Health Effects from Sludge and Recycled water      
                                                                                                                          2010 - 1900   91+ studies
E. coli (B. coli) and streptococcal  infections were document in 1900,  in women giving birth.  
By 1915 it was documented as a cause of meningitis after a head wound. 110 years later
E coli and group B streptococcal infections (28.5% and 34.1% overall) are still the primary
agents of neonatal meningitis. During the past 110 years, we have been busy learning how
to create chimeric bacteria and viruses never before seen in nature, such as E. coli 0157.
Moreover, our wastewater and drinking water treatment plants are DNA swap meets
generating new antibiotic resistant forms of bacteria and viruses.

Today we know pathogens are also involved in heart disease and strokes, even among
infants and young children. Prior to receiving millions of dollars to promote sludge use
research, the Water Environment Federation (Water Pollution Control Federation) actually
published studies showing sewage treatment plant workers were infected more than control

Thirty Coliform pathogens Table 1
Bacteria Pathogen Disease Table 2
Helminths Worm Disease Tables 4
Protozoa Disease Table 5
Fungi & Yeast Disease Table 6

Spreading disease causing organisms on agricultural crop land, parks, school grounds and
home lawns is a dangerous engineering solution to water pollution. However, not only did it
fail to solve the water pollution problem, it caused the spread of foodborne pollution as well
as  ground water pollution and created the current health system disaster.

In 1981 EPA, FDA and USDA stated that the safety of food grown on sludge is assured as
long as the guidance is followed. There is a caveat, the "government can not offer any
indemnity against product recall, seizure, or other enforcement actions."

The biosolids industry is scrambling to assess the financial risk from a growing number of tort
suits challenging land applications of biosolids that plaintiffs are filing in state courts as
federal courts are rejecting industry defenses that EPA regulations allowing the controversial
practice preempt the tort suits.

2010 -- Generating a Prion with Bacterially Expressed Recombinant Prion Protein
The prion hypothesis posits that a misfolded form of prion protein (PrP) is responsible for the
infectivity of prion disease. Using recombinant murine PrP purified from Escherichia coli, we
created a recombinant prion with the hallmarks of the pathogenic PrP isoform: aggregated,
protease-resistant, and self-perpetuating. After intracerebral injection of the recombinant
prion, wild-type mice developed neurological signs in ~130 days and reached the terminal
stage of disease in ~150 days. Characterization of diseased mice revealed classic
neuropathology of prion disease, the presence of protease-resistant PrP, and the capability
of serially transmitting the disease, confirming that these mice succumbed to prion disease.
Thus, as postulated by the prion hypothesis, the infectivity in mammalian prion disease
results from an altered conformation of PrP.
Science DOI: 10.1126/science.1183748

What is protein folding?
Proteins are biology's workhorses -- its "nanomachines." Before proteins can carry out these
important functions, they assemble themselves, or "fold." The process of protein folding,
while critical and fundamental to virtually all of biology, in many ways remains a mystery.
Protein folding is linked to disease, such as Alzheimer's, ALS, Huntington's, Parkinson's
disease, and many Cancers Moreover, when proteins do not fold correctly (i.e. "misfold"),
there can be serious consequences, including many well known diseases, such as
Alzheimer's, Mad Cow (BSE), CJD, ALS, Huntington's, Parkinson's disease, and many
Cancers and cancer-related syndromes.

For more information on prions and Alzheimers see

2010 -- Spinacia oleracea L. Leaf Stomata Harboring Cryptosporidium parvum Oocysts: a
Potential Threat to Food Safety
Cryptosporidium parvum is a cosmopolitan microscopic protozoan parasite that causes
severe diarrheal disease (cryptosporidiosis) in mammals, including humans and livestock.
There is growing evidence of Cryptosporidium persistence in fresh produce that may result in
food-borne infection, including sporadic cases as well as outbreaks. However, drinking and
recreational waters are still considered the major sources of Cryptosporidium infection in
humans, which has resulted in prioritization of studies of parasite etiology in aquatic
environments, while the mechanisms of transmission and parasite persistence on edible
plants remain poorly understood. Using laser scanning confocal microscopy together with
fluorescein-labeled monoclonal antibodies, C. parvum oocysts were found to strongly adhere
to spinach plants after contact with contaminated water, to infiltrate through the stomatal
openings in spinach leaves, and to persist at the mesophyll level. These findings and the fact
that this pathogenic parasite resists washing and disinfection raise concerns regarding food
Applied and Environmental Microbiology, January 2010, p. 555-559, Vol. 76, No. 2

2010 -- Detection of enteric viruses in sewage sludge and treated wastewater effluent.
Sewage sludge and treated wastewater when contaminated with enteric virus and discharged
into the environment, could pose a human health risk. The aim of study was to verify the
presence and viability of enteric viruses in sewage sludge and treated wastewater at a local
sewage plant in Florianopolis city, Brazil. Sewage sludge was concentrated by organic
flocculation and polyethylene glycol precipitation and wastewater by electronegative
membrane filtration and ultrafiltration by Centriprep Concentrator. Adenovirus (AdV),
hepatitis A virus (HAV), and Rotavirus (RV) were examined for all samples for 12 months and
Poliovirus (PV) was also tested for in sewage sludge samples. AdV was the most prevalent in
both kind of samples, followed by RV, PV (in sludge) and HAV. Viral viability by cell culture
(ICC-PCR) was: AdV: 100%, HAV: 16.7%, PV: 91.7%, RV: 25% in sludge and AdV: 66.6%,
HAV: 66.6% and RV: 0% in wastewater. IFA for AdV in sludge ranged from 70 to 300 FFU/ml.
QPCR for AdV ranged from 4.6 x 10(4) to 1.2 x 10(6) and from 50 to 1.3 x 10(4) gc/ml in
sludge and wastewater, respectively. HAV quantification in sludge ranged from 3.1 x 10(2) to
5.4 x 10(2) gc/ml. In conclusion, it was possible to correlate presence and viability of enteric
viruses in the environmental samples analyzed.
Water Sci Technol. 2010;61(2):537-44.

2010 -- Risk Factors for and Estimated Incidence of Community-associated Clostridium
difficile Infection, North Carolina, USA
We determined estimated incidence of and risk factors for community-associated Clostridium
difficile infection (CA-CDI) among patients treated at 6 North Carolina hospitals. CA-CDI case-
patients were defined as adults (>18 years of age) with a positive stool test result for C.
difficile toxin and no hospitalization within the prior 8 weeks. CA-CDI incidence was 21 and 46
per 100,000 person-years in Veterans Affairs (VA) outpatients and Durham County
populations, respectively. VA case-patients were more likely than controls to have received
antimicrobial drugs (adjusted odds ratio [aOR] 17.8, 95% confidence interval [CI] 6.6–48] and
to have had a recent outpatient visit (aOR 5.1, 95% CI 1.5–17.9). County case-patients were
more likely than controls to have received antimicrobial drugs (aOR 9.1, 95% CI 2.9–28.9), to
have gastroesophageal reflux disease (aOR 11.2, 95% CI 1.9–64.2), and to have cardiac
failure (aOR 3.8, 95% CI 1.1–13.7). Risk factors for CA-CDI overlap with those for healthcare-
associated infection.
EID Journal Home > Volume 16, Number 2–February 2010

2010 -- Free-living amoebae, Legionella and Mycobacterium in tap water supplied by a
municipal drinking water utility in the USA.
Legionella and Mycobacterium can proliferate within free-living amoebae (FLA) where they
are protected from disinfectants at concentrations that can kill bacteria but not protozoa.
Despite effective treatment of drinking water, microbes can enter water utility distribution
systems (DS) and hence the plumbing within building premises. Additionally, biofilm formation
may account for the persistence of microbes in the distribution system. In the present study a
domestic water tap in north-central United States (USA) was sampled in March and
September 2007 and analysed for FLA, Legionella and Mycobacterium.
Identification of organisms was determined by growth on specific culture media, light and
electron microscopy, and amplification of DNA probes specific for each organism. In both the
spring and fall samples, amoebae, Legionella and Mycobacterium were detected. However,
Acanthamoeba was prominent in the spring sample whereas Vahlkampfia and Naegleria were
the amoebae detected in the autumn. Bacterial proliferation in laboratory cultures was
noticeably enhanced in the presence of amoebae and biofilms rapidly formed in mixed
amoebae and bacteria cultures. It is hypothesized that temperature affected the dynamics of
FLA species population structure within the distribution system and that pathogenic bacteria
that proliferate within FLA, which are themselves opportunistic pathogens,
pose dual public
health risks.
J Water Health. 2010 Mar;8(1):71-82

2010 -- Manure- and Biosolids-Resident Murine Norovirus 1 Attachment to and Internalization
by Romaine Lettuce
The attachment of murine norovirus 1 (MNV) in biosolids, swine manure, and dairy manure to
Romaine lettuce and internalization of this virus were evaluated. The MNV in animal manures
had behavior similar to that of pure MNV; however, MNV in biosolids had significantly higher
levels of attachment and internalization than pure MNV or MNV in manures. The incubation
time did not affect the attachment of MNV in biosolids or manure. Confocal microscopy was
used to observe MNV on lettuce after SYBR gold-labeled MNV was added directly to lettuce
or after lettuce was submersed in labeled virus. MNV was observed on the lettuce surface,
inside open cuts, and occasionally within stomata. In general, lettuce pieces with a long cut
on the edge and short cuts on the stem was more likely to contain internalized MNV than
intact lettuce pieces, as observed by confocal microscopy; however, while the difference was
visible, it was not statistically significant. This study showed that the presence of MNV in
biosolids may increase the risk of fresh produce contamination and that the MNV in open
cuts and stomata is likely to be protected from sanitization.
Applied and Environmental Microbiology, January 2010, p. 578-583, Vol. 76, No. 2

2009 -- Darwinian Evolution of Prions in Cell Culture
Prions are infectious proteins consisting mainly of PrPSc, a β sheet–rich conformer of the
normal host protein PrPC, and occur in different strains. Strain identity is thought to be
encoded by PrPSc conformation. We found that
biologically cloned prion populations
gradually became heterogeneous by accumulating "mutants," and selective pressures
resulted in the emergence of different mutants as major constituents of the evolving
population. Thus, when transferred from brain to cultured cells, "cell-adapted" prions
outcompeted their "brain-adapted" counterparts, and the opposite occurred when prions
were returned from cells to brain. Similarly, the inhibitor swainsonine selected for a resistant
substrain, whereas, in its absence, the susceptible substrain outgrew its resistant
counterpart. Prions, albeit devoid of a nucleic acid genome, are thus subject to mutation and
selective amplification.
Science DOI: 10.1126/science.1183218

2009 -- Escherichia Coli Infections
Escherichia coli is one of the most frequent causes of many common bacterial infections,
including cholecystitis, bacteremia, cholangitis, urinary tract infection (UTI), and traveler's
diarrhea, and other clinical infections such as neonatal meningitis and pneumonia.

The vast majority of neonatal meningitis cases are caused by E coli and group B
streptococcal infections (28.5% and 34.1% overall, respectively). Pregnant women are at a
higher risk of colonization with the K1 capsular antigen strain of E coli. This strain is also
commonly observed in neonatal sepsis, which carries a mortality rate of 8%; most survivors
have subsequent neurologic or developmental abnormalities. Low birth weight and a positive
cerebrospinal fluid (CSF) culture result portend a poor outcome. In adults, E coli meningitis is
rare but may occur following neurosurgical trauma or procedures or complicating
Strongyloides stercoralis hyperinfection involving the CNS.
E Medicine Updated: Feb 19, 2009

2009 -- Rainfall Simulation in Greenhouse Microcosms to Assess Bacterial-Associated Runoff
from Land-Applied Poultry Litter
Runoff water following a rain event is one possible source of environmental contamination
after a manure application. This greenhouse study used a rainfall simulator to determine
bacterial-associated runoff from troughs of common bermudagrass [Cynodon dactylon (L.)
Pers.] that were treated with P-based, N-based, and N plus lime rates of poultry (Gallus
gallus) litter, recommended inorganic fertilizer, and control. Total heterotrophic plate count
(HPC) bacteria, total and thermotolerant coliforms, enterococci, staphylococci, Clostridium
perfringens, Salmonella, and Campylobacter, as well as antibiotic resistance profiles for the
staphylococci and enterococci isolates were all monitored in runoff waters. Analysis following
five rainfall events indicated that staphylococci, enterococci, and clostridia levels were
related to manure application rate. Runoff release of staphylococci, enterococci, and C.
perfringens were approximately 3 to 6 log10 greater in litter vs. control treatment. In addition,
traditional indicators such as thermotolerant and total coliforms performed poorly as fecal
indicators. Some isolated enterococci demonstrated increased antibiotic resistance to
polymixin b and/or select aminoglyocosides, while many staphylococci were susceptible to
most antimicrobials tested. Results indicated poultry litter application can lead to microbial
runoff following simulated rain events. Future studies should focus on the use of
staphylococci, enterococci, and C. perfringens as indicators
J Environ Qual 38:218-229 (2009)

2009 -- Survey of Wastewater Indicators and Human Pathogen Genomes in Biosolids
Produced by Class A and Class B Stabilization Treatments.
 This study also reports the first
detection (by culture or PCR) of Staphylococcus aureus and Clostridium difficile in biosolids.
Special attention should be given to the detection of S. aureus genomes here as a link has
been suggested between this organism and infection in residents living near agricultural
class B land application sites
Applied and Environmental Microbiology, January 2009, p. 164-174, Vol. 75, No. 1

