Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Infectious Disease Reports
Published in: Current Infectious Disease Reports 7/2018

01-07-2018 | Tropical, Travel and Emerging Infections (L Chen and A Boggild, Section Editors)

Illnesses Associated with Freshwater Recreation During International Travel

Authors: Daniel L. Bourque, Joseph M. Vinetz

Published in: Current Infectious Disease Reports | Issue 7/2018

Login to get access

Abstract

Purpose of Review

International travel, adventure travel, and eco-tourism are increasing over the past few decades. This review aims to summarize the spectrum of infections associated with recreational freshwater activities and international travel.

Recent Findings

Recreational water activities can be associated with a wide range of infections. Acute febrile illnesses due to leptospirosis and schistosomiasis are not uncommon in travelers following extensive freshwater exposure. Aeromonas and other water-associated pathogens are important to consider in a traveler presenting with a skin and soft tissue infection. Recreational water activities are often associated with diarrheal illnesses, especially in children, and the range of enteric pathogens includes bacterial pathogens such as Escherichia coli O157:H7 and Shigella species and the protozoan parasites Cryptosporidium and Giardia duodenalis. Infections due to free-living amebas though rare can lead to fulminant central nervous system infections.

Summary

A diverse range of infections may be associated with freshwater exposure, and it is important that these entities are considered in a returning traveler presenting with an acute illness.
Literature
1.
Haake DA, Dundoo M, Cader R, Kubak BM, Hartskeerl RA, Sejvar JJ, et al. Leptospirosis, water sports, and chemoprophylaxis. Clin Infect Dis. 2002;34:e40–3.CrossRefPubMedPubMedCentral
2.
Bharti AR, Nally JE, Ricaldi JN, Matthias MA, Diaz MM, Lovett MA, et al. Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis. 2003;3:757–71.CrossRefPubMed
3.
Corwin A, Ryan A, Bloys W, Thomas R, Deniega B, Watts D. A waterborne outbreak of leptospirosis among United States military personnel in Okinawa, Japan. Int J Epidemiol. 1990;19:743–8.CrossRefPubMed
4.
Cacciapuoti B, Ciceroni L, Maffei C, Di Stanislao F, Strusi P, Calegari L, et al. A waterborne outbreak of leptospirosis. Am J Epidemiol. 1987;126:535–45.CrossRefPubMed
5.
Centers for Disease C, Prevention. Outbreak of leptospirosis among white-water rafters—Costa Rica, 1996. MMWR Morb Mortal Wkly Rep. 1997;46:577–9.
6.
Sejvar J, Bancroft E, Winthrop K, Bettinger J, Bajani M, Bragg S, et al. Leptospirosis in “Eco-Challenge” athletes, Malaysian Borneo, 2000. Emerg Infect Dis. 2003;9:702–7.CrossRefPubMedPubMedCentral
7.
Hochedez P, Escher M, Decoussy H, Pasgrimaud L, Martinez R, Rosine J, et al. Outbreak of leptospirosis among canyoning participants, Martinique, 2011. Euro Surveill. 2013;18:20472.PubMed
8.
Clerinx J, Van Gompel A. Schistosomiasis in travellers and migrants. Travel Med Infect Dis. 2011;9:6–24.CrossRefPubMed
9.
10.
11.
•• Lingscheid T, Kurth F, Clerinx J, Marocco S, Trevino B, Schunk M, et al. Schistosomiasis in European travelers and migrants: analysis of 14 years TropNet surveillance data. Am J Trop Med Hyg. 2017;97:567–74. An important study describing the characteristics of 1465 cases of imported schistosomiasis in European travelers. CrossRefPubMedPubMedCentral
12.
Cetron MS, Chitsulo L, Sullivan JJ, Pilcher J, Wilson M, Noh J, et al. Schistosomiasis in Lake Malawi. Lancet. 1996;348:1274–8.CrossRefPubMed
13.
Lachish T, Tandlich M, Grossman T, Schwartz E. High rate of schistosomiasis in travelers after a brief exposure to the high-altitude Nyinambuga crater lake, Uganda. Clin Infect Dis. 2013;57:1461–4.CrossRefPubMed
14.
Ross AG, Vickers D, Olds GR, Shah SM, McManus DP. Katayama syndrome. Lancet Infect Dis. 2007;7:218–24.CrossRefPubMed
