WATERBORNE PATHOGENS

OF CONCERN IN
DEVELOPING COUNTRIES:

with Special Reference to Libya

Prof. Khalifa Sifaw Ghenghesh
Dept. of Medical Microbiology,
Faculty of Medicine
Tripoli - Libya
 INTRODUCTION

 Drinking water is a major source of

microbial pathogens in developing
countries.
 Waterborne disease cause more than 2
million deaths and 4 billion cases of
diarrhea annually.
 9 out of 10 deaths are in children and
virtually all of the deaths are in develop-
ing countries
WATERBORNE PATHOGENS IN
DEVELOPING COUNTRIES
 BACTERIA
Microorganism Major disease
---------------------------------------------------------------------------
Salmonella typhi Typhoid fever
S. paratyphi Paratyphoid fever
Other Salmonella Salmonellosis
Shigella spp. Bacillary dysentery
(Shigellosis)
Vibrio cholerae Cholera
Diarrheagenic E. coli Gastroenteritis
Yersinia enterocolitica Gastroenteritis
Campylobacter jejuni Gastroenteritis
Aeromonas spp. Gastroenteritis
Various mycobacteria Pulmonary illness
 ENTERIC VIRUSES
Enteroviruses
Polio viruses Poliomyelitis
Coxsackie A & B Aseptic meningitis
Other enteroviruses Encephalitis

Rotavirus Gastroenteritis

Adenoviruses Upper respiratory and

gastrointestinal illness
Hepatitis A & E viruses Infectious hepatitis

Norovirus Gastroenteritis
 PROTOZOA & HELMINTHS
Balantidium coli Balantidosis (dysentery)

Cryptosporidium parvum Cryptosporidiosis

(gastroenteritis)

Entamoeba histolytica Amoebic dysentery

Giardia lamblia Giardiasis (gastroenteritis)

Ascaris lumbricoides Ascariosis

 Causative Agents of Childhood Diarrhea in Libya
% positive
Agent Tripoli Benghazi Zliten
--------------------------------------------------------------------------------------------------
-
Single 41 35 44
Multiple 19 6 12
Rotavirus 32 24 27
Salmonella 11 7 14
Shigella 6 5 4
Enteropathogenic E. coli 11 8 ND
E. coli O157 7 ND ND
Campylobacter 6 2 ND
Yersinia enterocolitica 0.6 0 ND
Aeromonas 15 0 6
Cryptosporidium ND ND 13
Giardia lamblia ND ND 1
Entamoeba histolytica ND ND 12
 Bacteriological Quality of Drinking Water
in Libya
Type of No % positive for
Water tested E. coli Aeromonas
----------------------------------------------------------------------
Well 1000 37 49
Fasghia 56 27 73
Majin 62 ND 60
From Mosques 50 14 18
Mineral 216 0 0
Outbreaks of waterborne disease in England and Wales from
1991 to 2000

Cause Number of Number

Outbreaks of cases
----------------------------------------------------------------------------------------------------------
Public water supplies:
Cryptosporidium 23 2837
Campylobacter 1 281
Gastroenteritis 1 229
Total 25 3347

Private water supplies:

Campylobacter 8 178
Mixed Campylobacter 1 43
and Cryptosporidium
Cryptosporidium 3 74
Gastroenteritis 2 81
Giardia 1 31
E. coli O157 1 14
Total 16 421
Recreational contact with surface water
Viral gastroenteritis1 7

Swimming pool contact

Cryptosporidium 23 337
----------------------------------------------------------------------------------------------------------
Overall total 65 4112
 Outbreaks of waterborne disease in Tripoli
1992-2004

Number of Number
outbreaks of cases
--------------------------------------------------------------------------------
-
Public water supplies:
Shigella sonnei 1 >1500

Private water supplies:

Shigella flexneri 1 6
 Some Concerns Regarding Waterborne
Pathogens
 Efficacyof treatment (filtration and
chlorination) and the use of E. coli as a
fecal indicator:
 Chlorine-resistant parasitic protozoa
• Oocysts of Cryptosporidium parvum
 Various enteric viruses

 Important to match the appropriate

indicator for the group of pathogen(s)
of interest.
 Emerging Waterborne Issues

 Rapid urbanization of humans in developing

regions:
 Places further stress on inadequate water supply
and sanitation.
 Climate change:
 A change in the distribution of rainfall
• Heavy rain fall
• Flooding
 Greater extremes in global weather patterns
• Major waterborne outbreaks typically follow large storm
events in developing countries
 Evolution of new pathogens
 What We Should Do?

A combination of both monitoring of

water quality and epidemiological
surveillance.
 A comprehensive public health
surveillance strategy seems the most
efficient approach to better understand
and control the impact of water quality
on gastrointestinal disease.
 CONCLUSION

 Despite our efforts, waterborne pathogens will

always be a major issue for human health, and
particularly so in developing countries