2009 -- Ischemic stroke associated with adenoviral infection in a 4-year-old boy
Summary:  We present a case of childhood arterial ischemic stroke associated with proven
adenoviral upper respiratory tract infection in a previously healthy 4-year-old boy. Adenoviral
meningitis and encephalitis have been reported repeatedly, thus confirming the
neuroinvasive capability of these viruses. However, an association between adenoviral
infection and arterial ischemic stroke has not been described thus far. HIV and varicella
zoster virus are the only microorganisms that have been consistently associated with arterial
ischemic stroke in the absence of acute central nervous system infection. In HIV-infected
individuals ischemic stroke can be caused by vasculitis and hypercoagulability.
Granulomatous arteritis of the vessel wall causes post-varicella cerebral infarction and
ischemic stroke after herpes zoster ophthalmicus. We suggest that in our patient a post-
varicella cerebral infarction-like mechanism of adenoviral spread to the affected artery wall
occurred through the ophthalmic branch of the trigeminal nerve. Adenoviruses are
neuroinvasive and inflamed conjunctiva might have permitted introduction of the virus into
ophthalmic nerve tissue. In consequence, the stenotic lesion of the artery might have been
induced by the presence of adenovirus and the subsequent inflammatory reaction. We
recommend a prompt quest for adenoviral infection in all previously healthy children with
fever and clinical presentation compatible with ischemic stroke, because timely diagnosis and
treatment could improve the outcome and hasten neurological recovery.
Wiener Klinische Wochenschrift, Volume 121, Numbers 23-24 / December, 2009

2008 -- Coliform Contamination of Vegetables Obtained from Popular Restaurants in
Guadalajara, Mexico, and Houston, Texas
There are several notable findings with the microbiological analysis of the coliforms. We
originally assumed, as many other previous studies have done [1, 13, 14], that lactose-
fermenting bacteria isolated from MacConkey agar would be E. coli. Well known E. coli
virulence properties—including the presence of enterotoxins (heat-labile and heat-stable
toxins) and enteroaggregative phenotype, the defining characteristic of enteroaggregative E.
coli [15]—can be found with other non–E. coli coliforms found in food. These results
emphasize the importance of proper identification of bacteria, through biochemical testing or
other means, because non–E. coli bacteria not only appear morphologically similar to E. coli
but also have virulence properties similar to those of E. coli.
Clinical Infectious Diseases 2008; 47:218–21

2008 -- Canada -- extrinsic allergic alveolitis (Respiratory disease)
Sewage sludge disease -- caused by endotoxin antigen contaminated dust of heat-treated

2008 -- The Long-Term Health Outcomes of Selected Foodborne Pathogens
Diarrhea and vomiting are common symptoms, and in most cases, last for only a few days.
However, most foodborne pathogens can cause, in a small percentage of cases, serious
acute and/or life-long complications,including: kidney failure; paralysis; seizures;
hearing/visual impairments and mental retardation.

2008 -- Emerging infections: a perpetual challenge
Emerging and re-emerging infectious diseases, and their determinants, have recently
attracted substantial scientifi c and popular attention. HIV/AIDS, severe acute respiratory
syndrome, H5N1 avian influenza, and many other emerging diseases have either proved fatal
or caused international alarm. Common and interactive co-determinants of disease
emergence, including population growth, travel, and environmental disruption, have been
increasingly documented and studied. Are emerging infections a new phenomenon related to
modern life, or do more basic determinants, transcending time, place, and human progress,
govern disease generation? By examining a number of historically notable epidemics, we
suggest that emerging diseases, similar in their novelty, impact, and elicitation of control
responses, have occurred throughout recorded history. Fundamental determinants, typically
acting in concert, seem to underlie their emergence, and infections such as these are likely
to continue to remain challenges to human survival.
Lancet Infect Dis 2008; 8: 710–19

2008 -- Bacterial Pneumonia Caused Most Deaths in  1918 Influenza Pandemic
The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the
influenza virus acting alone, report researchers from the National Institute of Allergy and
Infectious Diseases (NIAID), part of the National Institutes of Health. Instead, most victims
succumbed to bacterial pneumonia following influenza virus infection. The pneumonia was
caused when bacteria that normally inhabit the nose and throat invaded the lungs along a
pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.

The following study fails to mention that recycled sewage water was used for
irrigation and but did note this is the first case E. coli in feral swine in the U.S.

2007 -- Escherichia coli O157:H7 in Feral Swine near Spinach Fields and Cattle, Central
California Coast1 - CDC Recent experimental and epidemiologic studies suggest that
domestic pigs are biologically competent hosts and a potential reservoir of Escherichia coli
O157:H7 (1,2). Cattle are considered the primary reservoir of E. coli O157, but fecal
shedding by other domestic livestock and wildlife has been described (3,4). E. coli O157 was
isolated from a wild boar in Sweden, but there is limited information on its occurrence in feral
swine in the United States (5). We report findings from an environmental and laboratory
investigation after a nationwide spinach-associated outbreak of E. coli O157 in which the
outbreak strain was isolated from feral swine and other environmental samples. EID Journal
Home > Volume 13, Number 12–December 2007

2007 -- Health Survey of Residents Living Near Farm Fields Permitted to Receive Biosolids
The authors studied the health status of residents living in Wood County, OH, near farm
fields that were permitted to receive biosolids. They mailed a health survey to 607
households and received completed surveys from 437 people exposed to biosolids (living
on or within 1 mile of the fields where application was permitted) and from 176 people
not exposed to biosolids (living more than 1 mile from the fields where application was
permitted). The authors allowed for up to 6 surveys per household. Results revealed that
some reported health-related symptoms were statistically significantly elevated among
the exposed residents, including excessive secretion of tears, abdominal bloating,
jaundice, skin ulcer, dehydration, weight loss, and general weakness. The frequency of
reported occurrence of bronchitis, upper respiratory infection, and giardiasis were also
statistically significantly elevated. The findings suggest an increased risk for certain
respiratory, gastrointestinal, and other diseases among residents living near farm fields on
which the use of biosolids was permitted. However, further studies are needed to address
the limitations cited in this study.
Archives of Environmental and Occupational Health,  Volume 62, Number 1 / Spring 2007
Pages: 5 - 11

2007 -- Recurrent Hemorrhagic Stroke in Children
A Population-Based Cohort Study
Background and Purpose— Although hemorrhagic strokes (HS) account for half of all strokes
in children, rates and predictors of recurrent HS have not been studied.
Methods— We collected data on all documented cases of HS (intracerebral hemorrhage,
subarachnoid hemorrhage, and intraventricular hemorrhage, except neonatal intraventricular
hemorrhage), among 2.3 million children (<20 years) enrolled in a Northern Californian
health maintenance organization from January 1993 to December 2004. Using Kaplan-Meier
survival analyses censoring at death or loss to follow-up, we determined rates of recurrent
HS. Log rank tests were used for bivariate comparisons.
Results— Among 116 children with atraumatic incident HS followed for a mean of 4.2 years,
11 had a recurrent HS at a median of 3.1 months (range 7 days to 5.7 years), yielding an
overall 5-year cumulative recurrence rate (CRR) of 10% (95% CI, 58% to 18%). Sixty-four
percent of recurrences were within the first 6 months. Whereas children with idiopathic HS
(n=29) had no recurrences, children with structural lesions (vascular malformations or
tumors) had a 5-year cumulative recurrence rate of 13% (95% CI, 7% to 25%; 9 recurrences
among 71 children; P<0.05 compared with idiopathic). Children with medical etiologies (eg,
thrombocytopenia, hypertension) had a 5-year cumulative recurrence rate of 13% (95% CI,
3% to 41%; 2 recurrences among 16 children), but the recurrences were within the first week.
Conclusions— Overall, 1 in 10 children with HS experienced a recurrence within 5 years,
despite available therapies. Whereas idiopathic HS rarely recurred, and HS due to medical
etiologies tended to recur acutely, children with structural lesions had a high and prolonged
risk for recurrence.
Stroke. 2007;38:2658.

2007 -- Transmission of Escherichia coli O157:H7 to cattle by house flies
The main reservoir of Escherichia coli O157:H7 is the digestive tract of cattle; however, the
ecology of this food-borne pathogen is poorly understood. House flies (Musca domestica L.)
might play a role in dissemination of this pathogen in the cattle environment. In our study,
eight calves were individually exposed to house flies that were orally inoculated with a mixture
of four strains of nalidixic acid-resistant E. coli O157:H7 (NalREcO157) for 48 h. Another
eight calves were individually exposed to uninoculated flies and served as the control. Fresh
cattle feces (rectal sampling) and drinking water were periodically sampled and screened for
NalREcO157 up to 19 days after the exposure. At the end of the experiment, all calves were
euthanized and the lumen contents of rumen, cecum, colon, and rectum as well as swab
samples of gall-bladder mucosa and the recto-anal mucosa were screened for NalREcO157.
On day 1 after the exposure, fecal samples of all eight calves and drinking-water samples of
five of eight calves exposed to inoculated flies tested positive for NalREcO157. The
concentration of NalREcO157 in feces ranged over time from detectable only by enrichment
(<102) to up to 1.1 × 106 CFU/g. Feces of all calves remained positive for NalREcO157 up to
11 days after the exposure and 62% were positive until the end of experiment. Contamination
of drinking water was more variable and all samples were negative on day 19. At necropsy,
the highest prevalence of NalREcO157 was in the recto-anal mucosa region, followed by
rectal and colonic contents.
Preventive Veterinary Medicine, Volume 80, Issue 1, 15 June 2007, Pages 74-81

2007 --Toxicogenomic response to chlorination includes induction of major virulence genes
in Staphylococcus aureus.
Despite the widespread use of chlorination for microbial control in aqueous environments,
cellular response mechanisms of human pathogens, such as Staphylococcus aureus, against
chlorination remain unknown. In this work, genome-wide transcriptional analysis was
performed to elucidate cellular response of S. aureusto hypochlorous acid, an active
antimicrobial product of chlorination in aqueous solution. Our results suggest that
hypochlorous acid repressed transcription of genes involved in cell wall synthesis, membrane
transport, protein synthesis, and primary metabolism, while amino acid synthesis genes were
induced. Furthermore, hypochlorous acid induced transcription of genes encoding major
virulence factors of S. aureus, such as exotoxins, hemolysins, leukocidins, coagulases, and
surface adhesion proteins, which all play essential roles in staphylococcal virulence. This
work implies that chlorination may stimulate production of virulence factors, which provides
new insight into host-pathogen interactions and effects of chlorine application for microbial
Environ Sci Technol. 2007 Nov 1;41(21):7570-5.

2007 -- Viruses as an Etiology of Obesity
Obesity is a serious chronic disease that has numerous etiologies. The prevalence of obesity
has increased dramatically since about 1980 in the United States and worldwide in both
developed and developing countries. This rapid spread is compatible with an infectious
origin. This review discusses the 5 animal viruses and 3 human viruses that have been
shown to cause obesity and examines the evidence to date for virus-induced obesity. The
obesogenic animal viruses include canine distemper virus, Rous-associated virus type 7,
Borna disease virus, scrapie agent, and SMAM-1. The first 4 viruses attack the central
nervous system to produce obesity. SMAM-1, an avian adenovirus from India, acts directly on
adipocytes and is the only animal virus that is associated with human obesity. The 3 human
adenoviruses, adenovirus (Ad) 36, Ad-37, and Ad-5, that are associated with obesity also
affect adipocytes directly. These viruses stimulate enzymes and transcription factors that
cause accumulation of triglycerides and differentiation of preadipocytes into mature
adipocytes. Ad-5 and Ad-37 have been shown to cause obesity in animals. Ad-36 has been
studied the most and is the only human adenovirus to date that has been linked with human
obesity. Ad-36 causes obesity in chickens, mice, rats, and monkeys and was present in 30%
of obese humans and 11% of nonobese humans. In twins discordant for infection with Ad-36,
the infected twins were heavier and fatter than their cotwins. The growing body of evidence
demonstrating that viruses produce human obesity supports the concept that at least some
of the worldwide epidemic of obesity in the past 25 years is due to viral infections.
Mayo Clinic Proceedings October 2007 vol. 82 no. 10 1192-1198

2006 -- Acanthamoeba castellanii Promotion of In Vitro Survival and Transmission of
Coxsackie B3 Viruses
This work was undertaken to determine whether Acanthamoeba could play a role in the
survival and transmission of coxsackieviruses and focused on in vitro interactions between
Acanthamoeba castellanii and coxsackie B3 viruses (CVB-3). Residual virus titer evaluations
and immunofluorescence experiments revealed a remarkable CVB-3 adsorption on amoeba
surfaces and accumulation inside cells. The survival of viruses was independent of the
dynamics of amoeba replication and encystment. In addition, our results indicated that virus-
infected amoebas can release infectious viruses during interaction with human macrophages.
On the basis of these data, Acanthamoeba appears to be a potential promoter of the survival
of coxsackieviruses and their transmission to human hosts.
Eukaryotic Cell, April 2006, p. 665-671, Vol. 5, No. 4

2006 -- RNA Viral Community in Human Feces: Prevalence of Plant Pathogenic Viruses
The human gut is known to be a reservoir of a wide variety of microbes, including viruses.
Many RNA viruses are known to be associated with gastroenteritis; however, the enteric RNA
viral community present in healthy humans has not been described. Here, we present a
comparative metagenomic analysis of the RNA viruses found in three fecal samples from two
healthy human individuals. For this study, uncultured viruses were concentrated by
tangential flow filtration, and viral RNA was extracted and cloned into shotgun viral cDNA
libraries for sequencing analysis. The vast majority of the 36,769 viral sequences obtained
were similar to plant pathogenic RNA viruses. The most abundant fecal virus in this study was
pepper mild mottle virus (PMMV), which was found in high concentrations--up to 10(9) virions
per gram of dry weight fecal matter. PMMV was also detected in 12 (66.7%) of 18 fecal
samples collected from healthy individuals on two continents, indicating that this plant virus is
prevalent in the human population. A number of pepper-based foods tested positive for
PMMV, suggesting dietary origins for this virus. Intriguingly, the fecal PMMV was infectious to
host plants, suggesting that humans might act as a vehicle for the dissemination of certain
plant viruses.
PLoS Biol. 2006 Jan;4(1):e3.

