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OCR for page 63
111
Microbiology of
Drinking Water
The principal microbiological contaminants found in drinking water of
the United States are bacteria, viruses, and pathogenic protozoa. Each is
considered in a separate section of this chapter. Helminths are included
along with the protozoa. Little information is available on mycoplasma,
pathogenic yeast, and pathogenic fungi in drinking water. Microbiologi-
cal contaminants, such as fungi and algae, do not seem to be important
causes of waterborne disease, although they are sometimes associated
with undesirable tastes and odors.
EPIDEMIOLOGY
The average annual number of waterborne-disease outbreaks in the
United States reported since 1938 is shown in Figure III-1 (Center for
Disease Control, 1976b). There was a decrease in the number of outbreaks
during the late 1930's and 1940's, but this trend was reversed in the early
1950's. There has been a pronounced increase in the outbreaks reported
by the Center for Disease Control (CDC) in Atlanta, Georgia, since 1971.
The reason for this apparent increase is not entirely clear, but it could be
either the result of improved reporting or an overloading of our treatment
plants with source water of increasingly lower quality. Since 1971, the
CDC, the Environmental Protection Agency (EPA), state epidemiolo-
gists, and engineers in state water-supply surveillance agencies have
cooperated in the annual reporting of outbreaks. The purposes of such
63
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64 DRINKING WATER AND H"LTH
50 _
CC
m 40
in
~ 30
of
LU 20
I:
I:
-
o
1938- 1941- 1946- 1951 - 1956- 1961 - 1966- 197 1
1940 1945 1950 1955 1960 1965 1970 1974
YEARS
FIGURE III-l Average annual number of waterborne disease outbreaks, 1938-1975.
reports are to control disease by identifying contaminated water sources
and purifying them, and to increase knowledge of disease causation. The
roles of many microbial agents, including, for example, Yersinia
enterocolitica and mycoplasma, remain to be clarified.
The most important waterborne infectious diseases that occurred in
1971-1974 are listed in Table III-1. The etiologic agent was determined in
only 53% of 99 disease outbreaks that involved 16,950 cases (Craun et al.
1976~. The remainder were characterized as "acute gastrointestinal illness
of unknown etiology."
Shigellosis was the most commonly identified bacterial disease (2,747
cases) in 1971-1974. Most of the cases were associated with non-municipal
water systems. Four typhoid fever outbreaks affected 222 people and
involved semipublic and individual water systems.
In 1974, 28 waterborne-disease outbreaks, comprising 8,413 cases, were
reported to the Center for Disease Control (1976a). The largest was an
outbreak of giardiasis that occurred in Rome, N.Y., with an estimated
4,800 cases. The second largest involved about 1,200 cases caused by
Shigella sonnet. In the third largest, which involved 615 cases of acute
gastrointestinal illness, the etiologic agent was not definitely determined,
but Yersinia enterocolitica was suspected. The fourth largest was caused
by Shigella sonnet and involved 600 persons. Nineteen states reported at
OCR for page 65
Microbiology of Drinking Water 65
least one outbreak. Craun et al. (1976) stated that "this probably reflects
the level of interest in investigating and reporting in different states rather
than the true magnitude of the problem within the state."
Semipublic water systems were associated with 55% of the outbreaks
and accounted for 32% of the total cases in 1971-1974. Municipal systems
accounted for 31% of the outbreaks, but 67% of the cases. Individual
systems accounted for 14% of the outbreaks and only 1% of the cases, but
outbreaks associated with individual systems probably are under-report-
ed, as opposed to those associated with municipal and semipublic
systems.
Deficiencies in treatment and contamination of groundwater were
responsible for a majority of the outbreaks (onto) and cases (onto) in 1971-
1974. Inadequate or interrupted chlorination was involved in 31% of the
outbreaks and 44% of the cases.
Craun et al. (1976) have drawn attention to the large number of
waterborne disease outbreaks involving travelers. In 1971-1974, 49 (onto) of
the 68 outbreaks that occurred in connection with semipublic and
individual systems affected travelers, campers, visitors to recreational
areas, or restaurant patrons; and 86% of the 49 outbreaks occurred
during April-September.
Outbreaks on cruise ships are excluded from the above tabulations, but
they are of interest and should be mentioned because they involve the
traveling public. For example, in June 1973, about 90% of 655 passengers
and 35% of 299 crew were affected by an outbreak of acute gastroenteri-
tis. An epidemiological investigation identified Shigella flexneri type 6
among early cases, and contaminated water and ice aboard the ship were
implicated as vehicles of transmission (Center for Disease Control, 19731.
