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Abstract: The world-wide deployment of cruise liners and naval units has caused an increased need for the disinfection of drinking water. The main cause for this is the unknown quality of drinking water in foreign harbours – besides the formation of bio-films due to the climatically disadvantageous conditions in the operational area. Water conduits on board are currently disinfected with calcium hypochlorite in case of microbiological contamination. Chemical and physical analyses after disinfection with calcium hypochlorite have shown that organic by-products consisting of trihalomethanes develop in considerable amounts during disinfection. Furthermore, the method is susceptible to handling errors and thus often leads to insufficient disinfection results. Hitherto, the use of other disinfection methods allowed by government regulations, especially chlorine dioxide, is not widely spread. Unlike disinfection with calcium hypochlorite, chlorine dioxide does not lead to the formation of trihalomethanes. Typical disinfection by-products (DBP) are the anions chlorite and chlorate, which are formed in oxidative processes. The formation conditions of these anions have not yet been elucidated. For this reason, the probability of the generation of inorganic by-products after disinfection with chlorine dioxide has been determined, and their occurrence in drinking water on board has been examined with respect to a possible correlation between water quality and the formation of chlorate and chlorite. Therefore, a chromatographic method was developed and validated in order to determine the periodical development of chlorate and chlorite from chorine dioxide in purified water at different pH-values as well as in actual drinking water samples from water conduits on board. The formation of the by-products chlorite and chlorate after disinfection with chlorine dioxide is influenced neither by pH-value nor by chemical properties of the disinfected water. Considering the examined conditions, chlorine dioxide is suitable for usage on board due to its simple handling and the low potential of producing by-products. [Copyright &y& Elsevier]

Abstract: Childhood hypersensitivity pneumonitis (HP) is often associated with exposure to antigens in the home environment. We describe a case of HP associated with indoor hydroponics in a 14-year-old girl. Water samples from hydroponics revealed Aureobasidium pullulans as the dominant fungal micro-organism (104 CFU/ml). The diagnosis is supported by the existence of serum precipitating antibodies against A. pullulans, lymphocytic alveolitis on bronchoalveolar lavage (BAL) fluid, a corresponding reaction on a lung biopsy, and the sustained absence of clinical symptoms following the removal of hydroponics from the home. We conclude that hydroponics should be considered as potential sources of fungal contaminants when checking for indoor health complaints. [Copyright &y& Elsevier]

Due to the promising results of a previous study of the performance of the novel MPN method (Legiolert™/Quanti-Tray®) compared to ISO 11731-2, this study was performed to compare Legiolert for Legionella pneumophila with the German regulatory requirements methods ISO 11731-2 (100 ml membrane filtration) and ISO 11731 (1 ml direct plating) for the enumeration of L. pneumophila and Legionella spp. from potable water. Data from a multi-laboratory study according to ISO 17994 showed that Legiolert yielded on average higher counts of L. pneumophila than the ISO 11731-2 method, but the comparison with ISO 11731 was inconclusive due to the number of samples needing to be tested. Likewise, comparisons of the MPN method for 100 ml to the highest result of either ISO 11731 or ISO 11731-2 according to Federal Environmental Agency recommendation (2012) yielded no conclusive difference, regardless of whether non-pneumophila species of Legionella were included in the evaluation. The MPN method has a high specificity for L. pneumophila of 97.9% which compares favourably to the specificity of 95.3% quoted for ISO 11731. The new method represents a significant improvement in the enumeration of L. pneumophila from drinking water and related samples. [ABSTRACT FROM AUTHOR]

Between 1 August and 6 September 2013, an outbreak of Legionnaires' disease (LD) with 78 cases confirmed by positive urinary antigen tests occurred in Warstein, North Rhine-Westphalia, Germany. Legionella (L.) pneumophila, serogroup (Sg) 1, monoclonal antibody (mAb) subgroup Knoxville, sequence type (ST) 345, was identified as the epidemic strain. This strain was isolated from seven patients. To detect the source of the infection, epidemiological typing of clinical and environmental strains was performed in two consecutive steps. First, strains were typed by monoclonal antibodies. Indistinguishable strains were further subtyped by sequence-based typing (SBT) which is the internationally recognized standard method for epidemiological genotyping of L. pneumophila. In an early stage of the outbreak investigation, many environmental isolates were found to belong to the mAb subgroup Knoxville, but to two different STs, namely to ST 345, the epidemic strain, and to ST 600. A majority of environmental isolates belonged to ST 600 whereas the epidemic ST 345 strain was less common in environmental samples. To rapidly distinguish both Knoxville strains, we applied a novel typing method based on DNA-hybridization on glass chips. The new assay can easily and rapidly discriminate L. pneumophila Sg 1 strains. Thus, we were able to quickly identify the sources harboring the epidemic strain, i.e., two cooling towers of different companies, the waste water treatment plants (WWTP) of the city and one company as well as water samples of the river Wester and its branches. [ABSTRACT FROM AUTHOR]

