Albrecht Wiedenmann

A randomized controlled trial assessing infectious disease risks from bathing in fresh recreational waters in relation to the concentration of Escherichia coli, intestinal enterococci, Clostridium perfringens, and somatic coliphages

We performed epidemiologic studies at public freshwater bathing sites in Germany to provide a better scientific basis for the definition of recreational water quality standards. A total of 2,196 participants were recruited from the local population and randomized into bathers and non-bathers. Bathers were exposed for 10 min and had to immerse their head at least three times. Water samples for microbiological analysis were collected at 20-min intervals. Unbiased concentration–response effects with no-observed-adverse-effect levels (NOAELs) were demonstrated for three different definitions of gastroenteritis and four fecal indicator organisms. Relative risks for bathing in waters with levels above NOAELs compared with nonbathing ranged from 1.8 (95% CI, 1.2–2.6) to 4.6 (95% CI, 2.1–10.1), depending on the definition of gastroenteritis. The effect of swallowing water provided additional evidence for true dose–response relationships. Based on the NOAELs, the following guide values for water quality are suggested: 100 Escherichia coli, 25 intestinal enterococci, 10 somatic coliphages, or 10 Clostridium perfringens per 100 mL. Recreational water quality standards are intended to protect the health of those consumers who are not already immune or resistant to pathogens that may be associated with indicator organisms. In contrast to current World Health Organization recommendations, we concluded that standards should be based on rates of compliance with NOAELs rather than on attributable risks determined above NOAELs, because these risks depend mainly on the unpredictable susceptibility of the cohorts. Although in theory there is no threshold in real concentration–response relationships, we demonstrated that a NOAEL approach would be a more robust and practical solution to the complex problem of setting standards.

PCR detection of Cryptosporidium parvum in environmental samples—a review of published protocols and current developments

Since 1991 more than 30 PCR protocols have been published, which show a potential to replace the current microscopic detection method for Cryptosporidium parvum in environmental samples and food. This review provides a synoptic comparison of these protocols with respect to the following features: isolation and purification of oocysts from tested matrices, elimination of free DNA, viability and infectivity assessment, release of nucleic acids, nucleic acid extraction, type of PCR (PCR, RT-PCR, internal-standard-PCR, in situ PCR, TaqMan-PCR), primary product detection, additional specificity control, secondary product detection, reported sensitivity, cross-reaction with other Cryptosporidium species, and target and sequence information such as amplicon length, primer sequences, multiple copy target, presence of strain-specific differences in the amplicon, GenBank accession numbers and gene function. The results demonstrate that problems like PCR inhibition, viability assessment, and the requirement of an extreme sensitivity have been solved. PCR assays would be most valuable to control presence-absence standards in defined matrix volumes, and the setup of such standards would very much contribute to a rapid introduction of this awaited technology into routine monitoring of environmental, water and food samples, and to a further standardization of the various protocols. It can be expected that satisfactory solutions for quantification will be found for a growing number of PCR-based assays. Systematic field evaluation and interlaboratory studies will complement our present knowledge of these methods in the near future.

Improved detection of Salmonella spp. in foods by fluorescent in situ hybridization with 23S rRNA probes: a comparison with conventional culture methods.

This report describes a new technique for the detection and identification of Salmonella species in food with the use of fluorescent in situ hybridization (FISH) with 23S rRNA-targeted oligonucleotide probes. Two species-specific 23S rRNA-targeted oligonucleotide probes (Sal-1 and Sal-3) were selected, and one (Sal-544) was newly designed. The relative specificities of these probes were compared with those of bacterial 23S rRNA sequences from the GenBank database and tested by in situ hybridization with bacterial cell smears of pure cultures. Fifty-one tested reference strains of Salmonella serovars belonging to subspecies I (enterica) hybridized with these probes. No cross-reactions with 46 other strains of the family Enterobacteriaceae or with another 14 bacterial strains from other families were observed. Storage of a Salmonella Panama test strain under various environmental conditions (2, 5, and 15% NaC1; -20 degrees C, 4 degrees C, and room temperature; pHs of 3.3 to 7.4) did not adversely affect the FISH method. No matrix effects were observed with 18 different kinds of foods. FISH was able to detect Salmonella spp. in 52 (probe Sal-1), 56 (probe Sal-3), and 35 (probe Sal-544) of 225 naturally contaminated food samples after 16 h of incubation in a preenrichment broth. When conventional culture and detection methods were used, Salmonella could be isolated from only 30 of these 225 samples. In contrast, FISH failed to identify Salmonella in only two of the culture-positive samples when Sal-1 and Sal-3 were used and in only three of the culture-positive samples when Sal-544 was used.

A case report of false negative Legionella test results in a chlorinated public hot water distribution system due to the lack of sodium thiosulfate in sampling bottles

We examined samples from the showers and the central water distribution system of a public building with an indoor swimming pool. The pool was used for school and recreational activities and as a sports therapy facility for patients with coronary heart disease. The buildings hot water system was contaminated with Legionella pneumophila. Due to the buildings intricate piping system, several attempts to completely eliminate legionellae by thermal and chemical disinfection had failed, so an external sanitation company was charged with the installation of a continuous chlorination device in order to keep Legionella concentrations low. The laboratory which was contracted by the sanitation company to monitor bacteria levels after installation of the chlorination device used sampling bottles without sodium thiosulfate and repeatedly reported an absence of Legionella. However, up to 69,000 colony forming particles (CFP) of Legionella pneumophila (Lp) per litre and up to 171 CFP/ml of heterotrophic bacteria could be detected when parallel samples were collected in bottles containing sodium thiosulfate at standard concentrations. Laboratories, epidemiologists, public health officials and technical staff who may be in charge of delivering, preparing or using sterile sampling devices for the collection of environmental samples to be tested for legionellae should be aware that cultures can return false negative results if the sampling containers used to collect chlorinated drinking water or chlorinated pool water samples do not contain a neutralizing agent to instantly inactivate residual halogen biocides. False negative results may lead to a false sense of security regarding the safety of water systems or the success of disinfection measures, and may thus endanger public health or even hinder the epidemiological clarification of outbreaks.

Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany.

The consequences of associated hematuria may be long-lasting, and hantavirus IgG is detectable years after acute infection.

Quantitative Detection of Cryptosporidium parvum after In Vitro Excystation by LightCycler PCR

Cryptosporidium parvum is a protozoan parasite (protist) which can infect a wide variety of vertebrates including man. It can cause a severe but usually self-limiting diarrhoea. It is transmitted by the fecal—oral route. Human infections and epidemics have been linked to the consumption of contaminated drinking water, swimming pool water, recreational water, milk, cider, and berries [1]. The infection starts with the oral uptake of infective sporulated oocysts. Inside each oocyst are four sporozoites which actively penetrate the oocyst wall when certain physiologic triggers such as temperature, changes in pH, and the presence of bile salts and pancreatic enzymes are present. This biological process can be simulated in vitro and is described as “in vitro excystation”. In vitro excystation has been widely used as a surrogate marker for viability and infectivity of Cryptosporidium parvum oocysts [2–8]. Usually the quantification of in vitro excystation is achieved by a microscopic evaluation of the excystation rate. On the other hand, various PCR protocols, including a TaqMan protocol, have been described in combination with in vitro excystation; they lack, however, a quantification of the PCR results [9–17].