In 1975, outbreaks of diarrhea on 8 ships affected between 9% and 61% of
the passengers. In most of these outbreaks the causal agents and vehicles
TABLE III-1 Etiology Of Waterborne Outbreaks
and Cases, 1971-1974
Disease OutbreaksCases
Gastroenteritis 467,992
Giardiasis 125,127
Shigellosis 132,747
Chemical poisoning 9474
Hepatitis-A 13351
Typhoid fever 4222
Salmonellosis 237
TOTAL 9916,950
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66 DRINKING WATER AND H"LTH
of transmission were unknown; water was identified as the vehicle in one
of them (Center for Disease Control, 1976b).
In 1975, 24 waterborne disease outbreaks involving 10,879 cases were
reported to the Center for Disease Control (1976b). No etiologic agent
was found for the two largest outbreaks (Sewickley, Pa. 5,000 cases and
Sellersburg, Ind. 1,400 cases). The third largest outbreak, involving over
1,000 persons, occurred at Crater Lake National Park, Oreg. Enterotoxi-
genic E. cold was isolated from residents of the park who became ill, and
from the park's water supply.
Seventeen of the 24 outbreaks and about 9070 of the cases reported to
CDC were designated as "acute gastrointestinal illness." This category
includes cases characterized by gastrointestinal symptoms for which no
specific etiologic agent was identified. Cases resulting from water
treatment deficiencies (2,695) or deficiencies in the water distribution
system (6,961) accounted for almost 89% of the total cases in 1975. As in
the past, most of the cases occurred in the spring and summer.
The reported numbers of outbreaks and illnesses represent only a
portion of the true totals. Craun et al. (1976) called attention to the
outbreak at Richmond Heights, Fla., in 1974 as an example of why good
disease surveillance is necessary and of the way in which many illnesses
may go unnoticed. Initially, only 10 cases of shigellosis in this outbreak
were recognized by authorities. An epidemiologic investigation revealed
that approximately 1,200 illnesses actually occurred. This large outbreak
might not have been detected if local health authorities had not been
conducting shigellosis surveillance. In another outbreak, some 1,400
residents of Sellersburg, Ind. (31% of the town's population) experienced
gastroenteritis. The high attack rate, rapid onset of the outbreak, review
of water sampling data, and the town-wide survey suggested that the
illness was waterborne, but no bacterial or viral pathogens or chemical
toxins were found in the town water supply. Until improved detection
and reporting systems are in use, the available epidemiological data will
represent only a small fraction of the waterborne-disease problems in this
country.
BACTERIA
The principal bacterial agents* that have been shown to cause human
intestinal disease associated with drinking water are: Salmonella typhi,
*Nomenclature in this report follows the 8th edition of Bergey's Manual of Determinative
Bacteriology (Buchanan and Gibbons, 1974).
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Microbiology of Drinking Water 67
typhoid fever; Salmonella paratyphi-A, paratyphoid fever; Salmonella
(other species and a great number of serotypes), salmonellosis, enteric
fever; Shigella dysenteriae, S. pexneri, and S. sonnet, bacillary dysentery;
Vibrio cholerae, cholera; Leptospira sp., leptospirosis; Yersinia enterocoli-
tica, gastroenteritis; Francisella tularensis, tularemia; Escherichia cold
(specific enteropathogenic strains), gastroenteritis; and Pseudomonas
aeruginosa, various infections. Several other organisms have been
associated with gastroenteritis, such as those in other genera of the
Enterobacteriaceae: Edwardsiella, Proteus, Serratia, and Bacillus.
Number of Cells Required to Infect
In attempting to assess the hazards in drinking water, it is important to
know how many viable pathogenic cells are necessary to initiate an
infection. McCullough and Eisele (19Sla,b,c,d) found that a dose of 106-108
salmonellae per person was necessary for most strains, although 105 cells
of some strains could infect. More recent studies by Dupont, Hornick,
and associates on selected enteric bacterial pathogens are summarized in
Table III-2. Some enteric pathogens are highly virulent, causing infection
when relatively few cells are administered (e.g., Shigellaflexneri and S.
dysenteriae), whereas others require large numbers to infect (e.g.,
Salmonella typhosa and Vibrio cholerae).
Virulence is a genetic trait and can vary markedly from strain to strain
(Meynell, 19611. Phenotypic variation in virulence can occur within a
given clone. A small percentage of the cells in a population may be
unusually virulent (Meynell, 1961; Meynell and Meynell, 1965~. Thus, it
does not always follow that because large numbers of cells are required
for infection in feeding trials, that large numbers in drinking water are
necessary to cause infection. Some few individuals may become infected
by small numbers of unusually virulent cells. Recent evidence also
indicates the possibility of genetic transfer of virulence from invading
microbes into the resident intestinal population, providing another me.ans
by which small numbers of organisms might initiate a disease state.
