key: cord-0042166-otso8m3a authors: Hazen, Terry C. title: Fecal coliforms as indicators in tropical waters: A review date: 2006-06-20 journal: nan DOI: 10.1002/tox.2540030504 sha: 7437a3adb462bd5e22dc3393441b858a8f242ef3 doc_id: 42166 cord_uid: otso8m3a Nowhere is the importance of accurate determination of recent human fecal contamination greater than in the tropics. The diversity of waterborne diseases and their severity is greatest in tropical environments. Since most of the countries in tropical climates are underdeveloped, with large populations that are undernourished, ill‐housed, with poor medical services, waterborne diseases may have a much greater effect on public health in the tropics than in temperate areas. Universally, tropical areas accept water maximum contaminant levels developed by temperate nations, despite the obvious differences in tropical climates. High densities of total and fecal coliform bacteria have been detected in pristine streams and in groundwater samples collected from many tropical parts of the world, even in epiphytic vegetation 10 m above ground in the rain forest of Puerto Rico. Nucleic acid (DNA) analyses of Escherichia coli from pristine tropical environs has indicated that they are identical to clinical isolates of E. coli. Many tropical source waters have been shown to have enteric pathogens in the complete absence of coliforms. Diffusion chamber studies with E. coli at several tropical sites reveal that this bacterium can survive indefinitely in most freshwaters in Puerto Rico. An evaluation of methods for the enumeration of fecal coliforms showed that currently used media have poor reliability as a result of large numbers of false positive and false negative results when applied to tropical water samples. Total and fecal coliform bacteria are not reliable indicators of recent biological contamination of waters in tropical areas. Fecal streptococci and coliphages in tropical waters violate the same underlying assumptions of indicator assays as the coliforms. Anaerobic bacteria like Bifidobacterium spp. and Clostridium perfringens show some promise in terms of survival, but not in ease of enumeration and media specificity. The best course at present lies in using current techniques for direct enumeration of pathogens by fluorescent staining and nucleic acid analysis, and developing tropical maximum contaminant levels for certain resistant pathogens in tropical waters. coliforms. Diffusion chamber studies with E. coli at several tropical sites reveal that this bacterium can survive indefinitely in most freshwaters in Puerto Rico. An evaluation of methods for the enumeration of fecal coliforms showed that currently used media have poor reliability as a result of large numbers of false positive and false negative results when applied to tropical water samples. Total and fecal coliform bacteria are not reliable indicators of recent biological contamination of waters in tropical areas. Fecal streptococci and coliphages in tropical waters violate the same underlying assumptions of indicator assays as the coliforms. Anaerobic bacteria like Bifidobacterium spp. and Clostridium perfringens show some promise in terms of survival, but not in ease of enumeration and media specificity. The best course at present lies in using current techniques for direct enumeration of pathogens by fluorescent staining and nucleic acid analysis, and developing tropical maximum contaminant levels for certain resistant pathogens in tropical waters. Over 2 billion people, or half of the world's population, have suffered from diseases due to drinking polluted waters (Barabas, 1986) . More than 250 million new cases of waterborne disease are reported each year, resulting in more than 10 million deaths. Nearly 75% of these waterborne disease cases occur in tropical and subtropical areas. Indeed, nearly 50% of diarrheal disease deaths (4.6 million) occur in children under 5 years of age, living in the tropics (Snyder and Merson, 1982; Bockemuhl, 1985) . Many investigators and government administrators assume that these high morbidity and mortality rates simply indicate the contaminated nature of water in tropical areas. However, determining the level of biological contamination in tropical source water is much more difficult than most regulatory agencies perceive, even regulatory agencies residing in tropical nations. Yet the need to accurately determine the level of biological contamination is much greater in tropical areas than it is in temperate areas. Tropical areas have a much greater number of waterborne diseases (Tables I and 11 ). In turn, these diseases are exacerbated by the greater reliance on surface water as a drinking water source and the lack of adequate sewage treatment (Feachem, 1977; Esrey et al., 1985) . The literature is sparse with specific references to fecal contamination in the tropics, yet there are some notable exceptions. Evison and James (1973) reviewed literature from Ceylon, Egypt, India, and Singapore, and reported that densities of Escherichia coli in water did not seem to coincide with known sources of fecal contamination. Feachem (1974) , working in rural areas of New Guinea, found fecal coliform (FC) densities from 0 to 10,000 colony-forming units (CFU) per 100 mL and fecal streptococci (FS) levels from 0 to 6000 CFU per 100 mL, although his mean densities for both indicator bacteria was greater than 100 CFU per 100 mL for nearly all sites. All sites were totally unacceptable for drinking water and Feachem concluded that all sites were grossly contaminated with fecal material because of the high indicator counts. Yet he stated that FC and FS densities were more closely correlated with the number of domestic animals in the watershed than with the number of people. In fact, FC and FS densities closest to the highest human population density were the lowest. In addition, typical of many tropical studies, Feachem did not do complete identification of positive isolates. In Sierra Leone, Wright (1982) reported densities of fecal coliforms from 40 to 240,000 most probable number (MPN) per 100 mL and FS densities from 7 to 64,000 CFU per 100 mL for water sources used by 29 settlements. However, Wright (1982) found no correlation between any of the fecal indicators that he measured and Salmonella spp. Fujioka and Shizumura (1985) found that streams in Hawaii had densities of fecal colifoms and fecal streptococci from 100 to 10,000 CFU per 100 mL, including those not known to be receiving contamination from any fecal source. Oluwande et al. (1983) found that rivers in Nigeria cCFU: colony-forming units; see Hazen et al. (1987) , Dufour (1986) , Found exclusively in the tropics. Hutchinson and Ridgway (1977) . and Hawkins et al. (1985) . (19871, Dufour (1986) , Hutchinson and Ridgway (1977) , and Hawkins et al. (1985) . had total coliform counts from 8 to 100,000 CFU per 100 mL. Oluwande et al. (1983) also assumed that the high densities of fecal indicators meant that these waters were heavily contaminated with human feces, even though their own data showed that densities of total coliforms were often higher upstream from known contamination sources. Thomson (1981) also found that Salmonella spp. in drinking water from wells in Botswana were not correlated to densities of total coliforms, fecal coliforms, or E. coli. He observed that Salmonella spp. could be found in the complete absence of E. coli, or fecal coliforms, and with either high or low densities of total coliforms. Lavoie and Viens (1983) reported that 95% of the traditional water sources in the Ivory Coast, West Africa, had unacceptably high densities of fecal coliforms (11,421 CFU per 100 mL), yet fewer than 55% of the positive total coliform isolates were actually E. coli and fewer than 66% of the FC isolates were actually E. coli (Lavoie, 1983) . However, when he examined the feces of local inhabitants he found that 92% of the total coliform isolates were E. coli and 89% of the FC isolates were E. coli. Few, if any, of these studies have carefully examined and tested the underlying assumptions of the fecal-pathogen indicator being used. Bonde (1977) eloquently enumerated these criteria as follows: 1. The indicator must be present whenever pathogens are present. It must be present only when the presence of pathogenic organ-3. It must occur in much greater numbers than the pathogens. 4. It must be more resistant to disinfectants and to aqueous envi-5. It must grow readily on relatively simple media. 6. It must yield characteristic and simple reactions enabling as far as possible an unambiguous identification of the group or species. It should preferably be randomly distributed in the sample to be tested. Its growth on artificial media must be largely independent of any other organism present. In the late 1800s Houston proposed the idea of using three groups of bacteria (i.e., coliforms, fecal streptococci, and the gas-producing clostridia that are commonly found in the feces of warm-blooded animals) as indicators of fecal pollution of waters (Hutchinson and Ridgway, 1977) . He argued that since these groups could only come from fecal sources their presence would indicate recent fecal pollution (Hutchinson and Ridgway, 1977) . For nearly 80 years the coliform group of bacteria has been used as such indicators. The indicator used isms is an imminent danger. ronments than the pathogens. universally to access biological contamination of water is E . coli, in both tropical and temperate countries (Barbaras, 1986) . The first drinking water regulation for microbial contamination in the