Case report of a very serious drinking water incident putting up to 50,000 inhabitants of a town near Bonn in North Rhine-Westphalia, Germany at risk. A concentrated solution of highly alkaline water by sodium hydroxide was accidentally washed into the town's drinking water at a pumping station and increased the pH-value of the water to 12. Residents who came into contact with the contaminated water immediately had a toxic reaction. The incident was detected by complaints from customers and after that was stopped within several hours. The pipes were flushed and the customers were warned not to use the water till the all clear. After this immediate management there was an investigation and the cause of the incident was detected as an accidental release of accumulated sodium hydroxide (NaOH) solution. The lack of a network alarm system and the automatic cut-off mechanisms as deficiencies in the design of the station were rectified by the water company immediately after the incident. [ABSTRACT FROM AUTHOR]

Abstract: In Germany, protozoal parasites are detected frequently in surface waters. This study aims to assess the parasitological pollution in a river course and two of its tributaries under regular weather conditions. Cryptosporidium was detected in 67% of all samples. The median concentration was 4oocysts/100l. Giardia lamblia were detected in 90% of the samples. The median concentration of G. lamblia was 22 cysts/100l and increased significantly following the river course. A statistically significant correlation was found between both parasites and the faecal indicators Clostridium perfringens and Escherichia coli. The intermittent occurrence of Cryptosporidium in the streams investigated was ascribed primarily to diffuse pollution, particularly during rainfall events. The relatively frequent detection of G. lamblia derived mainly from sewage treatment plants. The pathogen concentrations observed present a relevant public health risk as the river is used for recreational activities and agricultural purposes. [Copyright &y& Elsevier]

Abstract: Numerous investigations have demonstrated efficiencies of different disinfection methods, but until now only little is known about long-term effects on community compositions of drinking water biofilms. Changes in the community structure, especially regrowth of hygienically relevant microorganisms could be critical for the drinking water quality. In this study the long-term effect of disinfection methods on biofilm communities in drinking water systems was analysed. Old drinking water biofilms grown in silicone tubes were exposed to different preparations of disinfectants (free chlorine, chlorine dioxide, hydrogen peroxide combined with fruit acid, silver and silver with peracetic acid, respectively) and subsequently further exposed in the original drinking water. The comparison of the treated and regrown biofilm populations with untreated ones by the DNA-fingerprinting method denaturing gradient gel electrophoresis (DGGE) revealed a considerable population shift caused by the disinfectants. The disinfection methods induced a selection pressure on the biofilm populations depending on the composition and concentrations. The similarities between the treated and untreated biofilms were generally low. Compared to preparations with peracetic acid the disinfection with hydrogen peroxide and silver resulted in higher similarities of the treated and untreated biofilms, but the microbial diversity increased. It can be concluded that the disinfectants have a major impact on the drinking water biofilm communities and that possibly the intervention selects persisters and microorganisms, which can live on the residuals of the dead biofilm cells. For the evaluation of the efficiency of disinfection methods in drinking water installations it is necessary not only to consider reduction of certain bacteria but also to pay attention to the biofilm community. [Copyright &y& Elsevier]

Abstract: The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality. The clinical observation of two or more temporally related cases of nosocomial S. marcescens infection should raise the suspicion of an outbreak, particularly in the NICU or PICU setting. Since colonized or infected patients represent the most important reservoir for cross transmission, hygienic barrier precautions (contact isolation/cohortation, the use of gloves and gowns in addition to strictly performed hand disinfection, enhanced environmental disinfection) should immediately be implemented and staff education given. Well-planned sampling of potential environmental sources should only be performed when these supervised barrier precautions do not result in containment of the outbreak. The current strategy of empiric antibiotic treatment should be reevaluated by a medical microbiologist or an infectious disease specialist. Empiric treatment of colonized children should use combination therapy informed by in vitro susceptibility data; in this context the high propensity of S. marcescens to cause meningitis and intracerebral abscess formation should be considered. In vitro susceptibility patterns do not reliably prove or exclude the clonality of the outbreak isolate. Genotyping of the isolates by pulse-field gel electrophoresis or PCR-based methods should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results. [Copyright &y& Elsevier]