The consequences of an increasing prevalence in livestock and their
excrete of coliform organisms containing infectious plasmids and giving
rise to clinical conditions were not examined in detail because of time
constraints and their lack of immediate relevance to standard setting.
Similarly, the consequences of adding antibiotics to animal and poultry
feed and the enhanced hazards-of spreading drug-resistant organisms
were not examined.
The infecting dose also varies with the age and general health of the
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68 DRINKING WATER AND H"LTH
TABLE III-2 Infective Doses For Man of Bacterial Enteric
Pathogens
Subjects Infected/Total Tested
Enters Pathogen
Dose: Viable Cells 10i 102 103 104 105 106 107 108 109
Shigella dysenteriae
Strain M131 1/10 2/4 7/10 5/6
Strain A-1 1/4 2/6
Shigella flexr~eri
Seam 2A# 6/33a 33/49b66/87 15/24
Strain 2A# # 1/4 3/4 7/8 13/19 7/8
Salmonella typhi
Strain Quailes 0/14 32/116 16/32 8/9 40/42
Vibrio cholerae
Strain Inaba
With NaHCO3 11/13 45/52 2/2
No NaHCO3 0/2 0/4 0/4 2/4 1/2
Enteropathogen~c
E. cold
Strain 4608 0/5 0/5 4/8
SOURCES: Shigella dysenteriae: Levine et al., 1973; Shigella flexneri: Dupont et al., 1972b;
Dupont et al., 1969; Salmonella typhi: Cornice et al.. 1970; Vibrio cholerae: Cash et al., 1974;
Enteropathogen~c E. coli: Dupont et al., 1971.
aD.ose 1.8 x 102.
bDose: 5 x 103.
host population (MacKenzie and Livingstone, 1968~. Infants and the aged
may be particularly susceptible. Previous exposure to a given pathogen is
important, in that coproantibodies may prevent infection with a strain
that is generally present in the population, whereas a new serotype
introduced into the water supply may present an increased hazard.
Not all strains of Shigella are highly virulent. Shaughnessy et al. (1946)
determined infecting doses of four strains of Shigella while studying
immunization in volunteers. They found that infectivity in mice could not
be directly correlated with infectivity in humans and that doses of 109
organisms or higher `.vere needed to produce human infection. In their
extensive studies to develop a Shigella vaccine, Hornick, DuPont, and
associates observed the infective dose for several strains. With S. flexneri
2A, 30 of 39 volunteers became ill from a dose of 105-108 organisms
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Microbiology of Drinking Water 69
(DuPont et al., 1969~. They showed that Shigella must penetrate the
intestinal mucosa to produce symptoms of classic dysentery and that
addition of bicarbonate facilitated this process. Two vaccine strains of S.
exneri 2A, a hybrid of a Shigella mutant, E. colt, and a streptomycin-
dependent strain, could be safely administered orally in doses of 10~°
organisms or higher (DuPont et al., 1972a). A virulent strain could cause
symptoms in doses of as few as 180 organisms (DuPont et al., 1972b). With
Shigella dysenteriae 1 (Shiga strain)-an organism that has two pathogenic
modes, invasiveness and enterotoxin elaboration the infecting dose in
man was shown to be as low as 10 organisms (Levine et al., 19731.
With such high infectivity of Shigella, why are waterborne outbreaks
not more common? One possibility is that Shigella survives poorly in
water. Wang et al. (1956) pointed out that, in a number of bacillary
dysentery outbreaks involving water, the organism was not, or could not
be, isolated. Over several years of studying irrigation water in Colorado,
Wang et al. (1956) and Dunlop et al. (1952) were not successful in isolating
shigellae, although salmonellae were frequently isolated. The survival of
shigellae in water appears to be shorter than that of many other bacteria;
Dolivo-Dobrovolskiy and Rossovskaya (1956) found Shigella survival
times of only 0.5-4.0 h during the warmest time of the year. However,
enteric pathogens may survive much longer times in lake or river
sediment than in free waters, and resuspension of such pathogen-loaded
sediments at a later time may introduce a "slug" of bacteria into the
waters that is not completely removed by treatment systems.
Estimation of Disease Potential by Direct Quantitation of Bacterial
Pathogens
The detection of bacterial pathogens in water polluted with human or
animal fecal matter is relatively easy when large numbers of organisms
are present (American Public Health Association, 1975~. Pathogenic
bacteria have been isolated from relatively clean reservoirs, rivers,
streams, and groundwater; large samples, concentration techniques, and
often elaborate laboratory procedures are used. However, detecting the
presence of these pathogenic organisms in processed and disinfected
water is far more difficult.
