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Chapter 118 : Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes

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Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, Page 1 of 2

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Abstract:

This chapter investigates the overall colonization of thermal water and cold and hot water of particular hotels, including the detailed identification and typing of species and serogroups. The aim was also to evaluate the risk of particular hydrotherapy procedures, to identify the source of the Philadelphia strain in the spa complex, and to propose corrective actions to minimize the risk of future infections. Permanent chlorine dioxide disinfection was recommended for the hot water systems of the two hotels. A dilemma caused by the legislation has arisen as to how to treat the thermal water and its distribution system. Oxidizing biocides and ionizers are not permitted by law. Regular thermal disinfection is recommended, but its application is often unfeasible for the rapid settling of mineral deposits and scale, which usually clog pipes and valves. The bath equipment (mostly very sophisticated) contained many different kinds of tubing and hoses and air and water jets that were almost all colonized with biofilms harboring . Thermal and hot water distribution systems and hydrotherapy procedures present the sources, while aerosol inhalation and drinking water appear to be the transmission.

Citation: Drasar V, Polcar R, Christian Lück P. 2006. Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, p 489-492. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch118

Key Concept Ranking

Chlorine Dioxide
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Pseudomonas aeruginosa
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Figures

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FIGURE 1

Schematic diagram of the thermal water system. Water is drawn from two boreholes (BH1, BH2), pumped into the tank, and distributed to five hotels (BT, CL, KL, VL, NL) and an aquapark.

Citation: Drasar V, Polcar R, Christian Lück P. 2006. Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, p 489-492. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch118
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References

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1. Bornstein N.,, D. Maremet,, M. Surgot,, M. Novicki,, A. Arslan,, J. Esteve, and, J. Fleurette. 1989. Exposure to Legionellacae at a hot spring spa: a prospective clinical and serological study. Epidem. Inf. 102:3136.
2. Czech Ministry of Health. 2001. Decree of the Czech Ministry of Health No.423/2001: On Spas and Sources. European Guidelines for Control and Prevention of Travel Associated Legionnaires’ Disease, 2003 (www.ewgli.org).
3. Koide, M. 2002. Hot spring bath as the reservoir of Legionella bacterium. Intern. Med. 41:759.
4. Miyamoto H.,, S. Jitsurong,, R. Shiota,, K. Maruta,, S. Yoshida, and, E. Yabuuchi. 1997. Molecular determination of infection source of a sporadic Legionella pneumonia case associated with a hot spring bath. Microbiol. Immunol. 41: 197202.
5. Pelaz C.,, R. Cano, and, B. Baldrón. 2004. Legionella and spas in Spain (1993-2003). Poster No. 4., in 19th EWGLI Meeting Chamonix, Ab-stract book.
6. Rocha G.,, A. Veríssimo,, R. Bowker,, N. Born-stein, and, M. S. da Costa. 1995. Relationship between Legionella spp. and antibody titres at a therapeutic thermal spa in Portugal. Epidemiol. Infect. 115:7988.
7. Schaffler-Dullnig K.,, F. F. Reinthale, and, E. Marth. 1992. Nachweis von Legionellen im thermalwasser. Zbl. Hyg. 192:473478.
8. Tominaga M.,, Y. Aoki,, S. Haraguchi,, M. Fukuoka,, S. Hayashi,, M. Tamesada,, E. Yabu-uchi, and, K. Nagasawa. 2001. Legionnaires’ disease associated with habitual drinking of hot spring water. Intern. Med. 40:10641067.
9. Veríssimo A.,, G. Marrao,, F. Gomes da Silva, and, M. S. da Costa. 1991. Distribution of Legionella spp. in hydrothermal areas in continental Portugal and the Island of Sao Miguel, Azores. Appl. Environ. Microbiol. 57:29212927.

Tables

Generic image for table
TABLE 1

Tracing the source of the Philadelphia strain: concetrations in the thremal water system

Citation: Drasar V, Polcar R, Christian Lück P. 2006. Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, p 489-492. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch118
Generic image for table
TABLE 2

Tracing the source of the Philadelphia strain: species and serogroups isolated the thermal water system

Citation: Drasar V, Polcar R, Christian Lück P. 2006. Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, p 489-492. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch118
Generic image for table
TABLE 3

Tracing the source of the Philadelphia strain: hot water plumbing systems of particular spa hotels

Citation: Drasar V, Polcar R, Christian Lück P. 2006. Risk of in the Spa Industry: Inadequacy of Current Legislation Covering Thermal Waters used for Medicinal Purposes, p 489-492. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch118

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