7 jours après exposition, les canoéistes utilisant le site A présentaient des taux de symptômes gastro-intestinaux et des voies respiratoires supérieures significativement plus élevés que les canoéistes utilisant le site B ou les témoins non-exposées (spectateurs). À l'instar des baigneurs en eau de mer, les canoéistes en eau douce peuvent être rendus malades par une contamination dûe aux eaux d'égout. Le danger de l'eau douce peut être mesurée au mieux par la numération des virus plutôt que des bactéries.

Trad. légalisée en texte intégral sur le site

ISSN : 0140-6736

Four studies were carried out at separate locations to investigate the relationship between health effects and low-contact water sports and intensive microbiological sampling was conducted in parallel to the health studies at each site. The two sports examined were marathon canoeing and rowing. The extremes of water quality were at the estuarine sites on the River Torridge, where pollution levels varied from a geometric mean faecal coliform value of 62/100 ml at the App1edore/Instow site to 4613/l00 ml at the Bideford site. A comparison of "exposed" and "unexposed" groups, 5-7 days after exposure, showed that the health effects of low-contact water sports are minimal, within the water quality ranges which were studied.

Key words : Epidemiology ; health ; recreation ; standards ; water quality.

Texte intégral sur le site

Internal Medicine, Federal University of Sao Paulo, Rua Humberto I, 962 apt. 16, Sao Paulo, Sao Paulo, BRAZIL, 04018-033. cochrane.dmed@epm.br

BACKGROUND: Leptospirosis is a parasitic disease transmitted by animals. Severe leptospirosis may result in hospitalisation and about five per cent of the patients die. In clinical practice, penicillin is widely used for treating leptospirosis.

OBJECTIVES: To evaluate the effectiveness and safety of antibiotics versus placebo or other antibiotic regimens in treating leptospirosis. We addressed the following clinical questions: a) Are treatment regimens with antibiotics more efficient than placebo for leptospirosis? b) Are treatment regimens with antibiotics safe when compared to placebo for leptospirosis? c) Which antibiotic regimen is the most efficient and safest in treating leptospirosis? SEARCH STRATEGY: Electronic searches and searches of the identified articles were combined. SELECTION CRITERIA: STUDIES: Randomised clinical trials in which antibiotics were used as treatment for leptospirosis. Language, date, or other restrictions were not applied. PARTICIPANTS: Patients with clinical manifestations of leptospirosis.

INTERVENTIONS: Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen).

DATA COLLECTION AND ANALYSIS: Data and methodological quality of each trial were independently extracted and assessed by two reviewers. The random effects model was used irrespective of significant statistical heterogeneity.

MAIN RESULTS: Three trials met inclusion criteria. Allocation concealment and double blind methods were not clearly described in two. Of the patients enrolled, 75 were treated with placebo and 75 with antibiotics: 61 (81.3%) penicillin and 14 (18.6%) doxycycline. The patients assigned to antibiotics compared to placebo showed: a) Mortality: 1% (1/75) versus 4% (3/75); risk difference -2%, 95% confidence interval -8% to 4%. b) Duration of hospital stay (days): weighted mean difference 0.30, 95% confidence interval -1.26 to 1.86. c) Prolonged hospital stay (> seven days): 30% (7/23) versus 74% (14/19); risk difference -43%, 95% confidence interval -70% to -16%. Number needed-to-treat 3, 95% confidence interval 2 to 7. d) Period of disappearance of fever (days): weighted mean difference -4.04, 95% confidence interval -8.65 to 0.58. e) Leptospiruria: 5% (4/75) versus 40% (30/75); risk difference -46%, 95% confidence interval -88% to -3%. Number needed-to-treat 2, 95% confidence interval 1 to 33. REVIEWER'S CONCLUSIONS: Antibiotic regimens for treatment of leptospirosis is a form of care for which the evidence is insufficient to provide clear guidelines for practice. The randomised trials suggest that antibiotics could be a useful treatment for leptospirosis. Because of the questionable quality of two of the three trials, the indication for general use of antibiotics is uncertain. However, the evidence suggest that penicillin may cause more good than harm.

PMID: 10796767

MEDLINE - PMID: 6858958, UI: 83227989

Étude bibliographique préliminaire à un projet de combler le vide juridique concernant la qualité des eaux de loisirs nautiques. L'administration a peur du vide juridique ! (A.H.)

Department of Epidemiology, University of Bristol, UK.

Although the risks of contracting Weil's disease in the UK are small, it can be a serious illness. Recently the disease has attracted public interest. This interest has prompted confusion and anxiety among recreational water user groups such as canoeists who had not previously seen themselves as being particularly at risk. In this paper, the experience of symptoms associated with Weil's disease among canoeists, their understanding and perceptions of the disease, and their compliance with preventive advice on the British Canoe Union (BCU) warning card, have been studied. Gaps in understanding and of adherence to preventive advice were identified. Accordingly, it was concluded that health education for canoeists could be improved. Consideration is being given by the BCU to the value of preparing a canoeist instructors' training pack.

MEDLINE - PMID: 1490212, UI: 93145142

Division of Preventive Medicine and Public Health, University of Cantabria, Santander, Spain.

STUDY OBJECTIVE: To find out whether bathing in sewage polluted waters implies a danger to bathers' health and to determine the best microbiological indicator to predict the relation between bathing and the appearance of some symptoms. DESIGN: Cohort study.