Scientific literature presents a vast array of media and methods for
direct pathogen detection in finished water (Geldreich, 1975~. The
greatest emphasis has been on the Salmonella-Shigella group of enteric
organisms. Numerous modifications of well-known media are used for
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70 DRINKING WATER AND H"LTH
pre-enrichment, enrichment, selective inhibition, and isolation, and there
are many recommended modifications of incubation temperature and
time. Some methods use the classic most-probable-number (MPN)
procedure for quantification; others use membrane filtration. Reviews of
proposed procedures may be found in the Journal of the Water Pollution
Control Federation (Geldreich, 1968, 1969, 1970b; Van Donsel, 1971;
Reasoner, 1972, 1973, 1974, 1975~. A recent review appeared in the
fourteenth edition of Standard Methods (American Public Health
Association, 1975~.
There are serious limitations to the use of direct isolation of specific
pathogenic bacteria for evaluating water quality. First, there is no single
procedure that can be used to isolate and identify all these microorgan-
isms. Second, only for salmonellae are the available procedures
sufficiently accurate; the methods for other major pathogens such as
Shigella, Vibrio, and Leptospira-are inadequate. Third, none of the
available procedures is applicable to quantitative isolation of small
numbers of pathogens in drinking water. Fourth, even if procedures
could be recommended, it is doubtful whether laboratories doing routine
bacteriologic studies of water would have the expertise to carry out the
procedures reliably.
In outbreaks caused by gross contamination, the standard procedures
would be of value. Recently, Reasoner and Geldreich (1974) reviewed
several of the rapid-detection methods proposed for water and concluded
that the cost per test, although perhaps higher than for conventional
procedures, must be tolerated for potable-water quality assessment in
emergency situations created by natural disasters, treatment breakdown,
or rupture in the distribution network. None of these procedures would
provide protection to the public as great as that provided by the currently
used indicator organism, the coliform.
Indicator Organisms
The term "indicator organism," as used in water microbiology, means: a
microorganism whose presence is evidence that pollution (associated with
fecal contamination from man or other warm-blooded animals) has
occurred. Indicator organisms may be accompanied by pathogens, but do
not necessarily cause disease themselves.
As noted above, pathogens are usually more difficult to grow, isolate,
and identify than indicator organisms, and often require special media
and procedures. Indicator organisms, rather than the actual pathogens,
are used to assess water quality because their detection is more reliable
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Microbiology of Drinking Water 71
and less time-consuming. Pathogens appear in smaller numbers than
indicator organisms and are therefore less likely to be isolated. An
indicator organism should have the following characteristics:
· Applicable to all types of water.
· Present in sewage and polluted waters when pathogens are present.
· Number is correlated with the amount of pollution.
· Present in greater numbers than pathogens.
· No aftergrowth in water.
· Greater survival time than pathogens.
· Absent from unpolluted waters.
· Easily detected by simple laboratory tests in the shortest time
consistent with accurate results.
· Has constant characteristics.
· Harmless to man and animal.
No organism or group of organisms meets all these criteria, but the
"coliform group" of organisms fulfills most of them.
ESCHERICHIA COLI AND THE COLIFORM GROUP
Escherichia cold is commonly found in the human intestine. It is not
normally a pathogen, although pathogenic strains are known. Physiologi-
cally, E. cold and members of the genera Salmonella and Shigella are quite
similar. All are classified as enteric bacteria of the family Enterobacteria-
ceae (Cowan, 1974~. They are facultatively anaerobic, and are able to
ferment sugars with the production of organic acid and gas. These three
genera carry out a type of fermentation called "mixed-acid fermenta-
tion," but differ in a number of physiological characteristics. Many
physiological differences between various enteric bacteria are known
(Ewing and Martin, 1974), but at the beginning of the twentieth century
this was not so. In the early days of water bacteriology, some simple
operational distinctions were necessary. The lactose-fermentation test
became the prime diagnostic tool: E. cold ferments lactose with the
formation of acid and gas; Salmonella and Shigella do not ferment
lactose.
