Waterborne Infections - Differential Diagnosis Framework



Infections that can be acquired from fresh water, brackish water, sea water and treated water - swimming pools/hot tubs



GI

• Cyclosporiasis (Cyclospora spp.)

• Escherichia coli O157:H7 Infection

	- (E. coli O157-Shiga toxin-producing) and Hemolytic Uremic Syndrome (HUS)

• Giardiasis (Giardia)

• Viral gastroenteritis:

	- Norovirus

	- Adenovirus

	- Hepatitis A

	- Rotavirus

• Shigellosis (Shigella)

• Vibrio Cholera/Vibrio parahaemolyticus

• Salmonella typhi

• Entamoeba histolytica

• Harmful Algal Blooms (HABs)



Skin

• Cellulitis

	• Aeromonas hydrophila

	• Mycobacterium marinum

	• Vibrio vulnificus

	• Vibrio parahaemolyticus

	• Staphylococcus aureus and Streptococcus

	• Pseudomonas aeruginosa

	• Burkholderia pseudomallei (Melioidosis)

	• Chromobacterium violaceum

	• Edwardsiella tarda

	• Erysipelothrix rhusiopathiae

	• Mycobacterium fortuitum (Mycobacteria abscessus, chelonae, and fortuitum*)

	• Plesiomonas spp

	• Shewanella spp

	• Streptococcus iniae

	• Fungal - Waterborne filamentous fungi - Cutaneous Infections:

		• Cyphellophora europaea

		• Cyphellophora oxyspora

		• Cyphellophora reptans

		• Exophiala castellanii

		• Exophiala dermatitidis

		• Exophiala oligosperma

		• Exophiala phaeomuriformis

		• Exophiala spinifera

		• Ochroconis musae

		• Ochroconis tshawytschae

		• Phialophora bubakii

		• Phialemonium obovatum

		• Stachybotrys chartarum

		• Stachybotrys ramosus

		• Cunninghamella sp.

		• Rhizopus spp.

• Cercarial dermatitis (Swimmer's Itch) → Schistosomes

• Hot Tub Folliculitis and Dermatitis → Pseudomonas aeruginosa

• Necrotizing Fasciitis

	- Vibrio vulnificus

	- Aeromonas

	- Shewanella spp

	- Edwardsiella tarda



Respiratory Infections

• Legionella

• Otitis externa

• Sinusitis - Vibrio alginolyticus

• Harmful Algal Blooms (HABs)

• Fungi - Causing Respiratory Infections

	• Rhizopus spp.

	• Cunninghamella sp.

	• Exophiala dermatitidis

	• Stachybotrys ramosus/chartarum

	• Pseudallescheria boydii

	• Phialemonium sp.

	• Exophiala dermatitidis



CNS Infection

• Primary amebic meningoencephalitis: Naegleria fowleri

• Chronic granulomatous amebic encephalitis (GAE)

	- Acanthamoeba spp.

	- Balamuthia mandrillaris

• Fungi:

	- Cunningamella

	- Scedosporium

	- Rhizopus



Leptospirosis

• Incubation period is between 2 days - 4 weeks

• The illness is biphasic

• Clinical symptoms: headaches, chills, muscle aches, jaundice, conjunctival suffusion

• Manifestations include:

	- Meningitis

	- Liver failure

	- Kidney failure

	- And, in rare cases, death



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