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mapa strony: Start. arrow Manuał aptekarski arrow 07.2010 - "Zagrożenia dla zdrowia ludzi korzystających z kąpielisk."


 


07.2010 - "Zagrożenia dla zdrowia ludzi korzystających z kąpielisk." Drukuj Email
07.2010, nr 47/25 online
 
ZAGROŻENIA DLA LUDZI
 
KORZYSTAJĄCYCH Z KĄPIELISK.


    Utrzymanie kąpielisk w należytym stanie sanitarnym, porządkowym i technicznym, zapewnienie ich dostępności dla ludności i wykonywanie niezbędnych zabezpieczeń, należy do zadań właścicieli kąpielisk i władz lokalnych. Zgodnie z zapisem ustawy Prawo wodne do 31.12.2010 r. organizator, który planuje utworzyć kąpielisko ma przekazać do wójta, burmistrza lub  prezydenta miasta wniosek o umieszczenie w wykazie kąpielisk na sezon 2011.

NADZÓR NAD STANEM WÓD
 
   Organy Państwowej Inspekcji Sanitarnej prowadzą nadzór nad kąpieliskami w zakresie przewidywanych zagrożeń epidemiologicznych i sanitarno-technicznych skutkujących negatywnie na  zdrowie i bezpieczeństwo ich użytkowników zgodnie z obowiązującymi przepisami.
   Woda z kąpielisk i miejsc zwyczajowo wykorzystywanych do kąpieli badana jest w zakresie podstawowym określonym w zał. nr 1, oraz w zakresie rozszerzonym określonym w zał. nr 2 do rozporządzenia Ministra Zdrowia z dnia 16 października 2002 r. w sprawie wymagań, jakim powinna odpowiadać woda w kąpieliskach  /Dz. U. nr 123, poz. 1530/.
   W ramach badań podstawowych przeprowadza się ocenę wody w kąpieliskach pod względem bakteriologicznym z uwzględnieniem liczby paciorkowców kałowych, bakterii z rodzaju Salmonella, bakterii grupy coli, Escherichia coli oraz badania fizykochemiczne (przezroczystość, barwa, zapach, temperatura, oleje mineralne, substancje powierzchniowo czynne, osady smoliste, odczyn, BZT-5, procent nasycenia O2) wraz z oceną eutrofizacji akwenów wodnych, czyli pod kątem występowania zakwitów sinic.
   W zależności od potrzeb, zakres badań obejmuje również inne parametry związane z eutrofizacją, takie jak azot azotanowy i amonowy, fosfor oraz metale: chrom, kadm, ołów - są to tzw. badania rozszerzone.
 
MIKROORGANIZMY WODNE
 
    Mikroorganizmy występujące w wodzie można podzielić na dwie zasadnicze grupy:
   Mikroflora autochtoniczna (naturalna) to drobnoustroje stale bytujące i rozmnażające się w środowisku wodnym. W grupie mikroorganizmów najbardziej typowych dla środowiska wodnego znajdują się ruchliwe bakterie należące do rodzajów:
 
•    Pseudomonas,
•    Vibrio,
•    Aeromonas,
•    Spirillum,
 
oraz liczne gatunki bakterii autotroficznych, foto- i chemosyntetyzujących, takie jak bakterie nitryfikacyjne, siarkowe i żelazowe.
   Naturalna mikroflora autochtoniczna wód nie stanowi zagrożenia dla zdrowia człowieka. Bakterie wodne właściwe są przeważnie psychrofilne, giną w temperaturze powyżej 25oC, nie stanowią więc zagrożenia epidemiologicznego, ponieważ nie namnażają się w temperaturze ciała człowieka – ok. 37oC.

   Mikroflora allochtoniczna (obca) przedostaje się do wody zarówno z powietrza, gleby, jak i ze ściekami przemysłowymi i komunalnymi. Spotyka się ją najczęściej w wodach powierzchniowych.
   Większość flory allochtonicznej należy do typowej mikroflory, żyjącej w przewodzie pokarmowym ludzi i zwierząt wyższych tworzącej tzw. florę fizjologiczną organizmu.
   Są to głównie organizmy heterotroficzne – saprofityczne i pasożytnicze, wśród których najliczniej reprezentowaną grupą są:
 
•    gram-ujemne pałeczki jelitowe Escherichia coli,
•    bakterie z rodzaju Proteus, Klebsiella, Enterobacter,
 
a także pałeczki Pseudomonas aeruginosa oraz z rodzaju Arthrobacter czy Cornybacterium.  
   Flora allochtoniczna dostaje się do wód powierzchniowych głównie ze ściekami bytowymi. Bakterie te należą do grupy bakterii mezofilnych, przystosowanych do wzrostu w temperaturze około 35-37oC i do dużej zawartości substancji odżywczych w środowisku. Woda nie jest dla bakterii chorobotwórczych naturalnym środowiskiem. Trafiają one bezpośrednio do wody z chorego organizmu ludzi lub zwierząt, lub pośrednio poprzez ścieki, a także poprzez spływy z gleby skażonej bakteriami patogennymi. Woda jest jedynie przenośnikiem bakterii i to tylko w okresie, w jakim organizmy te mogą w wodzie utrzymywać się przy życiu. Jednak dane epidemiologiczne wskazują, że woda może być nadal przyczyną wielu zachorowań o charakterze żołądkowo-jelitowym.