Abstract: Constructed wetlands have been promoted in recent literature for use in rural communities in developed as well as in developing countries as an appropriate technology to be handled with low operational maintenance costs. Within a joint project supported by BMBF (Project No O2WA0107 and No 02WA0108) research was done concerning the sanitation effect of constructed wetlands on wastewater effluents. This article will focus on the detection and the removal of cysts of Cryptosporidium parvum and Giarda lamblia, those being the most frequently identified pathogenic protozoan parasites worldwide with increasing medical and economical consequences. Two plants, one installed in 2000 as a pilot plant at Langenreichenbach near Leipzig (Saxony, Germany), the other one in routine operation since 1993 in a training center at the town of Belzig (Brandenburg, Germany) were tested for three years. Detection methods from the US EPA (ICR Protozoan Method for Detecting Giardia Cysts and Cryptosporidium Oocysts in Water by a Fluorescent Antibody Procedure (EPA/814-B-95-003;) were employed in order to assess protozoal and bacterial reduction in the wastewater passing through different combinations of filter beds and fillings. Removal of cysts of Cryptosporidium and Giardia spp. turned out to be a 2log reduction in all plants. The most effective structural element was a two-stage combination of filter beds leading to the highest removal efficiency both for the protozoan and the bacterial indicator organisms. Also, washed sand (0-2mm grain size) in the filter bed proved to be most effective filter material; the planted reed (phragmites spp.) or willow (salix spp.), however, turned out to be of minor importance for the filtering activity. [Copyright &y& Elsevier]

Abstract: In this matched cohort study, clinical data from 43 paediatric cancer patients with bloodstream infection (BSI) were compared with 43 thoroughly matched control patients without BSI. BSI led to a median additional length of inpatient treatment of 12 days (IQR 8.5–16 days; P<0.001), accounting for median additional expenses of €4400 (IQR, €3145–5920) per case [6.970 US Dollar (IQR 4.938–9.294)]. Thus, BSI substantially increased financial resources required for inpatient treatment. These data compiled from a paediatric cancer unit may be utilized to estimate the cost–benefit ratio of targeted preventive measures. [Copyright &y& Elsevier]

Abstract: Different land use patterns were investigated for their potential as non-point sources of coliphage emissions into surface waters. Water samples were taken regularly at five locations in the upper reaches of the river Swist, Germany. Samples of surface and subsurface run-off were taken within the same catchment area after rainfall events using a newly developed device that made it possible to collect current concentrations of the effluent compounds. The water quality was examined for the occurrence of somatic coliphages and F+-specific RNA-bacteriophages as well as for various bacteria over the period of a hydrological year. The potential of various bacteria as indicators for the occurrence of phages was evaluated using statistical correlations. The load of coliphages varied depending on the land use type, but it did not differ as much as the bacterial parameters. River sections in intensively used areas turned out to be more contaminated than in less intensively used regions. The concentrations of phages from surface and subsurface run-off in most samples were quite low for all land use types and did not show conspicuous variations of surface and subsurface run-off within one land use type. Therefore, high concentrations of phages in river water cannot be explained only by non-point effluent from open ground. Following consideration of the statistical results, conventional indicator bacteria seem not to be reliable indicator organisms for coliphages and subsequently for human pathogen viruses. The detected concentrations of coliphages in several water samples of river sections surrounded by intensively used areas underpin an existing health risk in the use of river water for e.g. recreational activities or irrigation. [Copyright &y& Elsevier]

Abstract: Six sewage treatment plants (STP) were investigated over a 12-month period in order to measure the microbiological load of untreated municipal wastewater and to evaluate the removal efficiencies of different treatment systems. The STP investigated can be classified into three categories: bigger plants with tertiary treatment, smaller plants with enhanced secondary treatment, and very small compact facilities. The plants studied had a considerable quantitative impact on the hydrology of the catchment area; consequently, it was anticipated that the microbiological load of the effluent would also be significant. Eighty samples were taken from the influent and effluent of the STP, regardless of weather conditions, and several bacterial and two parasitological parameters were analysed. The average microbiological reduction of each STP was dependent on its capacity and treatment procedures and varied between 1.9 and 3.5log10. Small compact facilities had a significantly lower removal efficiency (2.0±1log10) and discharged treated wastewater with a poorer microbiological quality compared to larger plants with tertiary treatment or with enhanced secondary treatment (⩾2.8log10). Final sand filtration and extensive intermediate settling considerably improved the overall microbiological removal efficiency. During the study period, the microbiological water quality of the receiving water course was not significantly impaired by the discharge of any of the investigated plants; however, the compact facilities showed critical treatment deficiencies. In particular, the reduction of Giardia cysts was insufficient (<1.5log10) compared to that of the bigger plants (>3.0log10). In order to quantify the overall impact of microbiological loads on the receiving watercourse in this catchment area, it is also necessary to assess the pollution from combined sewer overflow basins and diffuse pollution. This will be considered in subsequent studies. [Copyright &y& Elsevier]