15.
16.
Visser LG, Polderman AM, Stuiver PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis. 1995;20:280–5.CrossRefPubMed
17.
Gray DM 2nd, Nakashima M, Davidson NO. Education and imaging. Gastrointestinal: schistosomiasis-diagnosis by colonoscopy. J Gastroenterol Hepatol. 2013;28:763.CrossRefPubMedPubMedCentral
18.
19.
Szekeres C, Galletout P, Jaureguiberry S, Crickx E, Monsel G, Chabriat H, et al. Neurological presentation of schistosomiasis. Lancet. 2013;381:1788.CrossRefPubMed
20.
Houdon L, Flodrops H, Rocaboy M, Bintner M, Feriot JP, Tournebize P, et al. Two patients with imported acute neuroschistosomiasis due to Schistosoma mansoni. J Travel Med. 2010;17:274–7.CrossRefPubMed
21.
Anita S, Amir KM, Fadzilah K, Ahamad J, Noorhaida U, Marina K, et al. Risk factors for typhoid outbreak in Sungai Congkak Recreational Park, Selangor 2009. Med J Malaysia. 2012;67:12–6.PubMed
22.
Pham Thanh D, Thompson CN, Rabaa MA, Sona S, Sopheary S, Kumar V, et al. The molecular and spatial epidemiology of typhoid fever in rural Cambodia. PLoS Negl Trop Dis. 2016;10:e0004785.CrossRefPubMedPubMedCentral
23.
Mahoney FJ, Farley TA, Kelso KY, Wilson SA, Horan JM, McFarland LM. An outbreak of hepatitis A associated with swimming in a public pool. J Infect Dis. 1992;165:613–8.CrossRefPubMed
24.
Garin D, Fuchs F, Crance JM, Rouby Y, Chapalain JC, Lamarque D, et al. Exposure to enteroviruses and hepatitis A virus among divers in environmental waters in France, first biological and serological survey of a controlled cohort. Epidemiol Infect. 1994;113:541–9.CrossRefPubMedPubMedCentral
25.
Bryan JA, Lehmann JD, Setiady IF, Hatch MH. An outbreak of hepatitis-A associated with recreational lake water. Am J Epidemiol. 1974;99:145–54.CrossRefPubMed
26.
Currie BJ, Dance DA, Cheng AC. The global distribution of Burkholderia pseudomallei and melioidosis: an update. Trans R Soc Trop Med Hyg. 2008;102(Suppl 1):S1–4.CrossRefPubMed
27.
28.
Saidani N, Griffiths K, Million M, Gautret P, Dubourg G, Parola P, et al. Melioidosis as a travel-associated infection: case report and review of the literature. Travel Med Infect Dis. 2015;13:367–81.CrossRefPubMed
29.
• Hagmann SH, Han PV, Stauffer WM, Miller AO, Connor BA, Hale DC, et al. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel. Fam Pract. 2014;31:678–87. An important study describing the range of illness in returning US international travelers over a 13-year period. CrossRefPubMedPubMedCentral
30.
Vally H, Whittle A, Cameron S, Dowse GK, Watson T. Outbreak of Aeromonas hydrophila wound infections associated with mud football. Clin Infect Dis. 2004;38:1084–9.CrossRefPubMed
31.
Kimbrough RC, Winn RE, Jeter RM, Warren WJ, Huddleston JR, Zak JC. Aeromonas infection from river and playa lake waters in West Texas and southeastern New Mexico. Southwest Respir Crit Care Chron. 2016;4:19–25.CrossRef
32.
Hanson PG, Standridge J, Jarrett F, Maki DG. Freshwater wound infection due to Aeromonas hydrophila. JAMA. 1977;238:1053–4.CrossRefPubMed
33.
Gold WL, Salit IE. Aeromonas hydrophila infections of skin and soft tissue: report of 11 cases and review. Clin Infect Dis. 1993;16:69–74.CrossRefPubMed
34.
35.
Hiransuthikul N, Tantisiriwat W, Lertutsahakul K, Vibhagool A, Boonma P. Skin and soft-tissue infections among tsunami survivors in southern Thailand. Clin Infect Dis. 2005;41:e93–6.CrossRefPubMed
36.
Tsai YH, Hsu RW, Huang TJ, Hsu WH, Huang KC, Li YY, et al. Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species. J Bone Joint Surg Am. 2007;89:631–6.CrossRefPubMed
37.
Slaven EM, Lopez FA, Hart SM, Sanders CV. Myonecrosis caused by Edwardsiella tarda: a case report and case series of extraintestinal E. tarda infections. Clin Infect Dis. 2001;32:1430–3.CrossRefPubMed
38.
39.