2006 -- Clonal Dissemination of Escherichia coli O157:H7 Subtypes among Dairy Farms in
Northeast Ohio
To ascertain the extent to which indistinguishable strains of Escherichia coli O157:H7 are
shared between farms, molecular characterization was performed on E. coli O157:H7 isolates
recovered during a longitudinal study of 20 dairy farms in northeast Ohio. Of the 20 dairy
farms sampled, 16 were located in a primary area and 4 were located in two other distant
geographical areas. A total of 92 E. coli O157:H7 isolates obtained from bovine fecal
samples, water trough sediment samples, free-stall bedding, and wild-bird excreta samples
were characterized. Fifty genetic subtypes were observed among the isolates using XbaI and
BlnI restriction endonucleases. Most restriction endonuclease digestion profiles (REDPs)
were spatially and temporally clustered. However, four REDPs from multiple sources were
found to be indistinguishable by pulsed-field gel electrophoresis between four pairs of farms.
The geographical distance between farms which shared an indistinguishable E. coli O157:H7
REDP ranged from 9 to 50 km, and the on-farm sources sharing indistinguishable REDPs
included cattle and wild bird feces and free-stall bedding. Within the study population, E. coli
O157:H7 REDP subtypes were disseminated with considerable frequency among farms in
close geographic proximity, and nonbovine sources may contribute to the transmission of this
organism between farms.
Applied and Environmental Microbiology, April 2006, p. 2621-2626, Vol. 72, No. 4

2006 -- Method to detect infectious proteins in soils could help monitor spread of the
diseases they cause
A method to extract and quantitatively detect prions from soil samples has been devised by a
team of scientists at two National Institute for Agricultural Research (INRA) labs in France
(Environ. Sci. Technol. 2006, 40, 1497). The technique could be "a good starting point" to
help identify and map prion-contaminated farmland as well as to monitor the fate of prions
over time, notes lead author Peggy Rigou.

Prions are malformed proteins that are thought to be the infectious agents responsible for
transmissible spongiform encephalopathies (TSEs), such as mad cow disease, scrapie in
sheep, and chronic wasting disease in deer. Prions can persist in soil for years, and some
animals are suspected of contracting TSEs by drinking water or grazing on ground that was
exposed to the carcasses of dead animals; by-products from animal processing; or animal
manure, urine, or blood.

2005 --
Host Range and Emerging and Reemerging Pathogens
An updated literature survey identified 1,407 recognized species of human pathogen, 58% of
which are zoonotic. Of the total, 177 are regarded as emerging or reemerging. Zoonotic
pathogens are twice as likely to be in this category as are nonzoonotic pathogens. Emerging
and reemerging pathogens are not strongly associated with particular types of nonhuman
hosts, but they are most likely to have the broadest host ranges. Emerging and reemerging
zoonoses are associated with a wide range of drivers, but changes in land use and
agriculture and demographic and societal changes are most commonly cited. However,
although zoonotic pathogens do represent the most likely source of emerging and
reemerging infectious disease, only a small minority have proved capable of causing major
epidemics in the human population.
Emerging Infectious Diseases, Vol. 11, No. 12, December 2005

2005 -- Thinking the unthinkable: Alzheimer’s, Creutzfeldt–Jakob and Mad Cow disease:
the age-related reemergence of virulent, Foodborne, bovine tuberculosis or losing your
mind for the sake of a shake or burger
Summary The possibility of the age-related reemergence of foodborne Mycobacterium bovis
(bovine tuberculosis) as a vector for Creutzfeldt–Jakob Disease (CJD or human Mad Cow
Disease) and Mad Cow disease itself is real. The CDC reported last May of an outbreak of
CJD linked to the consumption of meat contaminated ‘‘with the agent causing’’ bovine
spongiform encephalopathy (BSE) in a New Jersey racetrack between the time frame 1995-
2004. In the opinion of experts, ample justification exists for considering a similar
pathogenesis for Alzheimer’s, Creutzfeldt–Jakob and the other spongiform encephalopathies
such as Mad Cow disease. In fact, Creutzfeldt–Jakob and Alzheimer’s often coexist and at
this point are thought to differ merely by time-dependent physical changes. A recent study
links up to 13% of all ‘‘Alzheimer’s’’ victims as really having Creutzfeldt–Jakob disease.
Bovine tuberculosis, which includes Mycobacterium bovis and M: avium  intracellulare or
paratuberculosis, is and has always been the most prevalent threat to the cattle industry, and
the USDA reports that between 20% and 40% of US dairy herds are infected with
paratuberculosis alone. The health risk for milk tainted with M: bovis has been known for
decades and there was a time not so long ago when ‘‘tuberculin-tested’’ was printed on every
milk container. Schliesser stated that meat from tuberculous animals may also constitute a
significant risk of infection. At the turn of the 20th century 25% of the many US deaths from
TB in adults were caused by M: bovis.
Medical Hypotheses (2005), Volume 64, Issue 4, Pages 699-705

2005 -- Four Laboratory-Associated Cases of Infection with Escherichia coli O157:H7
An investigation of four cases of infection with Escherichia coli O157:H7 among laboratorians
from different clinical laboratories revealed that the DNA fingerprint pattern of each case
isolate was indistinguishable from that of an isolate handled in the laboratory prior to illness.
These data suggest that the infections were laboratory acquired, and they demonstrate the
importance of laboratorians strictly adhering to biosafety practices recommended for the
handling of infectious materials.
Journal of Clinical Microbiology, June 2005, p. 2938-2939, Vol. 43, No. 6

2005 -- The Dirty Work of Promoting “Recycling” of America’s Sewage Sludge
Serious illnesses, including deaths, and adverse environmental impacts have been linked to
land application of sewage sludge. EPA and the wastewater treatment industry have worked
with Congress to fund wastewater trade associations to promote land application,
supporting industry-friendly scientists and discouraging independent research, to prevent
local governments from restricting land application and to thwart litigation against
municipalities and the industry.

2005 -- Endotoxin exposure and symptoms in wastewater treatment workers.
BACKGROUND: Wastewater treatment workers can be exposed to biological and chemical
agents resulting in work-related health effects. The aim of this study was to investigate work-
related symptoms in these workers. METHODS: Questionnaire data of 468 employees from
67 sewage treatment plants is evaluated. Personal endotoxin exposure (8 hr measurements;
n = 460) was measured in a sample of workers in three different periods over 1 year.
RESULTS: Endotoxin exposure ranged from 0.6 to 2093 endotoxin units (EU)/m(3), the
geometric mean exposure was low (27 EU/m(3)). Factor analysis yielded three clusters of
correlated symptoms: "lower respiratory and skin symptoms," "flu-like and systemic
symptoms," and "upper respiratory symptoms." Symptoms appeared to be more prevalent in
workers exposed to endotoxin levels higher than 50 EU/m(3). A significant dose-response
relationship was found for "lower respiratory and skin symptoms" and "flu-like and systemic
symptoms" (P < 0.05). CONCLUSIONS: Wastewater treatment workers reported a wide range
of symptoms that may be work-related. Microbial exposures such as endotoxin seem to play a
causal role
Am J Ind Med. 2005 Jul;48(1):30-9.

2005 -- Fatal necrotizing fasciitis and myositis in a captive common bottlenose dolphin
(Tursiops truncatus) associated with Streptococcus agalactiae
Abstract. A common bottlenose dolphin (Tursiops truncatus) was presented for necropsy
after acute onset of gastrointestinal signs and cutaneous lesions that rapidly progressed to
death. Gross and microscopic findings were characterized by locally extensive severe
necrohemorrhagic fasciitis and cellulitis, and severe necrotizing myositis in the head and
dorsocranial thorax, with numerous disseminated gram-positive cocci. Streptococcus
agalactiae was isolated from the lesions and from visceral organs (liver and lung), and it was
identified by standard microbiology techniques. This communication is the first report of
necrotizing fasciitis in a marine mammal associated with S. agalactiae.
J Vet Diagn Invest 17:617–622 (2005)

2005 -- Neuroglial activation and neuroinflammation in the brain of patients with autism.
Autism is a neurodevelopmental disorder characterized by impaired communication and
social interaction and may be accompanied by mental retardation and epilepsy. Its cause
remains unknown, despite evidence that genetic, environmental, and immunological factors
may play a role in its pathogenesis. To investigate whether immune-mediated mechanisms
are involved in the pathogenesis of autism, we used immunocytochemistry, cytokine protein
arrays, and enzyme-linked immunosorbent assays to study brain tissues and cerebrospinal
fluid (CSF) from autistic patients and determined the magnitude of neuroglial and
inflammatory reactions and their cytokine expression profiles. Brain tissues from cerebellum,
midfrontal, and cingulate gyrus obtained at autopsy from 11 patients with autism were used
for morphological studies. Fresh-frozen tissues available from seven patients and CSF from
six living autistic patients were used for cytokine protein profiling. We demonstrate an active
neuroinflammatory process in the cerebral cortex, white matter, and notably in cerebellum of
autistic patients. Immunocytochemical studies showed marked activation of microglia and
astroglia, and cytokine profiling indicated that macrophage chemoattractant protein (MCP)-1
and tumor growth factor-beta1, derived from neuroglia, were the most prevalent cytokines in
brain tissues. CSF showed a unique proinflammatory profile of cytokines, including a marked
increase in MCP-1. Our findings indicate that innate neuroimmune reactions play a
pathogenic role in an undefined proportion of autistic patients, suggesting that future
therapies might involve modifying neuroglial responses in the brain.
Ann Neurol. 2005 Jan;57(1):67-81.

2004 -- Cerebrovascular disorders in children.
Cerebrovascular disorders are an important cause of mortality and chronic morbidity in
children. International incidence rates for childhood stroke (ie, from 30 days to 18 years of
age) have ranged from 1.3 to 13 per 100,000 children. Ischemic stroke is probably more
common than hemorrhagic stroke in children. The clinical presentation of stroke in children
varies according to age and location of the stroke. Over 100 risk factors for stroke in children
have been reported, but in up to one third of cases no cause is identified. The management
and prevention of stroke in children is not well studied and current recommendations are
based on adult studies, nonrandomized trials, or expert opinion. Over half of children with
stroke will develop lifelong cognitive or motor disability and up to one third will have a
recurrent stroke. This review briefly describes the epidemiology, risk factors, evaluation,
treatment, and outcome of stroke in children.
Curr Neurol Neurosci Rep. 2004 Mar;4(2):129-38.

2004 -- Infectious Disease: The Human Costs of Our Environmental Errors
For a few exhilarating decades in the middle of the twentieth century, it seemed the world
might have a reprieve from some major infectious diseases. After coordinated worldwide
efforts had virtually eliminated smallpox and made major inroads against other infectious
diseases such as influenza, tuberculosis, and polio, some public health officials
thought we had entered a new era in which infectious diseases would no longer be among
the planet’s worst killers. By the 1980s, though, those hopes were dashed, due in large part
to the burgeoning AIDS epidemic.
Beginning around the same time, dozens of other
infectious diseases—including Lyme disease, hantavirus pulmonary syndrome,
West Nile virus, and Ebola hemorrhagic fever—were either newly recognized,
spread to new locations, or became increasingly deadly.
In 2003 alone, SARS, avian
influenza, and monkeypox were among the infectious news makers. Along with the “new”
diseases, long-time threats such as malaria surged back, now killing about 3 million people
each year and infecting at least 300 million more, according to the 2002 U.S. National
Institute of Allergy and Infectious Diseases (NIAID) publication Microbes: In Sickness and in
Environmental Health Perspectives • VOLUME 112 | NUMBER 1 | January 2004

2004 -- Persistence of Enterohemorrhagic Escherichia coli O157:H7 in Soil and on Leaf
Lettuce and Parsley Grown in Fields Treated with Contaminated Manure Composts or
Irrigation Water
  --     USDA
Outbreaks of enterohemorrhagic Escherichia coli O157:H7 infections associated with lettuce
and other leaf crops have occurred with increasing frequency in recent years. Contaminated
manure and polluted irrigation water are probable vehicles
for the pathogen in many outbreaks. In this study, the occurrence and persistence of E. coli
O157:H7 in soil fertilized with contaminated poultry or bovine manure composts or treated
with contaminated irrigation water and on lettuce and parsley grown on these soils under
natural environmental conditions was determined. Twenty-five plots, each 1.8 by 4.6 m, were
used for each crop, with five treatments (one without compost, three with each of the three
composts, and one without compost but treated with contaminated water) and five replication
plots for each treatment. Three different types of compost, PM-5 (poultry manure compost),
338 (dairy manure compost), and NVIRO-4 (alkaline-stabilized dairy manure compost), and
irrigation water were inoculated with an avirulent strain of E. coli O157:H7. Pathogen
concentrations were 107 CFU/g of compost and 105 CFU/ml of water. Contaminated compost
was applied to soil in the field as a strip at 4.5 metric tons per hectare on the day before
lettuce and parsley seedlings were transplanted in late October 2002. Contaminated
irrigation water was applied only once on the plants as a treatment in five plots for each crop
at the rate of 2 liters per plot 3 weeks after the seedlings were transplanted. E. coli O157:H7
persisted for 154 to 217 days in soils amended with contaminated composts and was
detected on lettuce and parsley for up to 77 and 177 days, respectively, after seedlings were
planted. Very little difference was observed in E. coli O157:H7 persistence based on compost
type alone. E. coli O157:H7 persisted longer (by .60 days) in soil covered with parsley plants
than in soil from lettuce plots, which were bare after lettuce was harvested. In all cases,
E. coli O157:H7 in soil, regardless of source or crop type, persisted for .5 months after
application of contaminated compost or irrigation water.
Journal of Food Protection, Vol. 67, No. 7, 2004, Pages 1365–1370

