The frequency of recovery of atypical mycobacteria was estimated in two treatment plants providing drinking water to Paris, France, at some intermediate stages of treatment. The two plants use two different filtration processes, rapid and slow sand filtration. Our results suggest that slow sand filtration is more efficient for removing mycobacteria than rapid sand filtration. In addition, our results show that mycobacteria can colonize and grow on granular activated carbon and are able to enter distribution systems. We also investigated the frequency of recovery of mycobacteria in the water distribution system of Paris (outside buildings). The mycobacterial species isolated from the Paris drinking water distribution system are different from those isolated from the water leaving the treatment plants. Saprophytic mycobacteria (present in 41.3% of positive samples), potentially pathogenic mycobacteria (16.3%), and unidentifiable mycobacteria (54.8%) were isolated from 12 sites within the Paris water distribution system. Mycobacterium gordonae was preferentially recovered from treated surface water, whereas Mycobacterium nonchromogenicum was preferentially recovered from groundwater. No significant correlations were found among the presence of mycobacteria, the origin of water, and water temperature.

We studied the resistance of various mycobacteria isolated from a water distribution system to chlorine. Chlorine disinfection efficiency is expressed as the coefficient of lethality (liters per minute per milligram) as follows: Mycobacterium fortuitum (0.02) > M. chelonae (0.03) > M. gordonae (0.09) > M. aurum (0.19). For a C · t value (product of the disinfectant concentration and contact time) of 60 mg · min · liter ؊1 , frequently used in water treatment lines, chlorine disinfection inactivates over 4 log units of M. gordonae and 1.5 log units of M. fortuitum or M. chelonae. C ⅐ t values determined under similar conditions show that even the most susceptible species, M. aurum and M. gordonae, are 100 and 330 times more resistant to chlorine than Escherichia coli. We also investigated the effects of different parameters (medium, pH, and temperature) on chlorine disinfection in a chlorine-resistant M. gordonae model. Our experimental results follow the Arrhenius equation, allowing the inactivation rate to be predicted at different temperatures. Our results show that M. gordonae is more resistant to chlorine in low-nutrient media, such as those encountered in water, and that an increase in temperature (from 4°C to 25°C) and a decrease in pH result in better inactivation.

In the context of poliomyelitis eradication, a reinforced sentinel laboratory network for surveillance of enteroviruses (RSE) was implemented in France in January 2000, and the purpose of this report is to describe the results of the five first years of surveillance. From 2000 to 2004, the RSE laboratory network performed detailed surveillance of the circulating enteroviruses. No wild-type poliovirus was isolated from humans during the 5 years of surveillance, although two imported vaccine polioviruses were detected. During the same period, Sabin-like polioviruses were identified on five occasions in the sludge from sewage treatment plants, but no wild-type poliovirus was found. Over the 5 years of surveillance, information was collected from 192,598 clinical samples, including 39,276 cerebrospinal fluid specimens, of which 14.7% were positive for enteroviruses, 45,889 stool samples (4.3% positive for enteroviruses), 70,330 throat swabs (2.2% positive) and 14,243 sera (1.4% positive). The ten main nonpolio enteroviruses typed were as follows, in decreasing order of frequency: E-30, E-13, E-6, CV-B5, E-11, CV-B4, E-9, E-7, CV-B1, and CV-B2. During the year 2000, an outbreak of aseptic meningitis due to three main enteroviruses (echoviruses type 30, 13, and 6) was monitored. Continued surveillance of enteroviruses is important to alert physicians and public health officials to changes in disease trends. Although the geographical coverage of the RSE network as well as the percentage of enteroviruses identified must be improved, the large number of samples tested for enteroviruses shows the ability of virology laboratories to detect the circulation of enteroviruses and to report the possible identification of poliovirus (wild-type, vaccine-derived, or Sabin-like).

Comparison in virus-seeded mineral water of three detection methods for enteroviruses, direct hybridization, cell culture, and reverse transcription into cDNA followed by polymerase chain reaction and hybridization, showed that the last procedure was 10 to 1,000 times more sensitive than detection by cell culture and 10i to 107 times more sensitive than direct hybridization. The presence of naturally occurring enteroviruses was also demonstrated in activated sludge and in concentrated and non-concentrated surface water samples by reverse transcription-polymerase chain reaction-hybridization. However, in activated sludge and in concentrated surface waters, enzymatic amplification was sometimes inhibited by contaminants.

