Water Illnesses

/ Sunday, 15 July 2012 / Health

It’s hard enough to sometimes deal with finding adequate food, and protecting yourself from the elements, but there’s one other risk that affects bicycle tourists worldwide, getting some sort of disease from water – the key of life. Surely anyone on a long term bicycle journey or hiking has experienced random discomforts in their digestive tract, from an unknown source no matter how careful they may be – the fact is that contact with tainted water or drinking the water can cause some serious health implications.

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Even though you may be in a developed country with proper sanitation you can come at risk of some sort of pathogen in your body drinking straight out of the tap. I can count 4 times from being sick from the water in North America – widely known as one of the most developed areas in the entire world making riding not so fun in the slightest for days after. Recently I was diagnosed with parasites and suffered from some very painful issues due to the water sources I have been subjecting myself to – Most of this was written before those symptoms occurred – but due to the recent events I’ve decided to finish it off and detail some of the problems one may face while bicycle touring.

Not properly washing your water containers can be a source of bacteria growth

Waterborne diseases are caused by pathogenic microorganisms that most commonly are transmitted in contaminated fresh water. Infection commonly results during bathing, washing, drinking, in the preparation of food, or the consumption of food thus infected.  Microorganisms causing diseases that characteristically are waterborne, prominently include protozoa and bacteria, many of which are intestinal parasites, or invade the tissues or circulatory system through walls of the digestive tract. Various other waterborne diseases are caused by viruses. Other important classes of water-borne diseases are caused by metazoan parasites. Typical examples include certain Nematoda, that is to say “roundworms”, and also certain members of the Schistosomatidae, a family of blood flukes. The latter usually infect victims that make skin contact with the water. water borne diseases come from the water due to various water problems.

An African Bore Hole

More common than anything else will be the odd bout of Diarrhoea, stomach cramps and water loss – which is easy to be confused with over exertion on the bicycle during long riding days in challenging conditions. You can get these sort of symptoms by drinking water from taps where it hasn’t been untreated, or where problems with the sewage have occurred mixing with the clean water such as a pipe break or leak. If you’ve drank water from a stream or river you can allow pathogens or bacteria in your body due to the fact that wildlife could have been sharing the same water source upstream. Worse, if the water has been still or stagnant for some time you could allow eggs from different types of parasites allowing your warm temperatures to accelerate their growth causing similar symptoms of diarrhoea, vomiting, muscle aches and bloating, itching now working inside your body and feeding off your food and internals. You may start noticing rashes on your skin, anxiety and itching all over the body, especially the anus. If not treated it could cause nosebleeds, rapid breathing, liver or kidney failure or even death.

You can even get some of these diseases by eating food that has been contaminated either by the preparer, or from washing of the food before serving to you on your plate. Ecoli and Hepatitis A being the most commonly reported in the news can turn your insides into liquid shortly thereafter and cause significant damage if untreated.

Click to see a list of other diseases you can get from ingesting contaminated water, along with their symptoms.

[expand tag=”h3″ title=”List of Waterborne Illnesses”]

 Protozoal Infections

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
Amoebiasis (hand-to-mouth)Protozoan (Entamoeba histolytica) (Cyst-like appearance)Sewage, non-treated drinking water, flies in water supplyAbdominal discomfort, fatigue, weight loss, diarrhea, bloating, fever
Cryptosporidiosis (oral)Protozoan (Cryptosporidium parvum)Collects on water filters and membranes that cannot be disinfected, animal manure, seasonal runoff of water.Flu-like symptoms, watery diarrhea, loss of appetite, substantial loss of weight, bloating, increased gas, nausea
CyclosporiasisProtozoan parasite (Cyclospora cayetanensis)Sewage, non-treated drinking watercramps, nausea, vomiting, muscle aches, fever, and fatigue
Giardiasis (fecal-oral) (hand-to-mouth)Protozoan (Giardia lamblia) Most common intestinal parasiteUntreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats create ponds that act as reservoirs for Giardia.Diarrhea, abdominal discomfort, bloating, and flatulence
MicrosporidiosisProtozoan phylum (Microsporidia), but closely related to fungiThe genera of Encephalitozoon intestinalis has been detected in groundwater, the origin of drinking waterDiarrhea

Parasitic Infections:

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
Dracunculiasis (Guinea Worm Disease)Dracunculus medinensisStagnant water containing larvae, generally in parasitised CopepodaAllergic reaction, urticaria rash, nausea, vomiting, diarrhea, asthmatic attack.
TaeniasisTapeworms of the genus TaeniaDrinking water contaminated with eggsIntestinal disturbances, neurologic manifestations, loss of weight, cysticercosis
FasciolopsiasisFasciolopsis buskiDrinking water contaminated with encysted metacercariaGIT disturbance, diarrhea, liver enlargement, cholangitis, cholecystitis, obstructive jaundice.
Hymenolepiasis (Dwarf Tapeworm Infection)Hymenolepis nanaDrinking water contaminated with eggsAbdominal pain, severe weight loss, itching around the anus, nervous manifestation
Echinococcosis (Hydatid disease)Echinococcus granulosusDrinking water contaminated with feces (usually canid) containing eggsLiver enlargement, hydatid cysts press on bile duct and blood vessels; if cysts rupture they can cause anaphylactic shock
coenurosismulticeps multicepscontaminated drinking water with eggsincreases intacranial tension
AscariasisAscaris lumbricoidesDrinking water contaminated with feces (usually canid) containing eggsMostly, disease is asymptomatic or accompanied by inflammation, fever, and diarrhoea. Severe cases involve Löffler’s syndrome in lungs, nausea, vomiting, malnutrition, and underdevelopment.
EnterobiasisEnterobius vermicularisDrinking water contaminated with eggsPeri-anal itch, nervous irritability, hyperactivity and insomnia

Bacterial Infections:

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
BotulismClostridium botulinumBacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract by consuming contaminated drinking water or (more commonly) foodDry mouth, blurred and/or double vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea. Death is usually caused by respiratory failure.
CampylobacteriosisMost commonly caused by Campylobacter jejuniDrinking water contaminated with fecesProduces dysentery like symptoms along with a high fever. Usually lasts 2–10 days.
CholeraSpread by the bacterium Vibrio choleraeDrinking water contaminated with the bacteriumIn severe forms it is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea, cramps, nosebleed, rapid pulse, vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours.
SalmonellosisCaused by many bacteria of genus SalmonellaDrinking water contaminated with the bacteria. More common as a food borne illness.Symptoms include diarrhea, fever, vomiting, and abdominal cramps
Typhoid feverSalmonella typhiIngestion of water contaminated with feces of an infected personCharacterized by sustained fever up to 40°C (104°F), profuse sweating, diarrhea, less commonly a rash may occur. Symptoms progress to delirium and the spleen and liver enlarge if untreated. In this case it can last up to four weeks and cause death.

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A Bicycle Tourist must be very careful of the source of the water they are ingesting as one or more diseases may be residing in them – Preventative Maintenance is always recommended when drinking from areas where you are unsure about the water source.

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Beautiful on the eyes, but likely terrible on the insides – standing water does you no good!

 

Prevention:

Bottled water is available in nearly every part of the world now a days, allowing for safe ingestion and hydration – Costs can vary in different parts of the world, and you may even be able to buy water in Bulk by filling your own bottles from grocery stores without having to carry the plastic bottles which can be a hassle to dispose of and are a problem to our environment. In most areas of the developed world you may be able to find water out of a faucet in a bathroom or at the side of a building, but you may never know the source, if it was treated by the local areas sanitation service, brought up from a well in the ground – most if not all urban areas around the world have treated their water with chemicals such as chlorine, but you still run the risk of getting infected via bad pipes.

20120612_095412You can treat your water with small tablets or drops that contain Iodine, but recently the usage of treating water with Iodine has become unaccepted in various places around the world. It may turn your water a light brown colour and add a funny smell to it, but has the ability of destroying any Protozoan’s which should exist inside the water. Liquid treatment is available in most places around the world and involves treating the water for 30 minutes before consumption like ‘Waterguard’, mostly containing chlorine, again which can add a funny taste to the water. I have found it is best to throw  tea bag, or squirt a lemon into a water bottle to offset the foul taste of the water.

Boiling Water is a safe bet for any type of water you are unsure of, especially when taken out of streams, rivers or boreholes. Unfortunately stove fuel is at a premium for most bicycle tourists, and the process requires one to boil all the water for a minimum of 5 minutes to ensure all the bacteria and pathogens have been destroyed. When collecting water to boil it is important to collect it in a different container than what is being used to drink out of to avoid contamination of the bottles.

 

Your water bottles may also be a source for upset stomach, diarrhoea and other illnesses. If your water bottles do not have a protective cap, have not been washed inside and out properly, or if they are clear will allow bacteria and protozoans to multiply. One of my water bottles lost its cap and was continuously dirty, with a thick line of sludge around the mouthpiece likely causing the source of some nasty nights inside of a tent, as well as the bottom of my bottles starting to turn green from algae blooms from organisms inside the water I was sourcing.

 

 

MSR Miniworks Water FilterA Bicycle Tourist can carry a filtration system, such as the MSR Miniworks EX which uses a ceramic filter element to capture particulate matter that can affect your health, but still does not help from any viruses that may be in the water supply. Another popular device – the Steri-Pen uses Ultraviolet light to destroy living organisms inside the water. One simply needs to place the ‘pen’ inside the water and turn the light on for a period of time, however this does not act as a suitable filter when drawing water from dirty sources such as streams.

Out of all of these methods I’ve found the water treatment method to work best, saving on precious fuel, and avoiding the hassle of hand pumping a water filter – In fact in 3 years of Bicycle Touring I’ve yet to use my water filter and find it as dead weight even while I am in Africa. I plan on removing this tool from my arsenal, hoping to find someone who can use it in the bush/woods where it is more of use and carrying large amounts of water is not possible.

 

 

There’s More…

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Water is animals home, and also their toilet

 

 

But wait! Not only can drinking water affect you, but even contact can cause some significant damage to your insides – Diseases like Schistosomiasis, Dysentry, Legionnaires disease and Botulism are water contact diseases, and affect you in different ways..

Schistosomiasis also known as Bilharzia is a water-based disease which is considered the second most important parasitic infection after malaria in terms of public health and economic impact. The signs following infection are rashes or itchy skin. Two months after infection, fever, chills, cough and muscle aches may occur, as the parasites mature. Untreated infections can result in blood in urine and stools, and enlarged liver and spleen. In children there is a negative impact in terms of growth, nutritional status and cognitive development. Chronic infection leads to diseases of the liver, kidneys and bladder. Occasionally, the nervous system is affected causing seizures, paralysis or spinal cord inflammation. Schistosomiasis infection in humans, the definitive hosts, is caused by three main species of flatworm, namely Schistosoma haematobium, S. japonicum, and S. mansoni. In Asia, cattle and water buffalo can be important reservoir hosts. Infection occurs when free-swimming larvae penetrate human skin. The larvae develop in fresh-water snails. Humans are infected when they enter larvae-infested water for domestic, occupational and recreational purposes. After skin penetration, the larvae transform and are carried by the blood to the veins draining the intestines or the bladder where they mature, mate and produce eggs. Eggs cause damage to various tissues, particularly the bladder and liver. The reaction to the eggs in tissues causes inflammation and disease. When infected humans excrete parasite eggs with feces or urine into water, the eggs hatch releasing larvae that in turn infect aquatic snails. In the snail the parasite transforms and divides into second-generation larvae which are released into fresh water ready to infect humans. Those who work in irrigation or fishing are at increased risk for schistosomiasis. With the increase in wilderness or “off-track” tourism, more tourists are becoming infected. Schistosomiasis is endemic in 76 countries, most of which are in Africa. Other regions affected are: the Americas (Brazil, Suriname and Venezuela, as well as several Caribbean islands); the Eastern Mediterranean (Islamic Republic of Iran, Iraq, Saudi Arabia, Syrian Arab Republic and Yemen; and eastern Asia (Cambodia, China, Indonesia, Japan, Lao People’s Democratic Republic and the Philippines.

schistomes2

 

[expand tag=”h3″ title=”A list of Water Contact Diseases”]

Water Contact Diseases

Disease and TransmissionMicrobial AgentSources of Agent in Water SupplyGeneral Symptoms
SchistosomiasisMembers of the genus SchistosomaFresh water contaminated with certain types of snails that carry schistosomesRash or itchy skin. Fever, chills, cough and muscle aches
Vibrio IllnessVibrio vulnificus, Vibrio alginolyticus, and Vibrio parahaemolyticusCan enter wounds from contaminated water. Also got by drinking contaminated water or
eating undercooked oysters.
Symptoms include explosive, watery diarrhea, nausea, vomiting, abdominal cramps, and occasionally fever.
E. coli InfectionCertain strains of Escherichia coli (commonly E. coli)Water contaminated with the bacteriaMostly diarrhea. Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness.
M. marinum infectionMycobacterium marinumNaturally occurs in water, most cases from exposure in swimming poolsSymptoms include lesions typically located on the elbows, knees, and feet.. Lesions may be painless or painful.
DysenteryCaused by a number of species in the genera Shigella and Salmonella with the most common being Shigella dysenteriaeWater contaminated with the bacteriumFrequent passage of feces with blood and/or mucus and in some cases vomiting of blood.
Legionellosis (two distinct forms: Legionnaires’ disease and Pontiac fever)Caused by bacteria belonging to genus Legionella (90% of cases caused by Legionella pneumophila)Contaminated water: the organism thrives in warm aquatic environments.Pontiac fever produces milder symptoms resembling acute influenza without pneumonia. Legionnaires’ disease has severe symptoms such as fever, chills, pneumonia (with cough that sometimes produces sputum), ataxia, anorexia, muscle aches, malaise and occasionally diarrhoea and vomiting
LeptospirosisCaused by bacterium of genus LeptospiraWater contaminated by the animal urine carrying the bacteriaBegins with flu-like symptoms then resolves. The second phase then occurs involving meningitis, liver damage (causes jaundice), and renal failure
Otitis Externa (swimmer’s ear)Caused by a number of bacterial and fungal species.Swimming in water contaminated by the responsible pathogensEar canal swells causing pain and tenderness to the touch
BotulismClostridium botulinumBacteria can enter an open wound from contaminated water sources. Can enter the gastrointestinal tract by consuming contaminated drinking water or (more commonly) foodDry mouth, blurred and/or double vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea. Death is usually caused by respiratory failure.

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I’m sick, now what?

Don’t be surprised if you’ve picked up something along the way from long term bicycle touring – thankfully almost all of these diseases can be treated in short order with tablets from the pharmacy. A strong antibiotic dose of Ciproflaxin for 2 times a day for 7 days is sure to knock out most of the illnesses and bacteria that may be in your body, however if you’ve managed to pick up things like Tape Worms, Snails, or cysts you may need to try a different treatment like Praziquantel. Usually these treatments are a one time treatment, unless of course it has progressed to a more threatening stage, which may involve a visit to the hospital for further work. Don’t take all of this as the be-all definitive guide to water illnesses, as each disease can affect people differently. In my case I feel satisfied carrying a cycle of Antibiotics along for the ride, some anti diarrheal tablets, and rehydration salts should I find myself losing too much water while ill. If I find myself swimming in fresh water I am sure to monitor my health closely for days and weeks after to notice any signs of changes inside my body, likely allowing parasites in my body such as the time that I swam in Lake Malawi, guaranteeing the chance that I would become infected with a Parasite.

Final Thoughts..

Do your research before travelling so that you know what you may be up against, and keep a notepad of your health on a daily basis should you find yourself becoming ill suddenly. Remember that just because it looks clear doesn’t mean that its not contaminated! There are many different symptoms, and while referencing the list shown above it certainly doesn’t mean that something else could be at play – if you develop symptoms please talk to a medical professional as soon as possible, and may your hydration quests be disease free!


One comment

  1. January 6th, 2013

    Hi there,

    I wanted to chime in on this topic ; first off, thanks for this incredibly informational post. Second, there’s something called the Life Straw that kills all organisms as water passes through its filter. you may want to look into that. I came across Waterguard while traveling across Africa ; incredibly cheap and a potential lifesaver. I once bought about ten of these bottles just to be on the safe side :)

    Rossette


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