Who Knew? Think Twice Before Drinking from the Garden Hose

A news report from Hawaii where rat lungworm, a parasitic infection, can be spread when an infected snail, one of the parasite hosts, climbs into the garden hose and then one drink water from the hose.  Okay, this parasite is not common in the continental US, but is common in Hawaii and has been found in Louisiana and Florida.  That is not to say it can't make its way to other states, because while the one definitive host is the snail, the other definitive host is the rat.

Still, something to consider before taking that gulp of water from a hose that has been laying on the ground for weeks.....you never know what could have crawled in there.

From the CDC:

• "Angiostrongylus costaricensis is a parasitic nematode (worm) that resides in rodents and uses mollusks, such as slugs, as an intermediate host. Rats, such as the cotton rat, transmit the larvae through their feces. Slugs then ingest the larvae. Humans are accidental hosts of the parasite. The parasite is not able to complete its life cycle in humans and eventually dies in the abdomen.  "
•  "In humans, juvenile worms [can] migrate to the brain, or rarely in the lungs, where the worms ultimately die." 
• "Most cases of infection are diagnosed in Southeast Asia and the Pacific Basin, but the parasite has also been found in Australia, some areas of Africa, the Caribbean, Hawaii and Louisiana."  [It has also been found in Florida]. 
• "Very few cases have been reported in the continental United States. In 1993, a boy in New Orleans got infected by swallowing a raw snail “on a dare. ” The type of snail he swallowed isn’t known. He became ill a few weeks later, with muscle aches, headache, stiff neck, a slight fever, and vomiting. His symptoms went away in about 2 weeks, without treatment of the infection."

Local News
Health officials warn parents: Don't let your kids drink from the garden hose
By:
Terri Inefuku
Posted: May 12, 2017 03:44 PM HST
Updated: May 12, 2017 03:44 PM HST

Neglected Parasitic Infections of Poverty - Impact on Mental Health

An article in the NY Times brings to light the issue of neglected parasitic infections that may impact mental health.  In this case, Toxocara, a roundworm that lives in the intestines of stray or poorly kept cats and dogs, that can have health impacts on humans who become infected - breathing, liver function, eyesight and even intelligence.  The impact of infection on the brain is not well understood, but "has been linked to lower intelligence and epilepsy".  This is an issue in poorer areas where there are more stray cats and dogs.

Another common parasitic infection, that from Taxoplasmosis gondii, has been linked to cases of schizophrenia.  As we know,  cats are a definitive host for this parasite.

In a 2014 piece sited in the NY Times article, the author discusses a group of parasites that have been linked to mental performance and illness.  The author states,  "These chronic infections may partially account for the achievement gap noted among socioeconomically disadvantaged students."  He further states, "additional information has determined that the neglected infections of poverty also cause important psychiatric and neurological effects on vulnerable populations in the southern United States."  A table from that article summarizes this impact.

(Hotez, 2014. JAMA Psychiatry. 2014;71(10):1099-1100)


CDC web site for neglected parasitic infections (NPIs).


JAMA Psychiatry
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1895572
Neglected Infections of Poverty in the United States and Their Effects on the Brain
Peter J. Hotez, MD, PhD1,2,3
Author Affiliations |Article Information
JAMA Psychiatry. 2014;71(10):1099-1100. doi:10.1001/jamapsychiatry.2014.1045

CDC MMWR - Waterborne Disease Outbreaks from Drinking Water - 2013 to 2014

As an important raw material for most food operations, water must be evaluated as part of the hazard analysis. The source of the water as well as how that water is stored and used must be considered. In CDC's report, disease outbreaks associated with drinking water (period 2013-2014) are reviewed. By their definition, "for an event to be defined as a waterborne disease outbreak, two or more cases must be linked epidemiologically by time, location of water exposure, and illness characteristics; and the epidemiologic evidence must implicate water exposure as the probable source of illness."

A summary of key findings:

• "Legionella was implicated in 24 (57%) outbreaks, 130 (13%) cases, 109 (88%) hospitalizations, and all 13 deaths (Table 1). Eight outbreaks caused by two parasites resulted in 289 (29%) cases, among which 279 (97%) were caused by Cryptosporidium, and 10 (3%) were caused by Giardia duodenalis. Chemicals or toxins were implicated in four outbreaks involving 499 cases, with 13 hospitalizations, including the first reported outbreaks (two outbreaks) associated with algal toxins in drinking water."
• "Thirty-five (83%) outbreaks were associated with public (i.e., regulated), community or noncommunity water systems,¶ and three (7%) were associated with unregulated, individual systems. Fourteen outbreaks occurred in drinking water systems with groundwater sources and an additional 14 occurred in drinking water systems with surface water sources. The most commonly cited deficiency, which led to 24** (57%) of the 42 drinking water–associated outbreaks, was the presence of Legionella in drinking water systems"
• "All of the outbreak-associated deaths reported during this surveillance period as well as all of the outbreaks reported in hospital/health care settings or long-term care facilities, were caused by Legionella. A review of 27 Legionnaires’ disease outbreak investigations in which CDC participated during 2000–2014 identified at least one water system maintenance deficiency in all 23 investigations for which this information was available, indicating that effective water management programs in buildings at increased risk for Legionella growth and transmission (e.g., those with more than 10 stories or that house "
• "Cryptosporidium was the second most common cause of both outbreaks and illnesses, demonstrating the continued threat from this chlorine-tolerant pathogen when drinking water supplies are contaminated."