Herve V, Bigaillon C, Duhamel P, Petit MP, Soler C. Cutaneous abscess due to Plesiomonas shigelloides consecutive to a trauma in fresh water. Med Mal Infect. 2007;37:840.CrossRefPubMed
40.
Harth M, Ralph ED, Faraawi R. Septic arthritis due to Mycobacterium marinum. J Rheumatol. 1994;21:957–60.PubMed
41.
Iredell J, Whitby M, Blacklock Z. Mycobacterium marinum infection: epidemiology and presentation in Queensland 1971–1990. Med J Aust. 1992;157:596–8.PubMed
42.
Tsai HC, Kunin CM, Lee SS, Chen YS, Wann SR, Liu YW, et al. Fish gambler’s tenosynovitis caused by Mycobacterium marinum: environmental investigation of a fishing pond in Southern Taiwan. Diagn Microbiol Infect Dis. 2007;59:227–30.CrossRefPubMed
43.
Tebruegge M, Connell T, Ritz N, Orchard D, Curtis N. Mycobacterium marinum infection following kayaking injury. Int J Infect Dis. 2010;14(Suppl 3):e305–6.CrossRefPubMed
44.
WHO UNICEF. Progress on sanitation and drinking water: 2015 update and MDG assessment. New York: UNICEF and WHO, UNICEF; 2015.
45.
Soller JA, Bartrand T, Ashbolt NJ, Ravenscroft J, Wade TJ. Estimating the primary etiologic agents in recreational freshwaters impacted by human sources of faecal contamination. Water Res. 2010;44:4736–47.CrossRefPubMed
46.
Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: transmission, detection and identification. Int J Parasitol. 2000;30:1305–22.CrossRefPubMed
47.
Kramer MH, Sorhage FE, Goldstein ST, Dalley E, Wahlquist SP, Herwaldt BL. First reported outbreak in the United States of cryptosporidiosis associated with a recreational lake. Clin Infect Dis. 1998;26:27–33.CrossRefPubMed
48.
Huang DB, White AC. An updated review on Cryptosporidium and Giardia. Gastroenterol Clin N Am. 2006;35:291–314. viiiCrossRef
49.
Nash TE, Herrington DA, Losonsky GA, Levine MM. Experimental human infections with Giardia lamblia. J Infect Dis. 1987;156:974–84.CrossRefPubMed
50.
Stuart JM, Orr HJ, Warburton FG, Jeyakanth S, Pugh C, Morris I, et al. Risk factors for sporadic giardiasis: a case-control study in southwestern England. Emerg Infect Dis. 2003;9:229–33.CrossRefPubMed
51.
52.
Wang G, Doyle MP. Survival of enterohemorrhagic Escherichia coli O157:H7 in water. J Food Prot. 1998;61:662–7.CrossRefPubMed
53.
Keene WE, McAnulty JM, Hoesly FC, Williams LP Jr, Hedberg K, Oxman GL, et al. A swimming-associated outbreak of hemorrhagic colitis caused by Escherichia coli O157:H7 and Shigella sonnei. N Engl J Med. 1994;331:579–84.CrossRefPubMed
54.
Probert WS, Miller GM, Ledin KE. Contaminated stream water as source for Escherichia coli O157 illness in children. Emerg Infect Dis. 2017;23:1216–8.CrossRefPubMedPubMedCentral
55.
56.
Kramer MH, Herwaldt BL, Craun GF, Calderon RL, Juranek DD. Surveillance for waterborne-disease outbreaks—United States, 1993–1994. MMWR CDC Surveill Summ. 1996;45:1–33.PubMed
57.
Carter AM, Pacha RE, Clark GW, Williams EA. Seasonal occurrence of Campylobacter spp. in surface waters and their correlation with standard indicator bacteria. Appl Environ Microbiol. 1987;53:523–6.PubMedPubMedCentral
58.
Arvanitidou M, Stathopoulos GA, Constantinidis TC, Katsouyannopoulos V. The occurrence of Salmonella, Campylobacter and Yersinia spp. in river and lake waters. Microbiol Res. 1995;150:153–8.CrossRefPubMed
59.
Polo F, Figueras MJ, Inza I, Sala J, Fleisher JM, Guarro J. Prevalence of Salmonella serotypes in environmental waters and their relationships with indicator organisms. Antonie Van Leeuwenhoek. 1999;75:285–92.CrossRefPubMed
60.
• Martinez-Castillo M, Cardenas-Zuniga R, Coronado-Velazquez D, Debnath A, Serrano-Luna J, Shibayama M. Naegleria fowleri after 50 years: is it a neglected pathogen? J Med Microbiol. 2016;65:885–96. https://​doi.​org/​10.​1099/​jmm.​0.​000303. A comprehensive review of the epidemiology, microbiology, pathogenesis, and clinical manifestions of Naegleria fowleri infection in humans. CrossRefPubMed
61.
Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962–2008. Epidemiol Infect. 2010;138:968–75.CrossRefPubMed
62.
Schuster FL, Visvesvara GS. Free-living amoebae as opportunistic and non-opportunistic pathogens of humans and animals. Int J Parasitol. 2004;34:1001–27.CrossRefPubMed
63.
Siddiqui R, Khan NA. Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges. PLoS Negl Trop Dis. 2014;8:e3017.CrossRefPubMedPubMedCentral
64.
Cope JR, Ratard RC, Hill VR, Sokol T, Causey JJ, Yoder JS, et al. The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a US treated public drinking water system. Clin Infect Dis. 2015;60:e36–42.CrossRefPubMedPubMedCentral
65.
Yoder JS, Straif-Bourgeois S, Roy SL, Moore TA, Visvesvara GS, Ratard RC, et al. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis. 2012;55:e79–85.CrossRefPubMed
66.
Centers for Disease C, Prevention. Notes from the field: primary amebic meningoencephalitis associated with ritual nasal rinsing—St. Thomas, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep. 2013;62:903.
67.
Stubhaug TT, Reiakvam OM, Stensvold CR, Hermansen NO, Holberg-Petersen M, Antal EA, et al. Fatal primary amoebic meningoencephalitis in a Norwegian tourist returning from Thailand. JMM Case Rep. 2016;3:e005042.CrossRefPubMedPubMedCentral
68.
Marciano-Cabral F, MacLean R, Mensah A, LaPat-Polasko L. Identification of Naegleria fowleri in domestic water sources by nested PCR. Appl Environ Microbiol. 2003;69:5864–9.CrossRefPubMedPubMedCentral
69.
70.
Diaz JH. The public health threat from Balamuthia mandrillaris in the southern United States. J La State Med Soc. 2011;163:197–204.PubMed
71.
Diaz JH. Behavioral and recreational risk factors for free-living amebic infections. J Travel Med. 2011;18:130–7.CrossRefPubMed
72.
Kaji Y, Hu B, Kawana K, Oshika T. Swimming with soft contact lenses: danger of Acanthamoeba keratitis. Lancet Infect Dis. 2005;5:392.CrossRefPubMed
73.
Mannocci A, La Torre G, Spagnoli A, Solimini AG, Palazzo C, De Giusti M. Is swimming in recreational water associated with the occurrence of respiratory illness? A systematic review and meta-analysis. J Water Health. 2016;14:590–9.CrossRefPubMed
74.
Den Boer JW, Yzerman EP, Schellekens J, Lettinga KD, Boshuizen HC, Van Steenbergen JE, et al. A large outbreak of Legionnaires’ disease at a flower show, the Netherlands, 1999. Emerg Infect Dis. 2002;8:37–43.CrossRef
75.
76.
Ortiz-Roque CM, Hazen TC. Abundance and distribution of Legionellaceae in Puerto Rican waters. Appl Environ Microbiol. 1987;53:2231–6.PubMedPubMedCentral
77.
Everett ED, Nelson RA. Pulmonary melioidosis. Observations in thirty-nine cases. Am Rev Respir Dis. 1975;112:331–40.PubMed
78.
Covert TC, Rodgers MR, Reyes AL, Stelma GN Jr. Occurrence of nontuberculous mycobacteria in environmental samples. Appl Environ Microbiol. 1999;65:2492–6.PubMedPubMedCentral
Metadata
Title
Illnesses Associated with Freshwater Recreation During International Travel
Authors
Daniel L. Bourque
Joseph M. Vinetz
Publication date
01-07-2018
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 7/2018
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-018-0623-z

Other articles of this Issue 7/2018

Current Infectious Disease Reports 7/2018 Go to the issue

Transplant and Oncology (M Ison, N Theodoropoulos and S Pergam, Section Editors)

Cutaneous Manifestations of Infections in Solid Organ Transplant Recipients

Tropical, Travel and Emerging Infections (L Chen and A Boggild, Section Editors)

Update on Tick-Borne Bacterial Diseases in Travelers

Skin, Soft Tissue, Bone and Joint Infectious Disease (N Safdar and A Pop-Vicas, Section Editors)

Prosthetic Joint Infections: an Update

Transplant and Oncology (M Ison, N Theodoropoulos and S.Pergam, Section Editors)

Hepatitis C: Current Controversies and Future Potential in Solid Organ Transplantation
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits