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 #Waterborne #Infections #Differential #Diagnosis #InfectiousDiseases