One source of confusion is the necessity to distinguish between E. cold
and the "coliform group" of bacteria. Although the taxonomy of bacteria
is constantly undergoing revision (see Buchanan and Gibbons, 1974, for
the latest version), the genus Escherichia is well defined. It is distinguished
from other mixed-acid fermenters of the Enterobacteriaceae primarily on
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72 DRINKING WATER AND H"LTH
the basis of sugar-fermentation reactions, motility, production of indole
from t~yptophan, lack of urease, inability to utilize citrate as sole carbon
source, and inhibition of growth by potassium cyanide. However, the
"coliform group" is not so precisely defined. The "coliform group," as
defined in Standard Methods (American Public Health Association, 1975),
comprises all "aerobic and facultative anaerobic, gram-negative, non-
spore-forming, rod-shaped bacteria which ferment lactose with gas
formation within 48 hr at 35 C." This is not a taxonomic grouping, but an
operational one that is useful in water-supply and sewage-treatment
practice. It includes organisms in addition to E. colt, most importantly
Klebsiella pneumoniae and Enterobacter aerogenes, which are not m~xed-
acid fermenters. The entry of the term "coliform" into sanitary
bacteriology was associated with a policy established by H. E. Jordan
when he became editor of the Journal of the American Water Works
Association; he stated that he would substitute "coliform" for "E. colf' in
papers submitted to him (Jordan, 1937~.
Although most isolates classifiable as Escherichia by modern methods
ferment lactose, about 5-9% of them do not (Ewing and Martin, 1974~. No
isolates of the genus Salmonella, either in the species S. typhi or in other
species, produce gas from lactose (Ewing and Martin, 1974~; therefore, a
water sample containing Salmonella and a lactose-negative E. cold would
be negative on the coliform test and would probably be discarded without
further examination, because of the definition of"coliform." Even if
glucose were substituted for lactose in a coliform analysis, a significant
fraction of organisms would be missed, inasmuch as about 9% of isolates
of Escherichia do not form gas from glucose (Ewing and Martin, 1974~.
Because there are two procedures the multiple-tube-dilution or most-
probable-number (MPN) technique, and the membrane-filter (MF)
technique-the coliform group of organisms requires two definitions
(American Public Health Association, 1975~. On the basis of the MEN
technique, the group consists of all aerobic and facultatively anaerobic,
gram-negative, non-spore-forming, rod-shaped bacteria that ferment
lactose with formation of gas within 48 h at 35°C. On the basis of the ME
technique, the group consists of all organisms that produce a dark colony
(generally puIplish-green) with a metallic sheen within 24 h of incubation
on the appropriate culture medium; the sheen may cover the entire
colony or appear only in a central area or on the periphery. These two
groups are not necessarily the same, but they have the same sanitary
. ·^
slgnlucance.
If the coliform group is to be used as an indicator of fecal pollution of
water, it is important to know that the coliforms do not lose viability in
the water environment faster than pathogenic bacteria, such as salmonel
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Microbiology of Drinking Water 73
TABLE III-3 Comparative Die-Off Rates (Half-TimeJa of Fecal
Indicator Bacteria and Enteric Pathogens
Bacteria
Half-t~me Number
O of strains
1
Indicator Bacteria
Coliform (avg.) 17.~17.5 29
Enterococci (avg.) 22.0 20
Streptococci (from sewage) 19.5
S. equines 10.0 1
S. bovis 4~3 1
Pathogenic bacteria
Shigella dysenteriae 22.4 1
S. sonnet 24.5 1
S. pexneri 2S.8 1
S. enteritidis, paratyphi A&D 16.0 19.2 2
S. enteritidis, typhimurium 16.0 1
S. typhi 6.0 2
V. cholerae 7.2 3
S. enteritidis, paratyphi B 2.4 1
aTime required for 50~O reduction in the population. From McFeters et al. (1974).
lee and shigellae. Little information exists on the survival of bacteria in
finished water, and the data on other types of water are scattered and
fragmentary. McFeters et al. (1974) recently reviewed previous work and
presented their own data on die-o~ of intestinal pathogens in well water.
As seen in Table III-3, die-o~ rates for pathogens and coliforms are
approximately the same. Earlier work on the survival of salmonellae in
water was reviewed by McKee and Wolf (1963~.
Another factor to be considered is the relative sensitivity of coliforms
and bacterial pathogens to disinfection. Although this subject has been
studied little recently, the older work (Butterfield et al., 1943; Butterfield
and Wattle, 1946; Wattle and Chambers, 1943) indicated that there was
essentially no difference between these different organisms in sensitivity
to disinfection. This is not true when the coliform group is compared with
viral pathogens. Viruses survive longer than bacterial pathogens (Colwell
and Hetrick, 1976~.
SOME DEFICIENCES OF COLIFORMS AS INDICATOR ORGANISMS
Coliforms meet many of the criteria for an ideal indicator organism
previously listed; however, there are some deficiencies. There is after
OCR for page 124
124 DRINKING WATER AND HEALTH
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Microbiology of Drinking Water 125
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Representative terms from entire chapter:
finished water