Waterborne Pathogens

This blog comes under the category of “write about your personal experiences” and this has not been a fun one for apprentice instructor Bill Ian Burden.

You may have seen on facebook that some of the team have successfully completed their Paddle Sport Instructors (PSI) course. Unfortunately, I was unable to join them on the course as I had been struck down with a sickness and diarrhoea bug. I suspect I picked it up while doing the Foundation in Safety and Rescue Training in preparation for the PSI course a couple of weeks earlier.

On many of the Woodland Ways courses the topic of water is covered, and how to make wild water safe to drink. An important part of the Rule of Three in survival:

“Three minutes without air,
Three hours without shelter,
Three days without water,
Three weeks without food.”

As part of my on-going learning on the Instructor’s Apprenticeship, one of the modules I am looking to complete this year is water, so what better way to use my rather unfortunate personal experience than to learn more about what might have caused my illness.

Pathogens are a bacterium, virus, or other microorganism that can cause disease, and they are some of the major contaminants in water. Below are examples of each and their relative size:
• Particulates (silt, sand and other particulates. Sand up to 1/10th mm to 2mm, Silt <1/10th mm)
• Parasites (Giardia, Cryptosporidium, 1/100th mm)
• Bacteria (leptospirosis, typhoid, E. coli; 1000th mm)
• Viruses (polio, hepatitis; 1/100000th mm)
• Chemicals (heavy metals, organophosphates, blue-green algae toxins).

The larger particulates themselves, silt, sand or bits of plant matter may in themselves be harmless to humans in small quantities, however, it is the smaller pathogens and chemicals that are attached or trapped inside the particles that can cause us problems. Hence filtering is an important part of making water safe to drink. For further information on Water Filtration

There are many sources of contaminants in to our water; run-off from urban areas, industry, agricultural practices around livestock and crop production, as well as our wildlife, all add up to the simple truth that we shouldn’t drink from our waterways. And just to emphasise that point, even though the UK has regulations covering water treatment and water quality monitoring, there were 403,171 spills of sewage into England’s rivers and seas in 2020, according to the Environment Agency. (Source: The Guardian 27/10/21).

Here are some common water-borne diseases that could have been the cause of my complaint.

Parasite: Cryptosporidium
Disease: Cryptosporidiosis
Symptoms: Diarrhoea and abdominal discomfort.
Frequency: One of the prevalent causes of water-borne disease in the UK.
Other: Outer shell resistant to chlorine-based disinfectants, so chlorine-based treatment of water may not be sufficient.

Parasite: Giardia lambia or Giardia duodenalis
Disease: Giardiasis
Symptoms: Diarrhoea, indigestion, fatigue, dehydration, vomiting, mild fever, loss of appetite, and bloating.
Frequency: 3500 cases per annum in the UK, 25% contracted outside UK.
Other: Outer shell resistant to chlorine-based disinfectants, so chlorine-based treatment of water may not be sufficient.

Parasite: Entamoeba histolytica
Disease: Amoebiasis
Symptoms: Diarrhoea, bloody stool, occasional fever, fatigue, weight loss.
Frequency: Predominant in tropical areas.

Bacterium: Vibrio cholerae
Disease: Cholera
Symptoms: Severe diarrhoea, vomiting, abdominal cramps, dehydration.
Frequency: No cases originating in UK, returning travellers may be infected.
Other: Potentially fatal.

Bacterium: Salmonella typhi
Disease: Typhoid fever
Symptoms: Headache, constipation, diarrhoea, fever, vomiting, nausea, abdominal rash and loss of appetite.
Frequency: Rare in UK, approximately 500 cases per annum, mostly returning travellers.
Other: Potentially fatal.

Bacterium: Campylobacter
Disease: Campylobacteriosis
Symptoms: Diarrhoea (often bloody), fever, nausea, vomiting, abdominal pain.
Frequency: One of the most common causes of gastroenterological infections worldwide.
Other: Rarely fatal, younger children ore vulnerable.

Bacterium: Leptospira
Disease: Leptospirosis
Symptoms: Pain in the joints, high fever, red eyes and rashes, sore throat, headache, vomiting, bleeding,
red eyes, muscle pain
Frequency: Rare, only 50 to 60 cases in England and Wales each year.
Other: Infection is commonly known as Weil’s disease usually passed to humans from infected animals.

Bacterium: Shigella
Disease: Shigellosis
Symptoms: Fever, stomach cramps, diarrhoea.
Frequency: Highly infectious, therefore good sanitation required to prevent transmission.
Other: If no complications will usually clear up in 5 to 7 days, without any treatment.

Bacterium: Escherichia coli
Disease: E-Coli infection
Symptoms: Urinary tract infection, gastrointestinal diseases, anaemia or even kidney failure
Frequency: Highly infectious, therefore good sanitation required to prevent transmission.
Other: Bacterium that normally lives in the digestive tracts of humans and animals, some strains are harmless. Chlorine resistant.

Virus: Hepatitis A
Disease: Hepatitis
Symptoms: Fever, jaundice, chills, dark urine and abdominal discomfort.
Other: More common in areas with poor sanitation and hygiene.

Virus: Rotavirus or Norovirus
Disease: Viral gastroenteritis
Symptoms: Vomiting and diarrhoea.
Frequency: Highly infectious.
Other: No specific treatment, advice is to rest and drink plenty of fluids.

(N.B. Source for the above including frequency of cases is from NHS website).

Cholera, Typhoid fever, Hepatitis A can be prevented through vaccination, whilst I have had these vaccinations in the past, they are not up to date, so could potentially be the culprit.

Unfortunately, there is no dramatic ending to my tale of woe, in fact the answer was pretty non-descript from the doctor. I had had several tests over a period of about three weeks. A urinary tract infection was cleared up by a seven-day course of Nitrofurantoin antibiotics. The issues with my stomach persisted after this treatment and although further testing didn’t reveal anything specific, the doctor concluded that I had probably had an E-Coli infection. E-Coli will often clear up by itself untreated, but can leave the stomach lining inflamed, hence the continuing issues. A month-long course of Omeprazole was prescribed. Omeprazole is a type of medicine called a proton pump inhibitor (PPI). Proton pumps are enzymes in the lining of your stomach that help it make acid to digest food. Omeprazole prevents proton pumps working properly which reduces the amount of acid the stomach makes.

The main thing I have learnt from this Blog is that certain parasites, and also E-Coli, are resistant to Chlorine. Which got me questioning whether or not chlorine tablets recommended for use in survival situations will kill off these nasties? Apparently, LifeSystems Chlorine Dioxide tablets do, if you believe the box! Another reason to prefer to boil water rather than rely on chemicals that leave an bad taste, on my opinion.