2004 -- Fate of Salmonella enterica Serovar Typhimurium on Carrots and Radishes Grown in
Fields Treated with Contaminated Manure Composts or Irrigation Water
Three different types of compost, PM-5 (poultry manure compost), 338 (dairy cattle manure
compost), and NVIRO-4 (alkaline-pH-stabilized dairy cattle manure compost), and irrigation
water were inoculated with an avirulent strain of Salmonella enterica serovar Typhimurium at
107 CFU g–1 and 105 CFU ml–1, respectively, to determine the persistence of salmonellae
in soils containing these composts, in irrigation water, and also on carrots and radishes
grown in these contaminated soils. A split-plot block design plan was used for each crop, with
five treatments (one without compost, three with each of the three composts, and one without
compost but with contaminated water applied) and five replicates for a total of 25 plots for
each crop, with each plot measuring 1.8 x 4.6 m. Salmonellae persisted for an extended
period of time, with the bacteria surviving in soil samples for 203 to 231 days, and were
detected after seeds were sown for 84 and 203 days on radishes and carrots, respectively.
Salmonella survival was greatest in soil amended with poultry compost and least in soil
containing alkaline-pH-stabilized dairy cattle manure compost. Survival profiles of Salmonella
on vegetables and soil samples contaminated by irrigation water were similar to those
observed when contamination occurred through compost. Hence, both contaminated manure
compost and irrigation water can play an important role in contaminating soil and root
vegetables with salmonellae for several months.
Applied and Environmental Microbiology, April 2004, p. 2497-2502, Vol. 70, No. 4

2004 -- Antibodies to Periodontal Pathogens and Stroke Risk
Background and Purpose— The association between cerebrovascular events and
periodontitis has been found in few studies based on clinical periodontal examinations.
However, evidence on the association between periodontal pathogens and stroke is lacking.
Therefore, the aim of the study was to investigate whether elevated levels of serum
antibodies to major periodontal pathogens predict stroke in a case–control study.
Methods— The study population comprised 6950 subjects (aged 45 to 64 years) who
participated in the Mobile Clinic Health Survey in 1973 to 1976 in Finland. During a follow-up
of 13 years, a total of 173 subjects had a stroke. From these, 64 subjects had already
experienced a stroke or had signs of coronary heart disease (CHD) at baseline, whereas 109
subjects were apparently healthy. Two controls per case were matched for age, gender,
municipality, and disease status. Serum IgG and IgA class antibody levels to the periodontal
pathogens, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, were
determined by multiserotype enzyme-linked immunosorbent assay.
Results— The cases identified during the follow-up that were free of stroke or CHD at
baseline were more often IgA-seropositive for A. actinomycetemcomitans than were their
controls, 41.3% versus 29.3%. Compared with the seronegative, the seropositive subjects
had a multivariate odds ratio of 1.6 (95% CI, 1.0 to 2.6) for stroke. The patients with a history
of stroke or CHD at baseline were more often IgA-seropositive for P. gingivalis than were
their controls, 79.7% versus 70.2%. When compared with the seronegative, the seropositive
subjects had an odds ratio of 2.6 (1.0 to 7.0) for secondary stroke.
Conclusions— The present prospective study provides serological evidence that an
infection caused by major periodontal pathogens is associated with future stroke
Stroke. 2004;35:2020-2023;35/9/2020

2004 -- Protease-Resistant Human Prion Protein and Ferritin Are Cotransported across
Caco-2 Epithelial Cells: Implications for Species Barrier in Prion Uptake from the Intestine
Foodborne transmission of bovine spongiform encephalopathy (BSE) to humans as variant
Creutzfeldt-Jakob disease (CJD) has affected over 100 individuals, and probably millions of
others have been exposed to BSE-contaminated food substances. Despite these obvious
public health concerns, surprisingly little is known about the mechanism by which PrP-scrapie
(PrPSc), the most reliable surrogate marker of infection in BSE-contaminated food, crosses
the human intestinal epithelial cell barrier. Here we show that digestive enzyme (DE)
treatment of sporadic CJD brain homogenate generates a C-terminal fragment similar to the
proteinase K-resistant PrPSc core of 27-30 kDa implicated in prion disease transmission and
pathogenesis. Notably, DE treatment results in a PrPSc-protein complex that is avidly
transcytosed in vesicular structures across an in vitro model of the human intestinal epithelial
cell barrier, regardless of the amount of endogenous PrPC expression. Unexpectedly, PrPSc
is cotransported with ferritin, a prominent component of the DE-treated PrPSc-protein
complex. The transport of PrPSc-ferritin is sensitive to low temperature, brefeldin-A, and
nocodazole treatment and is inhibited by excess free ferritin, implicating a receptor- or
transporter-mediated pathway. Because ferritin shares considerable homology across
species, these data suggest that PrPSc-associated proteins, in particular ferritin, may
facilitate PrPSc uptake in the intestine from distant species, leading to a carrier state in
The Journal of Neuroscience, December 15, 2004, 24(50):11280-11290;24/50/11280

2003 -- Inhaled endotoxin and organic dust particulates have synergistic proinflammatory
effects in equine heaves (organic dust-induced asthma)
BACKGROUND: Equine heaves is a naturally occurring organic dust-induced asthma
characterized by airway neutrophilia, mucus hypersecretion and obstructive lung dysfunction.
However, the relative role of different dust components in disease severity remains unclear.
OBJECTIVE: This study investigated the relative contribution of inhaled endotoxin and
organic dust particulates (mainly mould spores) in inducing heaves in heaves-susceptible
horses. METHODS: Control and heaves-susceptible horses received inhalation challenges
with hay dust suspension (HDS) before and after lipopolysaccharide (LPS) depletion. Heaves-
susceptible horses also received inhalation challenge with HDS particulates with and without
the addition of LPS and were housed in two separate dusty environments during which mould
and endotoxin exposure was measured. The airway inflammatory and functional response to
each challenge was measured. RESULTS: Depletion of endotoxin from HDS attenuated the
airway neutrophilia and abrogated the airway dysfunction induced in heaves horses by
inhaled HDS. The airway response was re-established by adding back LPS to the depleted
HDS, confirming that the attenuation in airway response was due specifically to endotoxin
depletion. Interestingly, the magnitude of alteration in airway response following endotoxin
depletion and add-back was greater than that which could be attributed solely to endotoxin
per se, indicating that the LPS activity was enhanced by the other dust components.
Consistent with this possibility, washed particulates harvested from HDS enhanced the airway
response to inhaled LPS in heaves horses. Heaves horses given two different hay/straw
challenges had a significantly different severity of airway inflammation and dysfunction,
despite airborne dust and endotoxin concentrations in the horses' breathing zones being
similar. CONCLUSION: Although inhaled endotoxin appears not to be the only determinant of
disease severity in heaves, it does contribute significantly to the induction of airway
inflammation and dysfunction. This contribution is largely via the synergistic action of inhaled
endotoxin and organic dust particulates, although other soluble dust components also
contribute to a lesser degree.
Clin Exp Allergy. 2003 May;33(5):676-83.

2002 -- Interactions of pathogens and irritant chemicals in land-applied sewage sludges
Fertilisation of land with processed sewage sludges, which often contain low levels of
pathogens, endotoxins, and trace amounts of industrial and household chemicals, has
become common practice in Western Europe, the US, and Canada. Local governments,
however, are increasingly restricting or banning the practice in response to residents
reporting adverse health effects. These self-reported illnesses have not been studied and
methods for assessing exposures of residential communities to contaminants from processed
sewage sludges need to be developed.
To describe and document adverse effects reported by residents, 48 individuals at ten sites
in the US and Canada were questioned about their environmental exposures and symptoms.
Information was obtained on five additional cases where an outbreak of staphylococcal
infections occurred near a land application site in Robesonia, PA. Medical records were
reviewed in cases involving hospitalisation or other medical treatment. Since most complaints
were associated with airborne contaminants, an air dispersion model was used as a means
for potentially ruling out exposure to sludge as the cause of adverse effects.
Affected residents lived within approximately 1 km of land application sites and generally
complained of irritation (e.g., skin rashes and burning of the eyes, throat, and lungs) after
exposure to winds blowing from treated fields. A prevalence of Staphylococcus aureus
infections of the skin and respiratory tract was found. Approximately 1 in 4 of 54 individuals
were infected, including 2 mortalities (septicaemia, pneumonia). This result was consistent
with the prevalence of S. aureus infections accompanying diaper rashes in which the
organism, which is commonly found in the lower human colon, tends to invade irritated or
inflamed tissue.
When assessing public health risks from applying sewage sludges in residential areas,
potential interactions of chemical contaminants with low levels of pathogens should be
considered. An increased risk of infection may occur when allergic and non-allergic reactions
to endotoxins and other chemical components irritate skin and mucus membranes and
thereby compromise normal barriers to infection.
BMC Public Health 2002, 2:11

2001 -- Bacterial infections of free-living amoebae.
Free-living amoebae are a diverse group of ubiquitous unicellular organisms, some of which
cause severe central nervous system infections and keratitis. However, the focus of research
has shifted from the direct pathogenic effects of free-living amoebae towards their role as
carriers of pathogenic bacteria. Large outbreaks of legionellosis with numerous fatal cases,
both in hospitals and in the community, appear to be the visible tip of the iceberg of complex
relationships between amoebae and bacteria in biofilms. The recognition of amoebae as
reservoirs and vehicles for bacterial spread leads us to public health issues such as the
development of pathogenicity, antibiotic resistance, quality of public water supplies, housing
standards, sanitation and decontamination measures. In this review we discuss bacterial
infections of free-living amoebae from both a "biological" and general "infection control" point
of view.
Res Microbiol. 2001 Sep;152(7):613-9.

2001 -- Parkinsonism caused by Lipopolysaccharides of Salmonella Minnesota (a Case
A laboratory worker aged 22 was accidentally contaminated with 10 microgram Salmonella
minnesota lipopolysaccharides (LPS) through an open wound on the left thumb. A strong
sepsis-like inflammatory reaction to LPS started with fever, flu-like-symptoms, cough with
dyspnoea and vomiting. Three weeks after the contamination she suffered from generalized
cramps, disturbances of sensibility and symptoms of parkinsonism (bradykinesia, rigidity,
tremor, stiffness). These symptoms were increasing over the years due to the chronic
inflammation of the central nervous system caused by LPS (6600 pg LPS / ml cerebrospinal
fluid measured 6 years after the contamination with LPS).
Poster presentation at the XIV International Congress on Parkinson's Disease

2001 -- Blood borne transit of CJD from brain to gut at early stages of infection
Background: In Creutzfeldt-Jakob disease (CJD) and other related transmissible spongiform
encephalopathies it is critical to understand the various pathways by which the infectious
agent spreads to different organs.
Methods We injected a CJD agent into mice, either intracerebrally (ic) or intraperitoneally
(ip) and monitored the progressive appearance of abnormal PrP in peripheral tissues over
Results Abnormal PrP was detected in lymphoreticular tissues of the gastrointestinal tract as
early as 28 to 32 days after infection by both routes. This change persisted until the terminal
stages of disease. In contrast, abnormal PrP was not detected in brain or spinal cord until 80
to 120 days after ic inoculation, or until 170 days after ip inoculation.

Conclusions Brain lacks significant lymphatic drainage, and has little infectivity before 40
days, even after ic inoculation. Thus the infectious inoculum must spread to the gut by a
vascular route, a direction opposite to that generally assumed. This interpretation is
consistent with previous studies demonstrating white blood cell infectivity as well as
perivascular PrP accumulations in CJD. Notably, enteric infection at early as well as later
stages of disease, and regardless of the route of agent entry,
implicates potential
environmental spread by fecal matter.
BMC Infectious Diseases 2001, 1:20

2000 -- Chlordane Uptake and Its Translocation in Food Crops
Chlordane is a member of the persistent organic pollutants (POPs), a group of chemicals
characterized by extremely long residence in the environment after application. Technical
chlordane, composed of a large number of components, is a synthetic organochlorine
substance that was used primarily as an insecticide. Uptake by root crops of persistent soil
residues of chlordane was noted early in the chronology of the material. The present report
is the first comprehensive study of the uptake of weathered soil residues of chlordane and its
translocation throughout the tissues of food crops under both greenhouse and field
conditions. The data show that for all 12 crops chlordane is not limited to root tissue but is
translocated from the root to some of the aerial tissues. Chlordane accumulation in edible
aerial tissue appears to be dependent on plant physiology. As expected, chlordane was
detected in the edible root tissue of the three root crops examined, carrots, beets, and
potatoes. In the remaining crops chlordane was detected in the edible aerial tissue of
spinach, lettuce, dandelion, and zucchini, whereas it was not detected in edible aerial tissue
of tomatoes, peppers, and corn; trace amounts of chlordane were detected in the edible
aerial tissue of bush beans and eggplant. Under the conditions of the field trial the data
indicate that for weathered chlordane residues, the soil-to-plant uptake route dominates over
the air-to-plant uptake route. This is the case even when the soil concentration of the
recalcitrant, weathered residues, for which volatilization is expected to be minimal, is as high
as it would be directly following application. Greenhouse trials confirm this observation for
zucchini, a member of the Cucurbitaceae family, which bioaccumulates weathered chlordane
very efficiently in its edible fruits
J. Agric. Food Chem., 2000, 48 (5), pp 1909–1915

2000 -- Waterborne nosocomial [hospital] infections
Abstract  Waterborne pathogens cause infections in health-care facilities. Despite guidelines
addressing these pathogens, outbreaks and pseudo-outbreaks continue to occur. We
reviewed recent reports of infections caused by Pseudomonas aeruginosa,
Stenotrophomonas maltophilia, Chryseobacterium species, nontuberculous mycobacteria,
and Legionella species. Mycobacterium avium complex (MAC) infection in HIV patients has
been linked to hospital water distribution systems; molecular subtyping showed that MAC
isolates in patients and hospital water were identical. In immunosuppressed patients,
Fusarium infection has been linked to the hospital water distribution system; again molecular
subtyping showed that isolates from patients and the water supply were identical. Parasites,
especially Cryptosporidium, and viruses have also been implicated in nosocomial infection.
Transmission occurs via contact, ingestion, aspiration, or aerosolization of potable water, or
via the hands of health-care workers. Interventions designed to interrupt transmission of
waterborne pathogens have included the use of antimicrobial handwashes, targeted
disinfection of the water supply, and, in high-risk populations, restricting the use of tap water.
Current Infectious Disease Reports, Volume 2, Number 6 / December, 2000

1999 -- Sludge Magic at the EPA
David Lewis, EPA
According to scientists working for the Environmental Protection Agency's Office of
Research & Development, the Sludge Rule on land application of municipal wastes (40
CFR Part 503) promulgated in 1993 may be the most scientifically unsound action ever
taken by the agency. Rather than being protective, the rule actually threatens public
health and the environment. --- Disease-causing microorganisms that can lie dormant or
proliferate in soil treated with sludge are even more disconcerting to microbiologists. Samples
taken this year from land [Alice Minter Trust farm] in north Kansas City contained 650,000
salmonella and E. coli bacteria per 100 grams of soil -many thousands of times higher than
what is considered safe by public health officials. The source, apparently, was sludge applied
in the area before 1992.