We describe an outbreak of severe subcutaneous infections due to nontuberculous mycobacteria following mesotherapy. Epidemiological studies and molecular comparisons of Mycobacterium chelonae strains from different patients and the environment suggested that contamination may be associated with inappropriate cleaning of the multiple-injection device with tap water. CASE REPORTIn January 2007, a general practitioner notified the health authorities and the regional center for nosocomial infection control of a cluster of subcutaneous infections due to nontuberculosis mycobacteria (NTM) following mesotherapy.A complete screening for all potentially exposed patients who underwent mesotherapy with the practitioner from 1 October 2006 (the date of the first mesotherapy in the medical room suspected of contamination) to 15 January 2007 (the date of disruption of the mesotherapy practice) was designed. Each patient was contacted both by phone and by mail and urged to be examined by a specialist in the department of infectious diseases at a tertiary-care reference hospital in Paris. A retrospective cohort study of all exposed patients was performed to describe the temporal and spatial distribution of cases and identify risk factors. A case was defined as certain if the exposed patient had clinical subcutaneous lesions at the site of mesotherapy injections in association with cultures positive for NTM. A case was defined as probable if the exposed patient had clinical subcutaneous lesions but smear and culture results negative for NTM. An assessment study of hygiene practices was performed by an infection control practitioner at the outpatient clinic to determine potential risk factors to be tested in a comparative epidemiological study. Risk factors included the day of an outpatient visit, a patient's place in a series of patients receiving therapy on the same day, and the site of and reason for injections. For each case, the incubation period was estimated as the time between the last mesotherapy session before the onset of symptoms and the date of the first symptoms of NTM infection. Comparisons of means and proportions were calculated with standard statistics. As the clinic was closed on Wednesdays, Saturdays, and Sundays, visits on the days after closure, i.e., Mondays and Thursdays, were considered as a potential risk factor, expressed as the number of such visits per 100 patient visits. Multivariate analysis was performed using stepwise logistic regression with P-to-enter and P-to-remove values at 0.20. The Hosmer-Lemeshow statistic was used to test the goodness of fit of the model. All calculations were performed using SAS software release 8.02 (SAS Institute, Cary, NC) and considered significant at P of Ͻ0.05.Samples from tap water in the medical examination room, as well as from the injection device and topical creams, were examined to search for mycobacteria. Products used for mesotherapy injections were recovered from the office and analyzed by the laboratory of the French Agency for Sanitary Safety in Health P...

Arbitrarily primed PCR with three primers and pulsed-field gel electrophoresis were used to characterize a set of 75 clinicalLegionella pneumophila serogroup 1 isolates, with no apparent epidemiological link, obtained from 24 hospitals in Paris, France, from 1987 to 1997. Unexpectedly, 25 clinical isolates from 15 hospitals had an identical profile (termed type A) by both methods. The same profile was subsequently found in 16 of 64 randomly selected environmental L. pneumophila serogroup 1 isolates from 15 different sites in the Paris area. There was no evidence of geographic clustering or a peak incidence of type A isolation. Type A has not been found in France outside the Paris area, suggesting that a particular type of L. pneumophila serogroup 1 is specifically present in the Paris water distribution network.

In order to estimate the rate of microsporidia, cryptosporidia and giardia contamination of swimming pools, sequential samples of water were collected during a one-year period in six different swimming pools in Paris, France. Fourty-eight samples were submitted to filtrations. Eluates were examined for microsporidia using polymerase chain reaction (PCR) and for cryptosporidia and giardia using immunofluorescence staining. One of 48 specimens was positive for microsporidia. Using DNA sequence analysis, unknown microsporidia species were identified, which were close to an insect microsporidia Endoreticulatus schubergi. One sample was positive for cryptosporidia and none were positive for giardia. This study shows a low level of swimming pool water contamination by microsporidia, cryptosporidia or giardia, demonstrating the efficacy of cleaning filtration and disinfection procedures used in French swimming pools. ß

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