Legionella occurrence in municipal and industrial wastewater treatment plants and risks of reclaimed wastewater reuse: Review.

Wastewater treatment plants (WWTPs) have been identified as confirmed but until today underestimated sources of Legionella, playing an important role in local and community cases and outbreaks of Legionnaires' disease. In general, aerobic biological systems provide an optimum environment for the growth of Legionella due to high organic nitrogen and oxygen concentrations, ideal temperatures and the presence of protozoa. However, few studies have investigated the occurrence of Legionella in WWTPs, and many questions in regards to the interacting factors that promote the proliferation and persistence of Legionella in these treatment systems are still unanswered. This critical review summarizes the current knowledge about Legionella in municipal and industrial WWTPs, the conditions that might support their growth, as well as control strategies that have been applied. Furthermore, an overview of current quantification methods, guidelines and health risks associated with Legionella in reclaimed wastewater is also discussed in depth. A better understanding of the conditions promoting the occurrence of Legionella in WWTPs will contribute to the development of improved wastewater treatment technologies and/or innovative mitigation approaches to minimize future Legionella outbreaks.

[Lead pollution of drinking water in lower Saxony from corrosion of pipe materials]. / Die Bleibelastung des niedersächsischen Trinkwassers verursacht durch Korrosion von Rohrleitungsmaterialien.

BACKGROUND: The corrosion of drinking water pipe materials can release different elements into tap water. Especially important in this context is the heavy metal lead, which mainly leaches from the peripheral water distribution system. Lead is known to have numerous adverse effects especially to infants and children. AIM AND METHOD: The aim of this project was to assess the present state of drinking water contamination with lead in Lower Saxony and to promote the replacement of lead pipes. For this purpose a project was initiated comprising three parts. Firstly, a free examination of drinking water was offered in cooperation with local public health departments for private households with young women and families with children living in buildings constructed before 1974. Participants were asked to collect a cold tap water sample in their household after nocturnal stagnation and to complete a questionnaire. The collected samples were analysed by atomic absorption spectrometry for their lead concentration. Secondly, data from local public health departments on results of lead measurements, especially in buildings for the public, were collected and analysed. Finally, a working group 'lead replacement' consisting of representatives of all relevant parties (e.g., tenant and landlord associations, handicraft, building and health administration) was initiated. RESULTS: In the project in total 2,901 tap water samples from households were collected between the years 2005 and 2007. Of these, 7.5% had lead concentrations exceeding 10 microg/L (recommended limit of the World Health Organisation) and 3.3% had concentrations above the limit of the German drinking water ordinance (25 microg/L). There were remarkable regional differences in the frequency of tap water contamination. Multi-family houses were more frequently affected than single and double family houses. Additional data were collected in a preceding study in southern Lower Saxony. Of the 1 434 stagnation samples, 3.1% had lead concentrations greater than 10 microg/L and 0.6% had concentrations above the former limit of the German drinking water regulations of 40 microg/L.

[Surveillance of drinking water supply systems on markets and in vehicles]. / Die Uberwachung von Trinkwasseranlagen auf Märkten und in Fahrzeugen.

The new German Drinking Water Ordinance (TrinkwV 2001) demands that the requirements of water intended for human consumption be met up to the intrinsic tap, at which the water is used. This also applies to water supply systems for food trade aboard non-stationary facilities and in vehicles for commercial purposes. In contrast to stationary units for drinking water supply, the nonstationary units relocate and the responsibility changes with each public health authority agent. Therefore, a coordinated action between the federal states is desirable and necessary. The experience of the public health departments presents many non-compliant parameters of microbiology in water supply systems on markets and in vehicles. The development of practical and consistent recommendations for the surveillance of non-stationary units is required to give consistent standards to the users. The article gives a review about legal foundations and technical rules in order to define the drinking water supply systems on markets and in vehicles in compliance with the German Drinking Water Ordinance. Examples of laboratory results from different monitoring episodes from three federal states are shown.

[Acute effects on the health of children after accidental exposure to epichlorohydrine]. / Akute gesundheitliche Effekte bei Kindern nach einer akzidentellen Freisetzung von Epichlorhydrin.

