Exotic Tourist Destinations and Transmission of Infections by Swimming Pools and Hot Springs—A Literature Review

Abstract

A growing number of people undertake international travel, and yet faster growth of such travel is expected in the tropics. Information on the hazards presented by pool and hot spring waters in tropical countries is very limited. This review aims to collate available information on pool water quality, alongside data on cases and outbreaks associated with swimming in pools in tropical regions affecting both local populations and travellers. Bacteria species commonly causing cases and outbreaks in the tropics as well as elsewhere in the world were excluded, and the review focuses on studies related to pathogens that, with the exception of Cryptosporidium, are unusual in more temperate climates. Studies concerning subtropical countries were included in the light of climate change. Diseases transmitted by vectors breeding in poorly maintained, neglected or abandoned pools were also included. 83 studies dealing with Microsporidia, Leptospira spp., Schistosomas spp., Cryptosporidium spp., Acanthamoeba spp., Naegleria spp., Clostridium trachomatis, viruses, and vectors breeding in swimming pool and hot tub waters, and fulfilling predefined criteria, have been included in our survey of the literature. In conclusion, prevention strategies for pool safety in the tropics are imperative. Public health authorities need to provide guidance to westerners travelling to exotic destinations on how to protect their health in swimming pools.

Molecular genetic characterization of human Cryptosporidium isolates and their respective demographic, environmental and clinical manifestations in Egyptian diarrheic patients

“…The peak of Cryptosporidium bovine strain was attributed to land use patterns of polluted water supplies by young livestock (main reservoir), by hydrological means in areas with rainfall/flood actions; as well as the farming practices related to calving. On the other hand human strain predominance was linked to water contamination from human activities and with person-to-person transmission [70] .…”

Multi-spatial contamination of environmental aquatic matrices with Cryptosporidium: a climate, health, and regulatory framework for the Philippines

“…The detection of Cryptosporidium oocysts requires adjusting sampling and processing details to fit specific Table 1). Cryptosporidium oocysts exist among other naturally occurring particles in various water samples including sediments, sewage water, surface, and groundwater, even in chlorinated swimming pools and hot springs [9,24,[50][51][52]. However, investigations delving into interactions with biofilms are limited (14,57).…”

Chemical Ecology and Microbial Quality Assessment of Water of Recreational Hot Springs of Sikkim Himalayas

“…Thus, usually hot springs are devoid of pathogenic microbes despite the fact that many patients suffering from various diseases bathe in it regularly. Yet, few studies and reports on the hot spring pathogenic microbes gave an insight that there might be possibilities for public health outbreak and risks of getting infected with pathogenic strains contamination in hot spring bathing ponds [17]. Most serious outbreaks were caused by fungi (Microsporadia sp.…”

“…Naegleria sp. causes Primary Amoebic Meningoencephalitis by affecting the Central Nervous System of the vertebrates and other neuro diseases [25] whereas Acanthamoeba causes dermal lesions and nasal infections [17]. Among bacterial pathogens, Legionella sp.…”