SETTING: City of Santander (north of Spain). PARTICIPANTS: From the people going to four Santander beaches in the period from 1 July to 16 September 1998, a cohort of 2774 persons was recruited who agreed to participate in this study. Of those, 1858 successfully completed a follow up interview conducted in seven days. Respiratory, gastrointestinal, eye, and ear symptoms, and fever occurring during the seven day follow up were recorded. MAIN RESULTS: A total of 136 participants (7.5%) reported symptoms. Visitors reported experiencing symptoms with more frequency than residents. Incidence rates of gastrointestinal, cutaneous and high respiratory tract symptoms were higher in bathers, but the differences were not significant. Total symptoms were related with the amount of total coliforms, faecal coliforms, and faecal streptococci in the water. Gastrointestinal and skin symptoms kept a positive trend with the degree of water pollution by total coliforms in both crude and adjusted analyses. An increased risk was observed in 2500-9999 total coliforms per 100 ml, a figure over the proposed standard, although below the European Union mandatory limit.

CONCLUSIONS: The results of this study suggest that total coliforms are the best predictors of the symptoms.

PMID: 11351003 [PubMed - indexed for MEDLINE]

Laboratoire de virologie, Universite Victor Segalen Bordeaux 2, France.

Pathogenic enteric viruses can be introduced into the environment as a result of human activities. Enteroviruses are regularly detected in environmental waters or shellfish and can provoke potentially serious diseases. Some authors believe that enteroviruses could represent an interesting indicator of viral contamination in the environment. Since molecular approaches seem to be promising for the detection of these viruses, we developed a simple qualitative RT-PCR procedure for enteroviruses, together with a quantitative RT-PCR assay using RNA internal standard. After one-tube-RT-PCR, this standard and wild enterovirus RNA were detected by differential hybridization with specific probes and a fluorimetric reaction. The quantification of enteroviruses, conducted in a sewage treatment plant, showed a decreasing number of genomic copies from the entrance to the exit (from 3.8 x 10(5) to 5.4 x 10(4) RNA copies/mL) but indicated the presence of enterovirus RNA in the neighboring river (2.2 x 10(3) RNA copies/mL). In bathing areas, enterovirus RNA was detected in 16 out of 226 samples, with copies numbers ranging from 3.7 x 10(2) RNA copies/mL to 7 x 10(4) RNA copies/mL.

PMID: 11316372 [PubMed - in process]

Regional Medical Research Centre (Indian Council of Medical Research), Port Blair, Andaman and Nicobar Islands.

Leptospirosis occurs as seasonal outbreaks, lasting for about 3 weeks during October-November in North Andaman. A randomized controlled trial was undertaken to assess the efficacy of doxycycline prophylaxis in the prevention of infection and clinical disease due to leptospires during the outbreak period. A sample population of 782 persons, randomized into two groups was given doxycycline 200 mg/week and a placebo. The microscopic agglutination test was done on blood samples collected on day zero, after 6 weeks and after 12 weeks. Infection rates and attack rates of clinical illness were calculated in the two groups based on the serological results. Statistically there was no difference in the infection rates among the two groups. However, a statistically significant difference was observed in the clinical disease attack rates (3.11 vs. 6.82%) between study group and control group. The results of the study indicate that doxycycline prophylaxis does not prevent leptospiral infection in an endemic area, but has a significant protective effect in reducing the morbidity and mortality during outbreaks.

Publication Types : Clinical trial, Randomized controlled trial

PMID: 10755239, UI: 20216015

Family Practice Department, Ozarks Medical Center, West Plains, MO.

Leptospirosis is a common zoonosis present throughout Missouri. Previously regarded as an occupational illness of farmers and sewer workers, it is now primarily acquired from exposure to water polluted with the bacteria Leptospira. We present a case report of leptospirosis acquired through kayaking and review both the disease and the risk factor associated with kayaking.

MEDLINE - PMID: 1620089, UI: 92318881

Department of Anesthesiology, Box SL-4, Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA 70112-2632

desmith@tmc.tulane.edu

To evaluate cardiac chamber size and ejection fraction during head-out immersion of patients in the semisitting position in neutral temperature water bath, 12 volunteers were studied using transthoracic echocardiography (TTE). In this open, controlled, prospective clinical study, left ventricular end-systolic, end-diastolic volumes, and ejection fraction were measured in 12 adult awake healthy volunteers using TTE with the patient in a semisitting position pre-, during, and postimmersion in the Dornier extracorporeal shock wave lithotriptor water bath at 35 degrees C. Left ventricular end-diastolic volume significantly increased from an average of 96.0 +/- 10.8 to 130 +/- 19 cm(3), P < 0.0001 and left ventricular end-systolic volume increased from an average 38.9 +/- 6.9 to 45.2 +/- 8.0 cm(3), P < 0.01. Left ventricular ejection fraction increased significantly from control to water immersion from 0.59 +/- 0.1% to 0.65 +/- 0.1% (P < 0.001). The results of this study demonstrate that water immersion in normal healthy volunteers significantly increases both left ventricular diastolic and systolic volume, and that there is a significant increase in left ventricular ejection fraction after water immersion, (e.g., bathing, lithotripsy). While this increased cardiac filling is well-tolerated in most patients, it may not be well-tolerated in some patients who have limited cardiac reserve, including patients with heart failure.

PMID: 11175008 [PubMed - as supplied by publisher]

Un travail expérimental démontrant que la dégradation de la nage survient avant l'hypothermie dans le processus de la noyade en eau froide. Avec pour conséquence de privilégier une réanimation de la noyade plus que de l'hypothermie et d'adapter la portance des gilets de sauvetage (A.H.).

 Les directives concernant la qualité des eaux de baignade ne sont pas applicables au canoë-kayak (A.H.).