WSKAŹNIKI SANITARNE CZYSTOŚCI WÓD

    Jako wskaźniki czystości wód (również przeznaczonych do kąpieli) zostały przyjęte, z uwagi na miejsce ich występowania i liczebność, tak zwane wskaźniki sanitarne, do których należą:
 
•    Escherichia coli,
•    Enterococcus faecalis,
•    Clostridium perfringens,
 
przy czym w większości krajów wskaźnikiem obligatoryjnym jest Escherichia coli. Jest też ona najbardziej wiarygodnym wskaźnikiem, ponieważ jej obecność wskazuje na świeże zanieczyszczenie kałowe i możliwość wystąpienia towarzyszących im bakterii chorobotwórczych pochodzenia jelitowego.
   Paciorkowce kałowe (enterokoki) przeżywają dłużej w środowisku niż Escherichia i są bardziej oporne na działanie chloru, ale zdają egzamin jako wskaźnik czystości kąpielisk. Stwierdzono zależność pomiędzy stężeniem paciorkowców kałowych w wodzie, a zachorowaniami osób kąpiących się.
   Obecność Clostridium perfringens, z uwagi na przetrwalnikowanie tych bakterii jest wskazówką, że zanieczyszczenie fekaliami miało kiedyś miejsce. Uważa się, że gatunek ten może być dobrym wskaźnikiem zanieczyszczenia wód pierwotniakami Giardia i Cryptosporidium.
   Od lat wskaźniki sanitarne spełniają swoją rolę ostrzegawczą przed zakażeniami, ponieważ występuje istotna zależność pomiędzy liczebnością bakterii wskaźnikowych w wodzie, a ilością mikroorganizmów chorobotwórczych.

BAKTERIE CHOROBOTWÓRCZE,
A ZAKAŻENIA PRZENOSZONE DROGĄ WODNĄ

    Najczęściej występującym czynnikiem etiologicznym zakażeń przenoszonych drogą wodną są pałeczki duru brzusznego Salmonella typhi oraz pałeczki wywołujące czerwonkę Shigella sonnei, Shigella boydii, Shigella dysenteriae.
   Doniesienia ostatnich lat sugerują, że coraz częstszą przyczyną tzw. epidemii wodnych w Europie Zachodniej i Skandynawii są bakterie z rodzajów Yersinia i Campylobacter.
   Zachorowania mogą następować po wypiciu nieuzdatnionej lub zanieczyszczonej wody, ale również na skutek kąpieli w wodzie zanieczyszczonej odchodami. Stwierdzono też korelację pomiędzy zachorowaniami spowodowanymi pałeczkami E. coli O157, a silnymi deszczami wypłukującymi tę pałeczkę ze skażonej gleby.
   Bakteriami patogennymi, które wraz z odchodami i ściekami, a także spływami z pól, mogą dostać się do wody, są głównie mikroorganizmy związane z chorobami przewodu pokarmowego ludzi i zwierząt, jak również bakterie występujące u nosicieli, szczególnie dotyczy to nosicielstwa stwierdzonego u zwierząt.

Bakterie chorobotwórcze mogące występować w wodzie
 

Drobnoustroje

Występowanie

Campylobacter

Nosicielstwo u ludzi i zwierząt, ścieki, woda

Enterococcus

Przewód pokarmowy zwierząt i ludzi, ścieki, woda

Escherichia

Przewód pokarmowy ludzi i zwierząt, gleba, ścieki, woda

Helicobacter pylori

Odchody ludzi, woda

Legionella

Zbiorniki wodne, systemy grzewcze i klimatyzacyjne

Leptospira

Woda skażona wydalinami gryzoni

Listeria

Gleba, woda, rośliny, ścieki, zwierzęta hodowlane i dziko żyjące

Mycobacterium

Ścieki, woda

Pseudomonas aeruginosa

Woda, rośliny, zwierzęta, odchody ludzi

Salmonella

Odchody ludzi i drobiu, ścieki, woda, zakażona żywność

Shigella

Wydaliny, ścieki, woda, gleba, zakażona żywność

Staphylococcus

Skóra ludzi, zwierząt, woda, ścieki

Vibrio

Woda, ścieki, skorupiaki wodne

Yersinia

Woda, nosicielstwo u ludzi i zwierząt

 
Rodzaj Escherichia
 
   Są to bakterie występujące stale w przewodzie pokarmowym człowieka i zwierząt. Wiele szczepów dostawszy się do organizmu człowieka powoduje różne schorzenia.
   Wyróżnia się 5 głównych grup serologicznych szczepów  E. coli wywołujących biegunki przenoszone przez żywność i wodę.
   Są wśród nich szczepy:
 