Abstract: Background: Nosocomially acquired respiratory syncytial virus infections (RSV-NI) may cause serious problems in hospitalized paediatric patients. Hitherto, prospectively collected representative data on RSV-NI from multicenter studies in Germany are limited. Methods: The DMS RSV Ped database was designed for the prospective multicenter documentation and analysis of clinically relevant aspects of the management of inpatients with RSV-infection. The study covered six consecutive seasons (1999–2005); the surveillance took place in 14 paediatric hospitals in Germany. Results: Of the 1568 prospectively documented RSV-infections, 6% (n=90) were NI and 94% (n=1478) were community acquired (CA). A significantly higher proportion in the NI group displayed additional risk factors like prematurity, chronic lung disease, mechanical ventilation (med. history), congenital heart disease, and neuromuscular impairment. Of all NI, 55% occurred in preterms (30.6% of all RSV-infections in preterms with severe chronic lung disease of prematurity were NI). Illness severity as well as the total mortality, but not the attributable mortality was significantly higher in the NI group. In the multivariate analysis, NI was significantly associated with the combined outcome ‘complicated course of disease’. Conclusion: This is the first prospective multicenter study from Germany, which confirms the increased risk of a severe clinical course in nosocomially acquired RSV-infection. Of great concern is the high rate of (preventable) NI in preterms, in particular in those with severe chronic lung disease or with mechanical ventilation due to other reasons. [Copyright &y& Elsevier]

Abstract: A case of hospital-acquired legionellosis occurred in a 75-year-old male patient who underwent surgery due to malignant melanoma. Legionellosis was proven by culture of Legionella pneumophila serogroup 1 from bronchoalveolar lavage (BAL) fluid. Being a chronic smoker the patient used to visit the sickroom balcony that was located about 90m to the west of a hospital cooling tower. Routine cooling tower water samples drawn during the presumed incubation period revealed 1.0×104 CFU/100ml (L. pneumophila serogroup 1). One of three isolates from the cooling tower water matched the patient''s isolate by monoclonal antibody (mab)- and genotyping (sequence-based typing). Horizontal transport of cooling tower aerosols probably was favoured by meteorological conditions with thermal inversion. The case report stresses the importance of routine maintenance and microbiological control of hospital cooling towers. [Copyright &y& Elsevier]

Abstract: The purpose of our field study was to compare the performance of two portable bioaerosol samplers (Sartorius MD8 airport, and Merck MAS-100) for sampling Aspergillus fumigatus and other airborne thermotolerant fungi. From October 2001 to November 2001, a total of 336 samples were analyzed at 12 sampling days. During the sampling period fungal plate counts ranged from <1 to 300CFU/m3 for total thermotolerant fungi and from <1 to 76CFU/m3 for A. fumigatus. As compared to the MD8, the relative recovery of the MAS 100 was 0.96 for total thermotolerant fungi and 0.84 for A. fumigatus. We found a good correlation (Pearson''s r=0.94 for single, 0.95 for the mean of two, and 0.96 for the mean of three sequential samples) between both portable bioaerosol samplers. The spectrum of thermotolerat fungal genera and Aspergillus species showed only minor differences. We conclude that under the given conditions the results of both samplers are approximately comparable. [Copyright &y& Elsevier]

Abstract: Background: Nosocomially acquired respiratory syncytial virus (RSV) infections cause serious problems in hospitalized patients. An increased effort should be made to describe the problems connected with such infections in pediatric hospitals, with the aim of reducing the occurrence of nosocomial RSV infections (NI). Methods: A specialized database was introduced for surveillance and a multifaceted barrier concept based on the CDC recommendations was developed for the control of NI in a university children''s hospital in Germany. Results: Between 1999 and 2002 (November 1–April 30), 283 RSV infections (general population) were prospectively documented. Thirty-nine cases (13.8%) were nosocomial infections (NI) with an incidence density (ID) of 0.99/1000 patient days; 48.7% of all NI were found in prematurely born infants. Following the introduction of a surveillance and prevention policy, a 9-fold decrease of the ID (1.67 vs. 0.18/1000 patient-days) was found when comparing the first and the last season. Intensive care treatment was required in 18% of all documented RSV-infections, in 48.7% of all NI cases and in 43.5% of all RSV-infected prematurely born infants. Overall RSV-related mortality was 0.71%. Conclusions: Early diagnosis, a strict cohorting and contact isolation policy, and prospective surveillance contribute to the reduction of nosocomial RSV infection. [Copyright &y& Elsevier]