PURPOSE: In September 2002, two freight trains collided at Bad Muender, Germany. The inhabitants were potentially exposed to combustion products and to the human carcinogen epichlorohydrine (ECH). We aimed to describe the geographical distribution of and potential risk factors for acute symptoms among children residing in Bad Muender. METHODS: The parents of a random sample of children were invited to answer a mail-in questionnaire (response rate 63%). The main outcome measures were self-reported acute symptoms potentially associated with combustion products (e. g., irritation of the eyes, nose, or throat) and stress-related unspecific symptoms (e. g., gastrointestinal complaints, sleep problems, headaches). The main location during the first 26 hours after the train accident served as exposure proxy measure. In addition, potential predictors for the symptoms under study were assessed. RESULTS: The prevalence of symptoms associated with combustion products was 5.9%. Unspecific symptoms were reported for 6.3% of the children. Main location and prevalence of symptoms were not significantly associated. Physician-diagnosed asthma and nasal allergies were the main predictors of symptoms. CONCLUSION: The prevalence of acute symptoms was relatively high in a random sample of children living close to the incident. However, associations between exposure to the accident and symptoms could not be established conclusively.

[Drinking water supply with reference to geogenic arsenic contamination]. / Trinkwassergewinnung unter Berücksichtigung geogener Arsenbelastungen.

Geogenic Arsenic in Drinking Water. Drinking water production of surface spring water in southern Lower Saxony (Niedersachsen, Germany) was reduced because of microbiological contaminations and unreliably variable water reserves. Surface spring water in general has a low arsenic content. As a consequence ground water has been increasingly used for drinking water. Thus, high geogenic concentrations of arsenic in the central "Buntsandstein" in southern Lower Saxony caused high arsenic contents in the groundwater. Under the regulation of the German Drinking Water Ordinance (1986) the limit for total arsenic (40 micrograms/l) was exceeded in 2% of 150 fountains, wells and sources in southern Lower Saxony. Because of the well-known cancerogenic potential of arsenic the limit for total arsenic in drinking water was reduced from 40 micrograms/l to 10 micrograms/l suspending the new standard value until January 1996. This regulation based on new calculations revealing a skin cancer risk of roughly 6:10,000 and a mortality risk of roughly 1:10(6) in respect of lifetime in case of arsenic concentrations of 10 micrograms As/l drinking water. After that limit change 40% of 150 wells and sources in southern Lower Saxony exceeded the arsenic limit of 10 micrograms/l drinking water. As a matter of fact, it became necessary for a large number of water supply works to eliminate arsenic from the drinking water by technical means or to dilute drinking water with high concentrations of arsenic.

[Biological monitoring of persons in areas with increased soil mercury, arsenic and antimony content]. / Biomonitoring-Untersuchung bei Personen in Wohngebieten mit erhöhten Bodenwerten an Quecksilber, Arsen und Antimon.

Part of the northern Palatinate region in Germany is characterised by elevated levels of mercury, arsenic and antimony in the soil due to the presence of ore sources and former mercury mining activities. In a biomonitoring study, roughly 200 residents of this region were investigated for a putative increased absorption of these elements. Urine and scalp hair samples were examined. The results did not show a correlation between the mercury and antimony contents in the soil of the housing area and those in urine and hair. On the other hand, slightly but presumably non-hazardous, elevated arsenic contents in urine and scalp hair could be correlated to an increased arsenic content in the soil. According to multiple regression analysis this increase also correlated with the consumption of poultry, eggs and vegetables kept and cultivated respectively in grounds contaminated with arsenic. In urine, sex differences could be seen for antimony: male probands showing significantly higher mean urinary antimony levels than female probands. Urinary mercury contents were correlated with the amalgam area. Similarly, scalp hair of men contained significantly higher levels of arsenic and antimony in comparison to women. Mercury contents in scalp hair were correlated with the consumption of seafood. Children aged 2 to 6 years had significantly lower levels of mercury, arsenic and antimony in urine than the adult subjects. Thus, an elevated health hazard to these children by e.g. intake of contaminated soil is not expected.

Human biomonitoring of arsenic and antimony in case of an elevated geogenic exposure.