1999 -- Bacterial Toxins: Friends or Foes?
Many emerging and reemerging bacterial pathogens synthesize toxins that serve as primary
virulence factors. We highlight seven bacterial toxins produced by well-established or newly
emergent pathogenic microbes. These toxins, which affect eukaryotic cells by a variety of
means, include Staphylococcus aureus -toxin, Shiga toxin, cytotoxic necrotizing factor type 1,
Escherichia coli heat-stable toxin, botulinum and tetanus neurotoxins, and S. aureus toxic-
shock syndrome toxin. For each, we discuss the information available on its synthesis and
structure, mode of action, and contribution to virulence. We also review the role certain toxins
have played in unraveling signal pathways in eukaryotic cells and summarize the beneficial
uses of toxins and toxoids. Our intent is to illustrate the importance of the analysis of
bacterial toxins to both basic and applied sciences.
Emerging Infectious Diseases, Vol. 5, No. 2, March-April 1999

1999 -- Neurotoxicity from Municipal Sewage Sludge
In this case, industrial waste in the subject's household water supply included numerous
chemicals such as lead (1000 ppb) and manganese (100 ppb) (these values above the
maximum concentration levels permitted). Due to the clay under the soil, the drainage flowed
towards the subject's property. The family's livelihood, a herd of 150 cattle, deteriorated to
the point where they were given up and the property was abandoned.
Method: Neuropsychological testing of 9 family members.
Based on results of the Neurotoxicity Screening Survey, symptoms consistent with
neurotoxicity were found in all who completed the test. The two children born and raised on
the farm have been classified by their schools as mildly retarded and having attention-deficit
disorders, although there was no family history of these illnesses.
Similar results were found in numerous family members. Case 1 will be presented here.

1999 -- Free-living Amoebae Protecting Legionella in Water: The Tip of an Iceberg?
Bacteria are a main food source for free-living amoebae inhabiting aquatic systems. Some
bacteria however, have the ability to prevent intracellular destruction and can survive and
grow in amoebic cells as endosymbionts. Free-living amoebae are well adapted to their
hostile environmental conditions and are resistant to both desiccation, elevated temperatures
and various disinfectants. For their endosymbionts, amoebae represent perfect vectors,
providing both protection against adverse environmental conditions and transportation.
There is increasing interest in the potential role of free-living amoebae as reservoirs and
vectors of pathogenic bacteria. The best known of such pathogenic bacteria is Legionella,
and several studies provide evidence for the importance of the amoeba-bacterium
relationship in the biology and epidemiology of pneumonia caused by this pathogen.
Although the relative importance of endosymbiosis of this kind is unknown when it comes to
other human bacterial infections and the exact role of amoebic hosts in bacterial survival,
multiplication and transmission in the environment is still poorly understood,
naming free-
living amoebae the "Trojan horses" of the microbial world is appropriate
Scandinavian Journal of Infectious Diseases, 1999, Vol. 31, No. 4, Pages 383-385

1999 -- Changes in Antimicrobial Resistance among Salmonella enterica Serovar
Typhimurium Isolates from Humans and Cattle in the Northwestern United States,
We compared antimicrobial resistance patterns of Salmonella enterica serovar
Typhimurium (ST) of isolates from humans (n = 715) and cattle (n = 378) in the Pacific
Northwest from 1982 through 1997. The major changes in antimicrobial resistance can
be attributed to the widespread clonal dissemination of multidrug-resistant definitive
phage type 104 ST.
MR-DT104 was first detected almost simultaneously in several geographic areas, including
the United Kingdom (15), the United States (13), and Canada (16). Molecular genetic studies
indicate that the same gene cassette accounts for multiple resistance in isolates from these
and other diverse geographic areas (17,18). This study not only provides supporting
evidence that MR-DT104 from different regions are clonal in origin, but refutes the notion
that the multiple antimicrobial resistance of this clone was due to acquisition of new
resistance genes by indigenous ST in each region.
Emerging Infectious Diseases, Vol. 5, No. 6, November–December 1999

1998 -- Multiple sources of Escherichia coli O157 in feedlots and dairy farms in the
Northwestern USA
-- U of Wash. And USDA
Samples from cattle, other domestic and wild animals, flies, feeds, and water-troughs were
collected from 12 cattle farms and tested for Escherichia coli O157. E. coli O157 was isolated
from bovine fecal samples on all 12 farms with a within herd prevalence ranging from 1.1% to
6.1%. E. coli O157 was also found in 1 of 90 (1.1%) equine fecal samples, 2 of 65 (3.1%)
canine fecal samples, 1 of 200 pooled bird samples (0.5%), 2 of 60 pooled fly samples
(3.3%), and 10 of 320 (3.1%) water-trough sample sets (biofilm and water). No E. coli O157
were isolated from 300 rodents, 33 cats, 34 assorted wildlife, or 335 cattle feed samples.
Indistinguishable pulsed-field gel electrophoresis patterns of XbaI digested chromosomal
DNA and Shiga toxin types were observed for bovine and water-trough isolates from two
farms and for one equine and two bovine isolates from one farm.
Preventive Veterinary Medicine, Volume 35, Issue 1, 16 April 1998, Pages 11-19

1998 -- Role of Infection as a Risk Factor for Atherosclerosis, Myocardial Infarction, and
An increasing body of evidence has linked infections to atherosclerosis and thrombosis.
Herpesviruses cause atherosclerosis in experimental animals. Herpesviruses can also be
detected in atherosclerotic lesions in humans. Cytomegalovirus may play a role in
arteriosclerosis in transplanted hearts, and this virus, together with tumor suppressor protein
p53, can be found in restenosis lesions following angioplasty.Chlamydia pneumoniae and
dental infections are associated with coronary heart disease in cross‐sectional and
longitudinal studies, and preceding respiratory infections are associated with ischemic stroke.
Infections may favor formation of atherosclerosis and thrombosis by elevation of blood levels
of fibrinogen, leukocytes, clotting factor, and cytokines and by alteration of the metabolism
and functions of endothelial cells and monocyte macrophages. Low‐grade infections may
also be one of the causes of the inflammatory reaction observed in atherosclerotic lesions
and acute ischemic symptoms, reflected in elevated levels of C‐reactive protein. These
observations warrant further studies in this field.
Clinical Infectious Diseases 1998;26:719–734

1998 -- Invasive group A streptococcal disease in metropolitan Atlanta: a population-based
Active, population-based surveillance for invasive group A streptococcal (GAS) disease was
conducted in laboratories in metropolitan Atlanta from 1 January 1994 through 30 June 1995.
Clinical and laboratory records were reviewed and isolates characterized. One hundred and
eighty-three cases of invasive GAS disease were identified (annual incidence, 5.2 cases/100,
000). The incidence was highest among blacks (9.7/100,000 per year; relative risk (RR),
1.92; confidence interval (CI), 1.69-2.19; P < .0001) and the elderly, particularly nursing
home residents (RR, 13.66; CI, 7.07-26.40; P < .0001). The mean age of patients was 41.3
years (range, 0-95 years). Skin and soft-tissue infections were most common. Mortality was
14.4%; risk of death was significantly higher for patients with streptococcal toxic shock
syndrome (STSS) (RR, 9.73; CI, 3.34-29; P = .0008) and individuals infected with M-type 1
(RR, 7.40; CI, 1.5-16; P = .0084). Fourteen percent of invasive GAS infections were STSS
and 3% were
necrotizing fasciitis. Invasive GAS disease was associated with varicella
infection in children (RR, 12.19; CI, 5.58-26.62; P < .0001). M (or emm) types included M1
(16%), M12 (12%), and M3 (11%). Continued study of GAS disease is essential to further
define risk factors and risk of secondary cases and to develop effective prevention strategies.
Clin Infect Dis. 1998 Jul;27(1):150-7.

1997 -- Australia -- Determination of Statement of Principles concerning EXTRINSIC
ALLERGIC ALVEOLITIS ICD CODE: 495 Veterans’ Entitlements Act 1986 -- “antigenic
source” Sewage sludge contaminated with micro-organisms -- Fertilizer contaminated with
micro-organisms -- Compost dust contaminated with micro-organisms

1997 -- Chronic Sequelae of Foodborne Disease
The term foodborne disease encompasses a variety of clinical and etiologic conditions and
describes a subset of enteric disease (1-4), which in the United States ranks second in
prevalence to respiratory disease (2). In foodborne disease, the food may act as a vehicle
for the transmission of actively growing microorganisms or products of metabolism (toxins), or
it may have a passive role as a vehicle for the transmission of nonreplicating bacteria,
viruses or protozoa, or stable biologic toxins. In most cases, the clinical conditions usually
associated with foodborne disease are acute: diarrhea, vomiting, or other gastrointestinal
manifestations such as dysentery. However, other pathophysiologic responses may occur
independently or accompany acute-phase responses (1-4). A number of chronic sequelae
may result from foodborne infections, including ankylosing spondylitis, arthropathies, renal
disease, cardiac and neurologic disorders, and nutritional and other malabsorptive disorders
(incapacitating diarrhea). The evidence that microorganisms or their products are either
directly or indirectly associated with these long-term sequelae ranges from convincing to
circumstantial (1-4). The reason for this disparity is that, except in rare circumstances,
chronic complications are unlikely to be identified or epidemiologically linked to a foodborne
cause because these data are not systematically collected. Moreover, host symptoms
induced by a specific pathogen or product of a pathogen are often wide-ranging and
overlapping and therefore difficult to link temporally to a specific incident. These impediments
manifest themselves because the problems associated with chronic disease can result from
an infection without overt illness. Alternatively, the chronic sequelae may be unrelated to the
acute illness and may occur even if the immune system successfully eliminates the primary
infection; therefore, activation of the immune system may initiate the chronic condition as a
result of an autoimmune response (2-4). The variability of the human response—from overt
illness to chronic carrier status—is perhaps the most confounding issue.
Emerging Infectious Diseases, vol 3, No. 4, Oct.-Dec. 1997

1996 -- Arthritis From Foodborne Bacteria?
People who have had bacterial food poisoning may have potential for illness other than just
the temporary inconvenience of diarrhea and vomiting. "Certain individuals may suffer
chronic joint diseases, such as reactive arthritis, after being infected with bacteria ingested
with food," says James L. Smith. Infections from four rather common foodborne
pathogens'Campylobacter, Salmonella, Shigella, or Yersinia—may lead to reactive arthritis,
he says.

The following study failed to mention sewage sludge used as a fertilizer or recycled water
used to irrigate parks and school grounds.

1996 --
Emerging Foodborne Pathogens: Escherichia coli O157:H7 as a Model of
Entry of a New Pathogen into the Food Supply of the Developed World
In 1982, an investigation by the Centers for Disease Control and Prevention (CDC) of two
outbreaks of severe bloody diarrhea, associated with the same fastfood restaurant chain, led
to the identification of a strain of Escherichia coli, one that expressed O antigen 157 and H-
antigen 7, that had not previously been recognized as a pathogen (1, 2). Subsequently,
this strain was shown to belong to a category of E. coli that produce toxins which are similar
to Shiga toxin of Shigella dysenteriae and distinct from previously described E. coli heat-
stable and heat-labile toxins. As data were accumulating on the role of E. coli O157:H7
as a pathogen, parallel work in Canada was uncovering high rates of infection with this and
other Shiga In 1982, an investigation by the Centers for Disease Control and Prevention
(CDC) of two outbreaks of severe bloody diarrhea, associated with the same fastfood
restaurant chain, led to the identification of a strain of Escherichia coli, one that expressed O
antigen 157 and H-antigen 7, that had not previously been recognized as a pathogen (1, 2).
Subsequently, this strain was shown to belong to a category of E. coli
that produce toxins which are similar to Shiga toxin of Shigella dysenteriae and distinct from
previously described E. coli heat-stable and heat-labile toxins. As data were accumulating on
the role of E. coli O157:H7 as a pathogen, parallel work in Canada was uncovering
high rates of infection with this and other Shiga toxin-producing E. coli in patients with the
hemolytic uremic syndrome (3, 4). Subsequent research has indicated that E. coli O157:H7 is
the cause of 85-95 percent of cases of hemolytic uremic syndrome in North America, and
that non-0157 Shiga toxin producing E. coli are responsible for another 5-15 percent (5).
toxin-producing E. coli in patients with the hemolytic uremic syndrome (3, 4). Subsequent
research has indicated that E. coli O157:H7 is the cause of 85-95 percent of cases of
hemolytic uremic syndrome in North America, and that non-0157 Shiga toxinproducing
E. coli are responsible for another 5-15 percent (5). ---- A bovine reservoir of E. coli O157:H7
has been suspected ever since the first human outbreak was linked with ground beef
consumption in 1982. Prior to that time, neither the US Department of Agriculture
(USDA) Animal Laboratories nor the Pennsylvania State University Veterinary Research
Laboratory had ever detected this serotype in any of its samples (1). Since then, numerous
studies in several countries have shown that this organism is present in the gastrointestinal
tract of varying percentages of cattle (table 1).
Epidemiol Rev Vol. 18, No. 1, 1996