Some background from one of the references (copied below) on Legionella in water systems.

• "Legionnaires’ disease is a lung infection that is fatal for about one in 10 persons who become infected. Legionella, the bacterium that causes Legionnaires’ disease, grows well in warm water, but can be killed by disinfectants, such as chlorine. Persons can get Legionnaires’ disease when they breathe in small droplets of water contaminated with Legionella."
• "Legionella grows best in building water systems that are not well maintained, especially where levels of chlorine or other disinfectants are low and water temperatures are optimal for its growth. Legionnaires’ disease outbreaks most often occur in hotels, long-term care facilities, and hospitals. The most common sources are potable water (e.g., drinkable water used for showering), cooling towers, hot tubs, and decorative fountains."

CDC MMWR
https://www.cdc.gov/mmwr/volumes/66/wr/mm6644a3.htm?s_cid=mm6644a3_e
Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2013–2014
Weekly / November 10, 2017 / 66(44);1216–1221

Unpasteurized Apple Juice Leads to Two Outbreaks

Fresh apple cider in autumn...nothing better.

But unfortunately, contamination on apples can make its way into the cider unless preventive controls are taken.  So far this season, there have been two examples of contamination in fresh cider.

A small California farm stand, High Hill Ranch, was linked to seven cases of E. coli illness among  residents who consumed the unpasteurized apple juice from High Hill Ranch in mid-October.
In an statement issued by the owners of the farm, it appears that they are missing the point (below).
E. coli is more likely to be picked up from ground apples (wind fallen apples, drops, or whatever you want to call them).

A second case in Illinois may be a case of cryptosporidium, a parasite often originating from a contaminated water source, such as contaminated wash water or irrigation water.  Again, apples off the ground can be an issue.

Many folks like to have that fresh juice, however having it processed can eliminate any potential risk.  This is the reason the Juice HACCP regulation of 2001 was implemented.  There are other means of having it process that do not impact the flavor as much as heat pasteurization.  One is UV treatment and the other is high pressure processing.  These two methods impact flavor less but can help retain that fresh

County of El Dorado
https://www.edcgov.us/pressreleasedetail.aspx?id=30064771392
High Hill Ranch Issues Voluntary Recall of Unpasteurized Apple Juice

Department: Public Health Contact: Creighton Avila  Phone#: (530) 621-5153
Date: October 23, 2015

High Hill Ranch, located in the community of Camino in El Dorado County, has initiated a voluntary recall of its unpasteurized apple juice following notification from local health officials of suspected contamination with bacteria, likely Escherichia coli (E. coli.). El Dorado County health officials are warning consumers to not drink and dispose of any unpasteurized apple juice purchased from High Hill Ranch on or after October 6, 2015.

Cyclospora outbreak linked to fresh cilantro

An outbreak of cyclospoa, primarily impacting Texas, has been linked to fresh cilantro from the Puebla area of Mexico .
  
Cyclospora is a single cell parasite that causes an intestinal infection called cyclosporiasis.  Cyclospora is spread by people ingesting food or water that was contaminated with feces from an infected individual.  Humans are the only known host (unlike other parasites that have other animals hosts).  It is not unlikely, however, to be passed from person-to-person, because it needs time (days to weeks) after being passed in a bowel movement (pooped) to become infectious for another person.
It is seen mainly in tropical or subtropical regions of the world but makes its way into the United States, via contaminated food, primarily imported fresh produce, or from people who travel to these areas.  The symptoms take about a week to show up, and it is in the form of watery diarrhea, with frequent, sometimes explosive, bowel movements. (Other symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted.) Some people who are infected can be asymptomatic (no symptoms).


Texas Department of State Health Services
News Updates
https://www.dshs.state.tx.us/news/updates.shtm
Cyclospora – August 28, 2014

The Cyclospora illness outbreak being investigated by DSHS and local health departments in Texas along with the federal Centers for Disease Control and Prevention and Food and Drug Administration appears to have ended. The number of new illnesses being reported has returned to background levels, and the investigation has linked the cases in four restaurant clusters to cilantro imported from Puebla, Mexico.