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What’s wading in the water?

VCU Health disease specialists give tips on dodging disease and infections during summer water activities.

What’s summer without water sports and wet suits? However, as the official start of summer approaches and outdoor recreation abounds, VCU Health physicians are encouraging swimmers of all ages to be mindful of what wades in the water.

Both fresh water and pool water, though a fun summer staple, can harbor bacteria that cause serious illness. Outbreaks of a parasitic diarrhea-causing infection, cryptosporidium, which is linked to pools and water playgrounds, doubled in the United States from 2014-2016, according to the Centers for Disease Control. Known as crypto, it spreads though contact with the feces of an infected person.

Water playgrounds can be a breeding ground for such outbreaks because chlorine is not 100 percent effective in killing pathogens or bacteria, said Gonzalo Bearman, M.D., chair of the Division of Infectious Diseases at Virginia Commonwealth University School of Medicine and hospital epidemiologist at VCU Medical Center. He and Francine Cabral, Ph.D., a professor in the Department of Microbiology and Immunology, offered tips on having safe summer swimming experiences in a recent interview with VCU News.

 

What can swimmers do to protect themselves from recreational water illnesses and infections?

Francine Cabral, Ph.D.
Francine Cabral, Ph.D.

GB: People should swim in chlorinated water, preferably. If you have open sores and cuts avoid fresh water.

FC: Make sure that pools are properly maintained and chlorinated. Small inflatable pools that small children play in should be drained and allowed to dry out after every use. Salt water does not allow the growth or survival of amoebae. It’s best to swim in salt water pools or the ocean.

What should a person do if they feel they've been injured or infected after water related activities?

GB: Visit an emergency department or an urgent care center. If you suffer a puncture injury in fresh water, get out and wash with soap and water.

Are there any particular symptoms that indicate infection?

GB: Nausea, vomiting, fever, severe headache, diarrhea or a red, tender rash are all potentially concerning.

What are some general precautions swimmers should take when utilizing fresh water areas?

Gonzalo Bearman, M.D.
Gonzalo Bearman, M.D.

FC: For lakes and ponds, do not stir up the bottom as amoebae are on the bottom. Naegleria fowleri amoebae are organisms present in freshwater lakes, ponds and improperly chlorinated swimming pools. Naegleria fowleri causes a rapidly fatal disease of the central nervous system called Primary Amoebic Meningoencephalitis. The amoeba thrive on bacteria and divide rapidly as bacteria are their food source. Also, do not swim in areas that appear contaminated with bacteria and show cloudy water. In very hot weather, it is best to keep the head above water. Total submersion in warm water can incur infection, because Naegleria, a microscopic amoeba that can cause severe infection of the brain, enters humans through the nose. Try to prevent water from entering the nose. Nose clips are helpful, but don’t guarantee full protection. As an aside, never use tap water for nasal irrigation without boiling it. Use salt solutions or boil water if using Neti Pots.

What circumstances pose immediate danger when utilizing fresh water areas?

FC: Swimming in a lake with water associated with cooling towers from factories is dangerous. Cooling water discharge points are very warm and allow amoebae and bacteria to grow and divide. Hot springs are also places to avoid. Amoebae can also enter into the distribution systems (tap water). Lastly, pools surrounded by dirt and grass are not as safe as those surrounded by cement, because Naegleria can be in the soil.

What diseases, infections are swimmers susceptible to when utilizing fresh water areas?

FC: Pathogenic bacteria such as Legionella, Pseudomonas, E. coli, Shigella, and pathogenic protozoa such as Cryptosporidium, Giardia, and Naegleria fowleri can be found in water.

 

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