Chapter 2 : Freshwater: From Lakes to Hot Tubs

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This chapter focuses on human infections acquired in nonmarine environments, including natural freshwater environments (lakes, ponds, rivers, and streams) and man-made aquatic environments (swimming pools, hot tubs, whirlpools, and spas). The discussion is limited to infections associated with immersion or other exposure to aquatic macroor microenvironments. An appreciation of the wide variety of potential pathogens that occasionally cause problems for patients exposed to freshwater can be gained from the chapter. While , , and were more likely to cause outbreaks in freshwater, such as in lakes, ponds, and rivers, and were more likely to cause infections and outbreaks in treated waters, like in swimming pools. It is unusual to encounter community-acquired skin and soft tissue infections caused by mycobacteria other than and for which immersion in freshwater is an epidemiological factor. The antimicrobial susceptibility of species and the therapy of infections are discussed. Other free-living amoebae include and spp. These amphizoic amoebae may cause fulminant rapidly progressive central nervous system infection called primary amoebic meningoencephalitis (PAM) (due to Naegleria fowleri) or chronic slowly progressive disease called granulomatous amoebic encephalitis (GAE), primarily caused by several species of and by . Owners of swimming facilities need to pay more attention to maintenance, operation, disinfection, and filtration. While these issues are being resolved, some practical measures will come in handy to prevent further infections and associated outbreaks.

Citation: Ayi B, Dworzack D. 2009. Freshwater: From Lakes to Hot Tubs, p 69-95. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch2
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Trophozoite of an sp. or cysts of an sp. from brain tissue. Source: CDC Public Health Image Library (http://phil.cdc.gov).

Citation: Ayi B, Dworzack D. 2009. Freshwater: From Lakes to Hot Tubs, p 69-95. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch2
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Infections associated with exposure to freshwater

Citation: Ayi B, Dworzack D. 2009. Freshwater: From Lakes to Hot Tubs, p 69-95. In Schlossberg D (ed), Infections of Leisure, Fourth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555815950.ch2

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