1996 -- A cluster of Cancer Deaths among wastewater treatment workers
European Journal of Epidemiology 12:659-660, 1996

1994 -- Adhesion and Its Role in the Virulence of Enteropathogenic Escherichia coli
Escherichia coli is the major constituent of the human aerobic fecal flora. Despite its
occurrence as a commensal in the intestine, it was proposed that certain E. coli strains may
be responsible for outbreaks of infantile diarrhea (163). Although evidence accrued to
support this hypothesis, acceptance of the role of E. coli as an enteric pathogen came in
1945 when Bray demonstrated that a distinct serological strain of E. coli was responsible for
an outbreak of infantile diarrhea (29). When a serotyping scheme for E. coli was developed,
Bray's strain was shown to belong to serogroup 0111. Epidemiological and microbiological
studies in many countries followed, and E. coli isolates belonging to a number of 0
serogroups were implicated in outbreaks of infantile diarrhea. By the mid-1950s, at
least 13 E. coli 0 serogroups were considered to be causative agents of the disease (124,
163, 171). Not all E. coli isolates within these 0 serogroups are pathogenic (126, 206); certain
O:H serotypes in each 0 serogroup are associated with disease (124, 171, 210). A clonal
theory has been proposed as a reason for the restriction of pathogenicity to certain O:H
types (87, 153, 195). The E. coli serogroups and serotypes traditionally associated with
infantile diarrhea are shown in Table 1. Evidence will be presented in this review to show that
pathogenicity is not restricted to serogroup or serotype.
CLINICAL MICROBIOLOGY REVIEWS, Apr. 1994, p. 152-173 Vol. 7, No. 2

1993 -- Sludge Disposal: Sanitary Landfill-Open Dump-Superfund Site?
Journal of Proceedings of the New Mexico Conference On The Environment, sponsored by
Governor Bruce King, September 13-15, 1992. The Proceeding were published in February
1993 -- The paper concludes that sludge can not be safely disposed of on farmland
because: 1) only 28 out of 400 toxic pollutants are proposed for regulation, 2) 15 out of 25
toxic inorganics on the superfund list are not included, 3) Thirty-three pollutants considered
hazardous for land disposal are not included.

1993 -- Virulence of Enterohemorrhagic Escherichia coli 091:H21
Clinical Isolates in an Orally Infected Mouse Model -- Maryland
Eschterichia coli K-12 strains producing high levels of Shiga-like toxin type II (SLT-II) but not
SLT-I were previously shown to be virulent in an orally infected, streptomycin-treated mouse
model. In this investigation, we tested the virulence of several SLT-II-producing
enterohemorrhagic E. coli (EHEC) isolates from patients with hemorrhagic colitis or hemolytic
uremic syndrome. All of the strains tested were able to colonize the mouse intestine.
However, only two strains were consistently virulent for mice: 091:1121 strain B2F1(Str),
which was previously shown to carry two copies of si-II-related toxins, and 091:H21 strain
H414-36/89(Strr), which was found in this study to contain three genes from the si-Hi group.
The oral 50%o lethal doses of strains B2F1(Strr) and H414-36/89(Strr) when fed to
streptomycin-treated mice were less than 10 bacteria. Histological sections from moribund
mice fed the 091:H21 strains demonstrated extensive renal tubular necrosis; however,
hematological results were not consistent with a diagnosis of hemolytic uremic syndrome.
The central role of SLT in the virulence of the 091:1121 EHEC strains was supported by the
finding that streptomycin-treated mice preinoculated with monoclonal antibody specific for
SLT-II survived oral challenge with either B2Fl(Strr) or H414-36/89(Strr). The basis for the
variation in virulence among the SLT-II-producing EHEC strains tested was not determined.
However, a correlation between the capacity of an EHEC strain to grow in small intestinal
mucus and lethality in the streptomycin-treated mice was observed.
INFECTION AND IMMUNITY, Sept. 1993, p. 3832-3842, Vol. 61, No. 9

1993 -- The changing epidemiology of invasive group A streptococcal infections and the
emergence of streptococcal toxic shock-like syndrome.
A retrospective population-based study. OBJECTIVE. To determine disease incidence and
changes in the epidemiology of invasive group A streptococcal infections in a community in
Arizona. DESIGN AND SETTING. We retrospectively surveyed microbiology records from all
10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes
isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and
March 1990. Demographic and clinical information was abstracted from the medical records
of these patients. PATIENTS. A total of 128 patients with a median age of 53.5 years (range,
6 months to 96 years). OUTCOME MEASURES. Racial/ethnic differences in disease
incidence; mortality and changes in the clinical spectrum of disease over the study period.
RESULTS. The annual age-adjusted incidence was 4.3 per 100,000 but was 46.0 per
100,000 among Native Americans. Advanced age, age less than 5 years, hypotension, and
multi-organ system involvement were significantly associated with increased mortality. From
1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal
impairment, and gastrointestinal involvement increased significantly (chi 2 for trend P < or = .
02 for each feature). A toxic shock-like syndrome occurred in 8% of infections since 1988,
compared with none of the infections between 1985 and 1987 (P = .04). Patients with the
syndrome were younger than patients with other invasive infections (median age 15 vs 54
years, P = .02), and were less likely to have underlying medical conditions (P = .008).
CONCLUSIONS. Significant changes occurred in the spectrum of invasive group A
streptococcal infections in Pima County, Arizona, between 1985 and 1990. Native Americans
were at increased risk of acquiring these infections. Patients with the streptococcal toxic
shock-like syndrome had epidemiologic features that distinguished them from patients with
other invasive infections, including younger age and less underlying illness. JAMA. 1993 Jan

1990 -- Stroke in infective endocarditis
We reviewed 212 consecutive episodes of infective endocarditis in 203 patients at six
hospitals between 1978 and 1986 and found that 21% were complicated by stroke. Of 133
episodes involving native mitral and/or aortic valves, brain ischemia occurred in 19%, brain
hemorrhage in 7%, and non-central nervous system emboli in 11%; vegetations were
identified in 56% of 113 adequate echocardiograms and did not correlate with risk of
embolism. In native-valve endocarditis, most (74%) ischemic strokes had occurred by the
time of presentation and an additional 13% occurred less than or equal to 48 hours after
diagnosis; the incidence of brain ischemia was 13% on presentation, 3% during the first 48
hours of hospitalization, and 2%-5% during the remainder of the acute course. Stroke
recurred at a rate of 0.5%/day, often heralding relapse/uncontrolled infection. Only 9% of
ischemic infarcts were large (all in patients with Staphylococcus aureus infection), while 8%
were small and subcortical. Brain hemorrhage occurred primarily at the time of presentation,
particularly in intravenous drug abusers, and was associated with uncontrolled S. aureus
infection with pyogenic arteritis. Ischemic and hemorrhagic stroke continue to be frequent
and important in patients with infective endocarditis and are clustered during uncontrolled
Stroke. 1990;21:695-700

1989 -- Federal Register 503 list of EPA documented disease organisms in sludge - biosolids.

1989 -- Federal Register 503 list of EPA documented cancer causing chemicals in sludge -

1988 -- Occurrence of Pathogens in Distribution and Marketing Municipal Sludges
"Although the use of sludge as a soil amendment is attractive, it is not without potential health
risks. Toxic chemicals, including heavy metals and industrial organics, may enter the food
chain and present long-term health risks."  -- The plague causing bacteria Yersinia pestis
was consistently found in static pile compost. CDC authorities state,  "Outbreaks in people
still occur in rural communities or in cities." -- significant increases in bacterial populations,
including salmonellae, occurred during subsequent production of commercial s o i l
amendment products.

1988 -- Experimental Infection of Phlebotomus Papatasi with Sand Fly Fever Sicilian Virus
Experimental studies were conducted to evaluate humans as hosts infecting the sand fly
Phlebotomus papatasi with sand fly fever Sicilian (SFS) virus. Viral antigen and infectious
virus circulated in the blood of infected volunteers on days 4 and 5 after intravenous
inoculation with SFS virus. Viremia levels during the latter period were high enough to infect
feeding sand flies, but only 13% (9/69) of the flies became infected. One out of every 3
infected sand flies that survived to feed a second time transmitted SFS to a hamster. These
results confirm a vertebrate-sand fly-vertebrate transmission cycle for SFS virus, and
demonstrate that horizontal transmission may contribute to the maintenance of this virus in
Am. J. Trop. Med. Hyg., 39(6), 1988, pp. 611-616

1988 -- Neurotoxic effects of solvent exposure on sewage treatment workers.
Nineteen Sewage Treatment Workers (STWs) exposed to industrial sewage that contained
benzene, toluene, and other organic solvents at a primary sewage treatment plant in New
York City (Plant A) were examined for evidence of solvent toxicity. Fourteen (74%)
complained of central nervous system (CNS) symptoms consistent with solvent exposure,
including lightheadedness, fatigue, increased sleep requirement, and headache. The
majority of these symptoms resolved with transfer from the plant. Men working less than 1 yr
at Plant A were more likely to complain of two or more CNS symptoms than men who were
working there longer than 1 yr (p = .055). Objective abnormalities in neurobehavioral testing
were found in all 4 men working longer than 9 yr at this plant, but in only 5 of 15 employed
there for a shorter period (p = .03). These results are consistent with the known effects of
solvent exposure. Occupational health personnel must be aware that STWs can be exposed
to solvents and other industrial wastes.
Arch Environ Health. 1988 Jul-Aug;43(4):263-8.

1987 -- HEALTH effects associated with wastewater treatment, disposal, and reuse.  
Hadeed reported that the wastewater industy has retained its number one status as the most
dangerous career field based on the results of the 1986 Annual WPCF Safety Survey.
In New york, 164 workers from 14 wastewater plants work had a higher frequency of uninary
mutagens, after controlling for smoking, than 72 water treatment workers in the same
municipalities. The authors stated that while these findings provided strong evidence of
increased exposure to mutagenic substances among wastewater workers, the long-term
health effects of their exposure was unknown.
Journal Water Pollution Federation (1987) vol 59(6): pp 436-440

1987 -- Glycolipid Binding of Purified and Recombinant Escherichia coli Produced Verotoxin
in Vitro*
Escherichia coli verotoxin (also knowans Shiga-like  toxin) has been implicated in the
aetiology of the hemolytic uremic syndrome and hemorrhagic colitis. The glycolipid binding
specificity of verotoxin purified from E. coli H30 and verotoxin cloned from bacteriophage
H19B has been examined. Verotoxin from both sources binds specifically to globotriosyl
ceramide containing the carbohydrate sequence galactose al-4galactose/3l-4glucose-
ceramide. Removal of the terminal galactose or substitution with N-acetylgalactosamine
in 81-3 linkage deletes toxinb inding activity. A ceramide trihexoside species, consistent with
a globotriosyl ceramide structure was shown to be the major verotoxin-binding glycolipid of
cultured vero cells which are routinely used to measure the cytotoxicity of toxin samples.
THE JOURNAL OP BIOLOGICAL CHEMISTRY, Vol. 262, No. 18. Issue of June 25, pp, 8834-

1986 -- Epidemiologic Notes and Reports Thrombotic Thrombocytopenic Purpura Associated
with Escherichia coli O157: H7
-- Washington
Since Escherichia coli was first associated with bloody diarrhea in 1982 (1), several well-
documented cases of hemolytic-uremic syndrome (HUS) related to E. coli O157:H7 have
been described among children and adults (2,3). Patients with thrombotic thrombocytopenic
purpura (TTP) have clinical and pathologic features similar to patients with HUS. In contrast
to HUS, however, gastrointestinal infections have not been strongly implicated in the
pathogenesis of TTP (4,5). A patient who recently died in Seattle with a clinical and
pathologic diagnosis of TTP had bloody diarrhea associated with E. coli O157:H7 infection
for 1 week before the onset of her other symptoms. This patient's clinical course suggested
that E. coli O157:H7 infection may have been related to the development of TTP.
MMWR, August 29, 1986 / 35(34);549-51