United States was published in 1914. This was the first Public Health Service Drinking Water Standards regulation. Subsequently, this regulation was replaced by the U.S. Public Service Acts of 1915 and 1962. The current U.S. regulation comes from the Safe Drinking Water Act (Public Law 93-523,1974). The U.S. Environmental Protection Agency proposed changes that are now being implemented (Fed -era1 Register 48:45502-45521, October 1983). The law was approved in July 1986 and is currently in its first phase of implementation. The new regulation requires that there be 0 coliforms/100 mL by any method for any sampling frequency for drinking waters. WHO (Barbaras, 1986) only allows 10 coliforms/100 mL for small community water sources. For tropical nations and tropical parts of the United States, even the old regulations may be unrealistic. ,4s observed in Botswana (Thomson, 1981) and Sierra Leone (Wright, 319821 (Perez-Rosas and Hazen, 1988) , Yersinia enterocolitica (Elias et al., 19881 , and Aeromonus hydrophila were also found to be unrelated to densities of E. coli in source water. Thus pathogens could be present in the absence of E . coli in tropical source water. Indeed, it has been well demonstrated that high densities of enteric viruses, a dominant cause of waterborne disease in both temperate and tropical areas, may be found in the complete absence of fecal coliforms or E . coli (Berg and Metcalf, 1978) . In Nigeria (Oluwande et al., 19831, Hawaii (Fujioka and Shizumura, 1985) , New Guinea (Feachem, 19741 , Puerto Rico (Carrillo et al., 19851, Sierra Leone (Wright, 19821 , and the Ivory Coast (Lavoie, 1983) , high densities of E . coli were found in the complete absence of any known fecal source, i.e., no pathogens. Monitoring of' Puerto Rican waters by the U.S. Geological Survey reported that 54 out of 67 water sampling stations on rivers in Puerto Rico exceeded the recommended maximum contaminant levels (MCL) for recreational waters (i.e., 500,000 per 100 mL). Fujioka and Shizumura (1985) made the observation that densities of C. perfringens increased significantly in uncontaminated sites after rainfall. This suggests that under some conditions C. perfringens might have an extraenteral source. Wright (1982) found that source waters in Sierra Leone had densities of C. perfringens from 40 to 1500 per 100 mL, that they compared favorably with densities of fecal streptococci, and like the fecal streptococci they were unrelated to the isolation of Salmonella spp. C. perfringens seems to satisfy more of Bonde's criteria for an ideal indicator than the fecal coliforms or the fecal streptococci, yet it falls short on at least three points. Because few other studies have reported the use of fecal indicators other than E . coli in tropical source water, objective evaluations of the efficacy of these alternate indicators is difficult. At present, obligate anaerobes seem the best candidates for a better indicator for tropical source water, primarily due to their inability to survive extraenterally. However, all of these indicators have the inherent difficulty that under some conditions they may survive and that the media used for their enumeration may allow false positive background flora. In addition, the viable but nonculturable phenomena reported for many pathogens in both temperate and tropical waters suggests that indicators may only rarely be correlated with disease risk in source waters (Colwell et al., 1985; Hazen et al., 1987; L6pez-Torres et al., 1987) . The best indicator may be no indicator, i.e., directly enumerate selected resistant pathogens. This would allow a more realistic estimation of health risk. Immunofluorescent staining can detect densities of pathogenic bacteria as low as 10 cells per mL, a density that may give no culturable counts (Colwell et al., 1985) . Nucleic acid probes can detect enteric viruses at densities as low as one virus particle per liter. DNA probes have also been developed for enterotoxigenic E. coli (Bialkowska-Habrzanska, 1987; Hill et al., 1983; Moseley et al., 1982) and Salmonella spp. (Fitts et al., 1983) . Thus direct enumeration of pathogens is currently possible. Common enteric pathogens that might be enumerated could be polio virus, or Salmonella typhimurium. Detection of either one of these in tropical source water would indicate risk of human disease. Instead of enumeration, MCLs could be based on detection only. The public health of people living in the tropics and the economic development and respect of their countries in the world community is dependent upon a more suitable standard being developed for tropical source waters. The currently used FC assays are unacceptable for indicating biological contamination of tropical source waters. 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