•    enteropatogenne;
•    enterotoksyczne powodujące 90% zakażeń dróg moczowych i tzw. biegunkę podróżnych;
•    enteroinwazyjne;
•    enterokrwotoczne;
 
Rodzaj Salmonella
 
   Są to pałeczki gram-ujemne powodujące wiele schorzeń takich jak:
•    ostre choroby zakaźne: dur brzuszny wywołany przez Salmonella typhi oraz dur rzekomy wywołany przez Salmonella paratyphi;
•    zatrucia pokarmowe typu zakaźnego (salmonellozy);
   Rezerwuarem zarazka jest chory człowiek lub nosiciel, materiałem zakaźnym są wydaliny, ścieki lub zakażona żywność, głównie jaja, drób i mięso, soki owocowe, mleko.
   Epidemie pokarmowe i wodne występują w postaci ostrych zaburzeń żołądkowo-jelitowych związanych ze spożyciem wody lub pokarmu skażonego pałeczkami Salmonella.

SINICE JAKO CZYNNIK ETIOLOGICZNY ZAKAŻEŃ WODNYCH

    Zagrożeniem dla osób kąpiących się są również sinice występujące w wodzie. Dzięki oporności na ekstremalne warunki środowiskowe są wszechobecne. Mogą być przyczyną zakwitów występujących w jeziorach i innych środowiskach wodnych. Sinice zmieniają barwę wody oraz psują jej cechy organoleptyczne. Niektóre wydzielają toksyczne metabolity. Działają niekorzystnie na biocenozy wodne, ograniczają korzystanie z zasobów wodnych dla celów gospodarczych, stanowią zagrożenie dla ludzi korzystających z kąpielisk. Same toksyny sinicowe są bezbarwne i bezwonne, więc bezpośrednio niemożliwe jest ich zaobserwowanie. Toksyny normalnie nie są wydzielane do środowiska, znajdują się one w cytoplazmie. Uwalniają się po śmierci sinicy i rozpadzie komórki.

 
 
Główne grupy toksyn sinicowych

Neurotoksyny
 
   Neurotoksyny sinicowe odpowiedzialne są za zaburzanie funkcjonowania układu nerwowo-mięśniowego u ludzi i zwierząt. W wypadku zatruć ostrych może dojść do szybkiej śmierci organizmu, przez paraliż mięśni oddechowych.

Cytotoksyny
 
   Ich aktywność biologiczna jest bardziej uogólniona i rzadziej letalna dla organizmów. Substancje te powodują po wniknięciu do organizmu uszkodzenie wątroby, nerek, trzustki, śledziony, serca. Objawy zatrucia są uogólnione i wielonarządowe.
Hepatotoksyny
 
   U ludzi narażonych nawet na niewielkie dawki hepatotoksyn sinicowych obserwuje się takie objawy jak: wysypka naskórna, gorączka, wymioty, biegunka, a nawet ostre uszkodzenie wątroby. Najczęściej występującymi hepatotoksynami są mikrocystyny i nodularyny.

Dermatotoksyny
 
   Powodują intensywne podrażnienia skóry. Objawy takie jak: świąd skóry, pieczenie, obrzęk czy zaczerwienienie pojawiają się po kilku godzinach od kąpieli w wodzie zawierającej toksyny. Do tej grupy bioaktywnych substancji należą lipopolisacharydy (LPS) produkowane przez wszystkie sinice.

   Toksyny sinicowe nie ulegają rozkładowi w organizmie człowieka, a kumulują się w jego komórkach i mogą powodować efekt toksyczny po dłuższym okresie ekspozycji na nawet bardzo niskie stężenia. W około 60-90% zakwitów sinicowych występujących w zbiornikach wodnych na świecie wykazano obecność mikrocystyn. Doniesienia literaturowe potwierdzają, że mikrocystyna LR (MC-LR) jest najczęściej występującą toksyną sinicową. Związki te są dobrze rozpuszczalne w wodzie, stabilne zarówno w środowisku zasadowym, jak i kwaśnym. Nie ulegają rozpadowi w wysokiej temperaturze. Osoby kąpiące się, uprawiające sporty wodne lub pracujące w kontakcie z wodą są szczególnie narażone na szkodliwe działanie toksyn sinicowych z grupy dermatotoksyn. Działają one miejscowo, w wyniku zetknięcia się skóry lub błony śluzowej z toksyczną substancją i powodują reakcje uczuleniowe i podrażniające skórę. Toksyny te produkowane są przez gatunki Schizothrix, Oscillatoria, a objawy to: rumień, swędzenie, pieczenie, obrzęk, zaczerwienienie, pęcherze, które pojawiają się po kilku godzinach po kontakcie z wodą. Przyczyną podrażnień skóry może być też kostium kąpielowy, w którego porach materiału mogą znajdować się komórki sinic.

mgr biologii Marek Łukasiewicz

fot. Olga Sierpniowska

Literatura:
1.    Wytyczne WHO dot. jakości wody do picia wydanie drugie; Wyd.: Zarząd Główny Polskiego Zrzeszenia Inżynierów i Techników Sanitarnych; Warszawa 1998r.
 

 
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