1985 -- Criteria and Recommendations for Land Application of Sludges in the Northeast
The related polyhalogenated biphenyl compounds and their levels found in sludges from
various areas of the United States are shown in Table 16. These are average values, e.g.
the range in the Midwest was 240 to 1700 ppm with an average value of 765 ppm. The
prevalence of polychlorinated biphenyls (PCBs) in sludge is well documented (271,344). Furr
et al. (161) found PCBs in concentrations up to 23 ppm in all sludges from eighteen
American cities. PCBs have been found in municipal sludges of Canadian cities (270).
Tucker et al. (442) found that the stability of_ PCBs isomers in sludge is directly proportional
to their degree of chlorination.PCBs are persistent in soils (320,325) and have demonstrated
both acute and chronic toxicity. Acute .signs of poisoning in humans include eye discharge
and swelling of upper eyelid, acne-form eruption, and pigmentation of the skin (176). The
demonstrated chronic toxicities of PCBs include carcino-genicity (331), teratogenicity
(316), and chromosomal alterations,(351)
Post-dosing effects
oth treated and control animals exhibited signs of discomfort immediately after dosing.
These signs were manifest as frequent examinations of the injection site and increased
activity. However, fifteen to thirty minutes after dosing, the Boston sludge-treated animals
began to show signs of effects on the central nervous system. Orientation was affected to
some degree in all groups as animals rotated repeatedly ii) both clockwise or counter-
clockwise directions; one animal (dosed at 32.9 mg/kg) turned over continuously for a period
of four to six minutes. Additionally,  motor coordination  and  gait were  adversely affected by
the Boston sludge extract in  nearly  all the animals. Animals dosed with Dallas sludge extract
showed few of the signs of toxicity of the Boston sludge extract groups and were more nearly
like control animals.
.. All signs of excessive activity had diminished in all animals within the first four hours. By
twenty-four hours post-dosing, decreased activity and decreased muscle tone were observed
in all sludge groups,while control animals appeared normal. Deaths were recorded at the
highest dose for both sludge extracts.Within six days, all moribund animals at all dose levels
had either recovered or died. - ^Mean   time-to-death   for   Boston   sludge   extract ranged
from 4.5 to 1.8 days, decreasing with increasing dose. The same decrease in mean time-to-
death with increasing dose was observed for Dallas sludge extract, although the range of 3
to 1 days was some what shorter (Table 22).
No gross lesions were observed in any animals which could be associated with the test
materials. Additionally, no treatment effects were seen in gross or relative organ weights.
Hepatic cytochrome P-450 levels were not significantly, different from control values (data not
shown). These results indicate that PCBs content of these sludges was probably low. In fact,
analysis of PCBs content of these sludges indicated relatively low levels of 0.84 and 1.00
ppm for Boston and Dallas sludges, respectively.
Over all, this study demonstrates that an organic extract of municipal sewage sludge can be
extremely toxic. This toxicity did not correlate with PCBs consent or mutagenicity; although
the mutagenic sample: was more toxic the quantitative difference was not qualitatively
J. G. Babish
DE Baker, DR Bouldin, HA Elliott, JR Miller - Bull 851, Pennsylvania State University, 1985

1984 -- Respiratory viruses and sudden infant death.
Viruses were shown to be present in the respiratory tract in 200 of 763 cases of the sudden
infant death syndrome studied in the nine years 1974-82. Epidemiological and pathological
evidence suggested that the distribution of viruses in the sudden infant death syndrome
differs between infants aged 3 months or less and those aged over 3 months: the incidence
of detection of virus was 14% in the younger group compared with 39% in the older group.
The distribution of the viruses in these two groups was compared with that in 1341 live
infants with respiratory virus infections. Adenovirus, influenza virus, parainfluenza virus, and
rhinovirus had similar distribution among the victims of the sudden infant death syndrome
and live controls. The incidence of detection of respiratory syncytial virus was increased in
the older infants dying of the sudden infant death syndrome (90% of the cases detected)
compared with the older group of live infants (53%). Antibody studies, detection of virus, and
epidemiological data suggest that respiratory syncytial virus may be a precipitating factor of
sudden death in older infants.
Br Med J (Clin Res Ed)  1984;288:1491-1493 (19 May),

1984 -- "Biological Health Risks Associated with the Composting of Wastewater" ,
they found there were biological effects on the workers from their exposure to composts.
Physical examinations of the control group revealed there was an excess of abnormal eye,
ear, nose and skin conditions among the workers exposed to the composts.  Nose and throat
cultures were positive for Aspergillus fumigatus.
Journal of Water Pollution Control Federation, 1984. 57 (12), pp. 1269-76
ZyActionP=PDF&Client=EPA&Index=1981 Thru 1985&File=D%3A%5CZYFILES%5CINDEX%20DATA%

1983 -- Work related symptoms among sewage workers.
Employees at six sewage treatment plants and three drinking water plants were interviewed
for the presence of specific medical symptoms. Serum immunoglobulin concentrations, white
blood cell counts and fibrinogen degradation product concentrations (FDP) in urine were
determined as were the number and species of airborne Gram negative rods in order to
characterise exposure to aerosols of sewage water. The highest number of bacteria was
found in areas where the sewage water was agitated. A significantly higher proportion of
employees at sewage treatment plants reported skin disorders, diarrhoea, and other
gastrointestinal symptoms than the control group. No significant differences were found
between the groups for white blood cell count or serum immunoglobulin concentrations,
except that IgM concentrations were slightly higher in the sewage workers. Some workers had
serum transaminase concentrations in excess of normal; some of these returned to normal
after the summer holiday. Among non-smokers a higher proportion of sewage treatment
workers had increased amounts of FDP in urine. It is conceivable that the symptoms
observed were caused by toxins from Gram negative bacteria.
Br J Ind Med. 1983 August; 40(3): 325–329.

1983 -- Vero Cell Toxins in Escherichia coli and Related Bacteria: Transfer by Phage and
Conjugation and Toxic Action in Laboratory Animals, Chickens and Pigs
H. Williams Smith, P. Green and Z. Parsell
Summary: Sixty-eight of 519 strains of Escherichia coli and six of 10 strains of Pseudomonas
aeruginosa produced toxins acting on Vero cells (VT+); all of 63 Salmonella, Shigella,
Klebsiella, Enterobacter and Proteus strains were VT–. Most of the VT+ E. coli strains were
from weaned pigs suffering from oedema disease and/or diarrhoea and belonged to
serogroups O141:K85,88, O141:K85, O138:K81, and O139:K82; six VT+ E. coli strains were
from diarrhoeic human babies, four of serogroup O26 and two of serogroup O128. The VT
genes in two of the O26 strains and in the O128 strains were located in the genome of the
phages with which they were lysogenized. One O141:K85,88 pig E. coli strain transferred its
VT genes, probably by conjugation, to E. coli K12. The VTs of the human E. coli strains, the
pig E. coli strains and the P. aeruginosa strains were antigenically different from each other;
unlike the others, the P. aeruginosa VT was heat-resistant. Cell-free preparations of cultures
of E. coli K12 to which the VT genes of the four human E. coli strains had been transferred
caused fluid accumulation in ligated segments of rabbit intestine. Inoculated intravenously,
they were lethal for mice and rabbits; similar preparations of E. coli K12 to which the VT
genes of the pig E. coli strain had been transferred produced a disease in pigs that clinically
and pathologically resembled oedema disease.
Journal of General Microbiology 129 (1983), 3121-3137; DOI  10.1099/00221287-129-10-

1983 ---Incidence of Bacterial Enteropathogens in Foods from Mexico
We examined food consumption patterns of U.S. students temporarily living in Guadalajara,
Mexico. Consumption of foods prepared in Mexican homes was associated with an increased
risk of acquisition of diarrhea. Foods from commercial sources and private Mexican homes in
Guadalajara were subsequently examined for contamination with coliforms, fecal coliforms,
and bacterial enteropathogens. For comparison, selected restaurant foods were obtained in
Houston, Tex. Food obtained from Mexican homes showed generally higher counts of
coliforms and fecal coliforms than those obtained from commercial sources in Mexico and
Houston. The foods in Mexico, both from homes and commercial sources, commonly
contained Escherichia coli and occasionally enterotoxigenic E. coli. Foods in Houston were
not contaminated with E. coli or enterotoxigenic E. coli. Salmonella (17 isolates), Shigella (4
isolates), and Aeromonas hydrophila (1 isolate) were found only in the foods obtained from
Mexican homes. Enterotoxigenic non-E. coli Enterobacteriaceae was recovered with
approximately equal frequency from all food sources.
APPLIED AND ENVIRONMENTAL MICROBIOLOGY, Aug. 1983, p. 328-332 Vol. 46, No. 2

1983 -- Laboratory Investigation of Hemorrhagic Colitis Outbreaks
Associated with a Rare Escherichia coli Serotype -- O157 CDC
Two outbreaks of hemorrhagic colitis, a newly recognized syndrome characterized by bloody
diarrhea, severe abdominal pain, and little or no fever, occurred in 1982. No previously
recognized pathogens were recovered from stool specimens from persons in either outbreak.
However, a rare E. coli serotype, O157:H7, was isolated from 9 of 20 cases and from no
controls. It was also recovered from a meat patty from the implicated lot eaten by persons in
one outbreak. No recovery of this organism was made from stools collected 7 or more days
after onset of illness; whereas 9 of 12 culture-positive stools had been collected within 4 days
of onset of illness. The isolate was not invasive or toxigenic by standard tests, and all strains
has a unique biotype. Plasmid profile analysis indicates that all outbreak-associated E. coli
O157:H7 isolates are closely related. These results suggest that E. coli O157:H7 was the
causative agent of illness in the two outbreaks.
J Clin Microbiol. 1983 September; 18(3): 512–520.

1984 -- Mortality associated with nosocomial urinary-tract infection
In a prospective study, 131 of 1458 patients acquired 136 urinary-tract infections (defined as
greater than 10(5) colony-forming units per milliliter) during 1474 indwelling bladder
catheterizations. Seventy-six patients (25 infected and 51 noninfected) died during
hospitalization; death rates were 19 per cent in infected patients and 4 per cent in
noninfected patients. Multiple logistic regression analysis demonstrated that seven of 21
prospectively monitored variables were associated with mortality among the catheterized
patients. The adjusted odds ratio for mortality between those who acquired infection and
those who did not was 2.8 (95 per cent confidence limits, 1.5 to 5.1). The acquisition of
infection as not associated with the severity of underlying disease; among patients who died,
infections occurred in 38 per cent of those classified as having nonfatal underlying disease
(15 of 39) and in 27 per cent of those classified as having fatal disease (10 of 37). Twelve
deaths may have been caused by acquired urinary-tract infections. Two patients had urinary-
tract pathogens in premortem blood cultures. Another 10 died with clinical pictures
compatible with serious infection, but no diagnostic cultures were performed. We conclude
that the acquisition of urinary-tract infection during indwelling bladder catheterization is
associated with nearly a threefold increase in mortality among hospitalized patients, but the
reason for this association is not yet clear
NEJM, Volume 307:637-642  September 9, 1982  Number 11

1982 -- The first case of Escherichia coli O157 infection in England and Wales was reported
in 1982; and the first case in Scotland in 1984.

1981 --
Land Application of Municipal Sewage Sludge For The Production of  Fruits and
Vegetables. A Statement of Federal Policy and Guidance
---  Signed by EPA, FDA, USDA
EPA is responsible for maintaining  the integrity  of our environment, FDA is responsibility for
maintaining the integrity of our food products, and USDA is responsible for maintaining the
integrity of our agricultural production. All three agree that heavy metals, toxic organic
compounds, and pathogenic microorganisms are a great concern.

EPA, FDA and USDA state that the safety of food grown on sludge is assured as long as the
guidance is followed. There is a caveat, the "government can not offer any indemnity against
product recall, seizure, or other enforcement actions, -- However, the risk of such
enforcement actions would be no greater than the risks associated with normal
farming and processing practice." The basic guidance was in the 1979 solid waste regulation
Part 257. The policy "recognizes that pathogen survival is greater in warm, moist
environments, than in extremely arid or colder environments."

1981 --
Lucas reviewed the nonmicrobiologic contaminates of wastewater aersols, noting that toxic
gases and myriad chemicals, both organic and inorganic, may pose a significant
hazard to wastewater treatment workers and potentially to the general public in surrounding
Rylander and Lundholm investigated several clinical symptoms among workers at wastewater
treatment plants. Because there were high levels of gram-negative bacteria and bacterial
endotoxins present in the wastewater plant environment, it was suggested that the symptoms
were caused by exposure to airborne endotoxins.
Because of the concern that antibiotic resistance factors (R plasmids) in coliforms are being
transferred to enteric bacterical pathogens in wastewater, environmental waters, or
individuals who harbor such coliforms previously ingested in the course of water associated
activities, some investigators have suggested the need for more stringent water quality
standards limiting the densities of coliforms in environmental waters and for more advanced
purfication of wastewater prior to its discharge into the environment. To address this issue,
Shaw and Cabelli isolated multiple-drug-resistant strains of Escherichia coli, representing
about 8.3% of the total E. coli population, from the water at an estuarine site, --
Journal Water Pollution Control Federation (1981) vol 53 (6): pp.776-786

1981 -- Colonization of growing radish plants by clinical and nonclinical isolates of Klebsiella
inoculated onto seeds
Abstract:   Klebsiella was found to multiply and colonize growing radish root bulb surfaces
following the inoculation of seeds with 10(1)–10(4) cells. All 29 cultures of Klebsiella originally
isolated from 5 different sources were capable of growth to 10(6)–10(7) colony-forming
units/g of root bulb within 1 week after seed germination. Linear regression analysis
illustrated differences in Klebsiella survival rates over 4 weeks of radish plant development.
Analysis of covariance showed the survival ability was Klebsiella from
vegetables>mastitis>human, water, and pulp mill isolates. It was also shown that Klebsiella
species 2 had a significantly higher survival rate than the other Klebsiella species. This
finding correlates well with the observation that Klebsiella species 2 is the most common
Klebsiella species isolated from vegetables. Average densities for all Klebsiella groups at
plant harvest (5 weeks) ranged from 10(3)–10(5) colony-forming units/g of radish plant. The
possible health significance of these densities of Klebsiella on vegetables consumed raw by
humans is discussed.
Current Microbiology, Volume 5, Number 5 / September, 1981

1981 -- Production of Heat-Labile or Heat-Stable Enterotoxins by Strains of Escherichia coli
Belonging to Serogroups 044, 0114, and 0128
During the last decade there have been considerable advances in understanding the
mechanisms by which Escherichia coli strains cause acute diarrhea, and currently three
groups are recognized (16). Some strains produce heat-stable (ST') or heat-labile (LT')
enterotoxins which are detectable by the infant mouse test or tissue culture tests,
respectively; these strains are referred to as enterotoxigenic. A second group of strains
invades intestinal epithelial cells and this group is known as enteroinvasive. The third group
has been recognized since the early 1950s as a cause of infantile enteritis and is termed
enteropathogenic (EPEC); these strains belong to certain specified 0 serogroups, and
little is known about their pathogenic mechanisms. A study of a small number of epidemic
EPEC strains by Klipstein et al. (10), using the rat jejunum perfusion technique, showed that
toxins were involved in the induction of water secretion, although these toxins were not
detected by the tests routinely used for identifying LT and ST.
INFECTION AND IMMUNITY, Jan. 1981, p. 500-503, Vol. 31, No. 1

1981 -- Airborne irritant contact dermatitis due to sewage sludge.
An outbreaks of cases of airborne irritant contact dermatitis developed among incinerator
workers employed in a sewage treatment facility. Contamination of the workplace and
workers' clothing by sludge from the interstices of an incinerator exhaust fan proved to be the
cause of the problem. The irritancy of the sludge was determined by tests in rabbits. There
was no recurrence of the problem after the institution of hygienic measures designed to
control contact with the sludge during subsequent fan maintenance procedures.
J Occup Med. 1981 Nov;23(11):771-4.

1981 -- Risk to Health from Microbes -- Who

1980 -- EnterotoxigenicEscherichia coli (ETEC) isolated in the Tel-Aviv (Israel) area
Abstract  The prevalence of enterotoxigenicE. coli (ETEC) as a pathogenic agent of
diarrhoea in the Tel-Aviv (Israel) area was determined, and the isolated E. coli strains
characterized. During three periods (summer 1977, summer 1978, and summer 1979), a total
of 335 specimens were tested for the presence of E. coli producing LT and ST toxin. Most of
the specimens were from sporadic ambulatory diarrhoea cases (children and adults)
attending a number of health care clinics in Tel-Aviv. Two to five colonies were tested from
each sample. ETEC was detected in 69 cases (20%): LT/ST strains were isolated from 9
cases (2.7%); LT from 7 cases (2.1%); and ST from 53 cases (15.2%). ETEC was isolated in
all age groups. In 19 specimens, 2 or more of 4 colonies tested were enterotoxigenic and
were identical according to biotype, antibiotic sensitivity, and serogroup. These findings
suggest that enterotoxigenic strains predominated in the bacterial population of the stool
specimen. Part of the isolated ETEC strains belonged to serotypes already known as
enterotoxigenic in different geographic areas of the world. The most frequently encountered
were serogroups O8 (9 cases) represented by at least three serotypes, among them O8:K40:
H9, and serotype O6:K15:H16 (5 cases); a number of serotypes were represented only by
two cases or by single cases. Among 16 LT-producing stains (LT/ST and LT-only), 13
belonged to 3 serogroups, while ST-only strains represented a large spectrum of serotypes,
some of which are now known as enterotoxigenic. Several serotypes common in other
geographical locations were not detected.
Medical Microbiology and Immunology, Volume 169, Number 1 / December, 1980

1979 -- Coliform Mastitis - A Review -- BACTERIOLOGY OF COLIFORM MASTITIS
"Coliform" is a general term for fermentative gram-negative bacilli that inhabit the intestinal
tract of man and other animals normally without causing disease and that are contained
within the family Enterobacteriaceae." Furthermore, "Certain members of this group -
Escherichia coli, Enterobacter aerogenes and cloacae, Klebsiella, Citrobacter (previously
Escherichia freundii)  and the paracolon bacteria - have caused mastitis in cows"
J Dairy Sci 62:1-22

1978 -- Infectious Disease Hazards of Landspreading Sewage Wastes
Human diseases associated with land application of sludge, pathogen movement, pathogen
viability, and disinfection are discussed in a literature review. Common infectious pathogens
found in sewage include bacteria, protozoa, helminthic parasites , and viruses. Outbreaks of
the diseases associated with forms of these pathogens have been directly traced to irrigation
practices of sewage sludge, domestic wastes, and treated waste water disposal.
Contamination of water supplies and consumption of raw vegetables and shellfish grown in
the presence of sewage are the major means of transfer of sewage-related diseases to
humans. Effects of sewage-borne pathogens on irrigation and treatment plant operators
have been negligible. Percolation of waste water through certain soil types can remove
amoeba cysts, helminth ova, and some bacteria and viruses; surface runoff of waste water
poses a potential hazard. Heat drying, liming, composting, irradiation, and pasteurization
have been found to be more effective than chlorination in pathogen removal. Pathogen-
bearing aerosols from sprinkler irrigation of waste water can be reduced by modification of
irrigation equipment and by establishing of a buffer zone of trees and shrubs. (Lisk-FIRL)
Journal of Environmental Quality Vol. 7, No. 1, p 1-9, January-March, 1978. 3 tab.

1977 -- Studies on humans exposed to airborne sewage sludge.
A clinical investigation was made among workers in a sewage treatment plant and age
matched controls not exposed to sewage. Acute incidences of fever and eye symptoms were
found in about 50% of the exposed population. Serum immunoglobulins, white blood cells
and thrombocytes were elevated in the exposed group. A higher percentage of increased
levels of C-reactive protein and fibrinogen degradation products was found in the exposed
group. Although no definite cause-effect relationship can be established the responsible
agent in the environment could well be endotoxins.
Schweiz Med Wochenschr. 1977 Feb 12;107(6):182-4.

[1975 -- Epidemiology of salmonellae and fertilizing of grassland with sewage sludge
(author's transl)] [Article in German]
Our investigations prove that sludge contains Salmonellae in more than 90% of samples. The
maximum number of organisms reached 10(7) per liter. One of our most important findings
was the fact that neither aerobic stabilization nor anaerobic digestion significantly reduces
the contamination with Salmonellae. Moreover we found that Salmonellae in sewage sludge
spread on grass may survive up to 72 weeks. Fertilizing with unsanitized sludge may
therefore lead to transmission from plant to animal. The increasing number of Salmonella
carriers among our herds of cattle and their striking accumulation during the grazing period
demonstrate that such transmission represents a growing danger. Sanitizing of sludge to be
used as fertilizer is therefore urgent. We have investigated the sanitary effect of
pasteurisation and of gamma irradiation on sewage sludge. After a proper pasteurisation in 5
plants (70 degrees C for 30 minutes) 98-100% of tested sludge samples contained less than
10 Enterobacteriaceae per gramm. The application of 300 krad resulted in a percentage of
97.2% of samples with less than 10 Enterobacteriaceae per gramm.
Zentralbl Bakteriol Orig B. 1975 Sep;161(1):54-60.

1974 -- A new E. coli 0 group 0158 associated with an outbreak of infantile enteritis --  
Abstract: An outbreak of acute diarrhoea occurred amongst babies in a special care baby
unit. Thirteen babies were at risk; six suffered diarrhoea and three of these died. An
Escherichia coli with an unidentifiable O antigen and flagellar antigen H23 was isolated from
all six cases. This O antigen has been accepted into the international scheme as O158.
J Clin Pathol 1974;27:832-833

1973 -- Airborne Stability of Simian Virus 40
The influence of relative humidity on the airborne survival of simian virus 40 (SV40) was
studied by allowing virus aerosols to age in rotating drums at 21 or 32 C and at a relative
humidity (RH) value ranging from 22 to 88%. Airborne SV40 virus was stable at every RH
tested at 21 C, but aerosols maintained at 32 C were inactivated within 60 min at mid-range
RH values. The unusual stability at 21 C over a broad RH range indicates that potentially
biohazardous situations may occur under laboratory conditions if this virus becomes
accidentally airborne.
APPLIED MICROBIOLOGY, Aug. 1973, p. 146-148, Vol. 26, No. 2

1966 -- Lethal Gram-Negative Bacterial Superinfection in Guinea Pigs Given Bacitracin -- 10
million fold increase
Oral administration of a single dose of bacitracin (either 2,000 or 10,000 units) was lethal to
more than 80% of guinea pigs. Within the first 12 hr, there was a 2,000-fold fall in the number
of gram-positive organisms in the cecum. An increase in the number of coliform bacteria in
the cecum was demonstrable within 6 hr, and, by 48 hr, these organisms had increased from
the normal level of less than 100 per gram to approximately 1 billion per gram. The changes
in intestinal bacterial flora were associated with development of a severe cecitis, mild ileitis,
and acute regional lymphadenitis. Bacteremia, primarily due to coliform bacteria, was
demonstrated in approximately 40% of the animals killed between 72 and 96 hr after
administration of bacitracin. Development of this disease syndrome was suppressed by the
administration of neomycin and polymyxin B, nonabsorbable antibiotics effective against
coliform bacteria. The lethal disease produced by bacitracin in the guinea pig is similar to
that produced by penicillin.
JOURNAL OF BACrERIOLOGY, August, 1966 Vol. 92, No. 2

1965 -- Escherichia coli and Neonatal Disease of Calves -- Scotland
The economic loss occasioned by neonatal disease in young calves has been recognized for
many years. It is apparent from postmortem and bacteriological examination of such calves
that there are many causes of this loss; however, colibacillosis infection caused by
Escherichia coli is by far the most common (117, 147). The clinical syndrome believed to be
associated with colibacillosis may vary considerably. Calves may be affected with diarrhea for
prolonged periods of time, or they may die suddenly with an acute septicemia. There are,
however, other diseases of calves which may simulate colibacillosis (i.e., acute septicemias
caused by Streptococcus, Diplococcus, Pasteurella, and Salmonella spp.).
BACTERIOLOGICAL REVIEWS, Mar., 1965, Vol. 29, No. 1

1964 -- Comparison of the Recovery of Escherichia coli from Frozen Foods and Nutmeats by
Confirmatory Incubation in EC Medium at 44.5 and 45.5 C
The productivity of confirmatory EC broth for the isolation of fecal Escherichia coli
was determined at 44.5 and 45.5 C. A variety of frozen pre-cooked foods and an
assortment of nutmeats were examined after primary incubation in Lauryl Sulfate
Tryptose (LST) broth. In 85.3% of the cases, the parallel tubes of EC broth incubated
for 24 hr at 44.5 and 45.5 C
gave rise to identical E. coli responses of positive, false
positive, and negative.
The remaining 14.7% of the reactions represent the
qualitative difference between the two temperatures.
The EC test at 45.5 C was
more specific for E. coli, since two- to threefold fewer false positives were
produced at this temperature than at 44.5 C. However, fecal E. coli recoveries were
slightly higher (4%) at the lower temperature. Incubating the EC tubes from the
interval of 24 to 48 hr gave rise to an additional 4.3% of E. coli recovery, but this
was accompanied by an excessive production of false positives (75.9%),

representing a 3.5-fold decrease in specificity. It is recommended that, in the
confirmatory use of EC broth in the examination of frozen foods and nutmeats for
the recovery of fecal E. coli, the test be made at 45.5 C in a water bath and limited
to 24 hr of incubation only, to insure optimal specificity. During the study, a “fixed”
productivity ratio was noted; E. coli+/LST+ equaled approximately one-fourth or 25%.
The significance of this ratio is discussed.
APPLIED MICROBIOLOGY, Vol. 12, No. 2, p. 127-131 March, 1964

1954 -- Bone Abscess caused  by E. coli
The Journal of Bone and Joint Surgery Vol. 36B, No. 3, August 1954

This paper concerns the investigation of the types of coliform organisms encountered in the
urines of one hundred consecutive cases of pyuria admitted to Townleys Hospital, Bolton,
during 1948. Recently Warner (1948), discussing urinary infection in paraplegic patients, has
drawn attention to the frequency with which Bact. aerogenes was found. This organism was
insensitive both to sulphanilamide and to penicillin, and Warner considered that these drugs
may be of only limited value in urinary infection. It was thought that it would be interesting to
discover if a similar high incidence of Bact. aerogenes would be found in
other types of urinary infection and to consider all the types of coliform organisms found from
the point of view of chemotherapy.
It was found that in group 1 Bact. coli was the predominant organism (49 strains compared
with 12 of other organisms) whereas in group 2 Bact. coli was relatively uncommon (7 strains
compared with 56 of other organisms,).
J. clin. Path.-(1949), 2,- 134

1935 -- A Study of B. coli mutabile from an Outbreak of Diarrhea in the New-born*
DURING the winter of 1933-1934 a succession of cases of a hitherto
unrecognized diarrhea occurred among the new-born in the Memphis General
Hospital. Forty-seven per cent of the infants affected died.
Am J Public Health Nations Health. 1935 November; 25(11): 1241–1251

1928 --
B. coli and menigitis


1900 -- An Analytical Account Of Fifty-Seven Cases Of Puerperal Infection--
31 deaths
The fact, however, would again appear to be established that, while the streptococcus
pyogenes is the most common exciting cause of puerperal infection, yet other organisms play
an only slightly subordinate part. A positive result was obtained i6 times; streptococcus, in
pure or mixed culture, was found io times, and it is interesting to note that in like manner
bacillus coli occurred 9 times, thrice where rupture of the perineum into the rectum was
present. Staphylococcus pyogenes- aureus and albus were also frequently cultivated. --
As to those of septic arthritis: in one, one joint, and in the other, both joints, were involved.
The joints were opened and drained, and in each case the patient made a good recovery.

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Jim Bynum, VP
Help for Sewage Victims

Coliform exhibit optimum
growth in  the 20-37° C range
(68 - 98.6°F).  Total Coliform
are gram negative members of
the Family Enterobacteriaceae
that ferment lactose at 98.6°F
to produce gas and/or acid
within 48 hours. Other members
of the Family
take a longer time to ferment

Fecal coliform exhibit minimal
growth at an elevated
temperature. They are a few
thermotolerant members of the
Family Enterobacteriaceae
that ferment lactose at
112.1°F  to produce gas
and/or acid within 48 hours.

E. coli and Klebsiella are the
primary fecal coliform that
exhibit less than 5% growth rate at
the elevated temperature.
They act as opportunistic
pathogens when they are
introduced into body
locations where they are not
normally found, especially if
the host is debilitated or

While there may be some
non-pathogenic strains, the
International Escherichia and
Klebsiella Centre (WHO) has a
collection of approximately 60,000 E.
coli strains, most of which are clinical
isolates. Clinical isolates means they
are pathogens associated with
disease.  About half of the hospital
acquired infections are caused by the
coliform bacteria