Part of the northern Palatinate region in Germany is characterized by elevated levels of arsenic and antimony in the soil due to the presence of ore sources and former mining activities. In a biomonitoring study, 218 residents were investigated for a putative increased intake of these elements. Seventy-six nonexposed subjects in a rural region in south lower Saxony were chosen as the reference group. Urine and scalp hair samples were obtained as surrogates to determine the internal exposures to arsenic and antimony. The analyses were performed using graphite furnace atomic absorption spectrometry except for arsenic in urine, which was determined by the hydride technique. This method does not detect organoarsenicals from seafood, which are not toxicologically relevant. In the northern Palatinate subjects, slightly elevated arsenic contents in urine and scalp hair (presumably not hazardous) could be correlated with an increased arsenic content in the soil. On the other hand, the results did not show a correlation between the antimony contents in the soil of the housing area and those in urine and hair. Except for antimony in scalp hair, age tended to be associated with internal exposures to arsenic and antimony in both study groups. Consumption of seafood had a slight impact on the level of urinary arsenic, which is indicative of the presence of low quantities of inorganic arsenicals and dimethylarsinic acid in seafood. The arsenic and antimony contents in scalp hair were positively correlated with the 24-hr arsenic excretion in urine. However, antimony in scalp hair was not correlated with seafood consumption as was arsenic in scalp hair and in urine. This indicated the existence of unidentified common pathways of exposure contributing to the alimentary body burden. Short time peaks in the 24-hr excretion of arsenic in urine, which could not be assigned to a high consumption of seafood, were detected for six study participants. This suggests that additional factors relevant in the exposure to arsenic are still unidentified.

[Causalgia in neurologic expert assessment]. / Kausalgien in der neurologischen Begutachtung.

Rendering an expert opinion on causalgia, after having clear determined it as the disease, poses many problems to the examiner. One ought to make this diagnosis with its serious consequences only under the following conditions: --when it is a case of a mostly partial trauma of a nerve with considerable intermingling of sympathetic fibres; --when the pains have a burning and primarily superficial character; --when the pain appear soon (hours, mostly days or weeks, more rarely months afterward) after the trauma; --when the pains are accompanied by considerable vasovegetative symptoms (cold sweats, cyanosis, hyperhidrosis and others). Secondary algodystrophic changes (muscle, joints, bones, and skin) are to be considered. In quantitatively judging the effects, an over-evaluation, as well as an underevaluation, is to be avoided by all means. Therapeutic effects and spontaneous remission after six to twelve months are to be considered. An exemplary case, in which a deterioriation of the capacity to work from 20 to 100% (!) was assumed, showed the need for taking the personality structure of patient into consideration.

[Neurosarcoidosis. Comparative analysis of the clinical profile based on 537 cases from the world literature up to 1963 and from 1976-1988]. / Neurosarkoidose. Vergleichende Analyse des klinischen Profils anhand von 537 Beobachtungen aus der Weltliteratur bis 1963 und von 1976-1988.

Observation of neurosarcoidosis in a thirty-year-old black female characterised predominantly by bilateral facial nerve paralysis gave rise to a review of literature since 1978 and also to a comparison with an early study in 1963. As described 1963 the clinical picture is characterized by increased protein content of the CSF (33.8%), facial nerve paresis (25.5%), pleocytosis (23%), diabetes insipidus (21%), hemiparesis (17.2%), organic psychosis (16.9%), papilloedema (15.5%), ataxia (13%), convulsive seizures (12.5%), optic atrophy (12.5%), loss of hearing (12.2%), nystagmus (8.6%) and numerous other symptoms more rarely found. This corresponds to the symptoms of chronic basal meningitis with an infiltration in the neighbouring structures of brain and less frequently the spinal cord. In only 58.7% of the cases (presumably at the onset of sarcoidosis) was the bronchial tract (or the lungs) affected, in 11.5% the skin or the eyes. Although the clinical picture is clear enough the etiology has yet to be determined. Evidence of a pathogen or a pathogenic agent (analogous to berylliosis) has never been established to date. On the other hand there are some indications of a disturbance in the immune system, perhaps of a particular genetic foundation since sarcoidosis strikes black patients with conspicuous frequency. There exist more cases in one family. Exceeding expected random distribution, many patients have the HLA-Factor B 8 (on the chromosome 6) and DR 3. The Kveim-Test was in 71 cases positive, in 12 cases negative. The possibilities of carrying out studies of CSF - analogous to the studies of bronchial lavage - in the most cases of neurosarcoidosis have not been exhausted as to determine the activity of the T-lymphocytes, the interleucines, the angiotensin-converting enzyme while the Gallium 67 scintigraphy and other methods to determine the non-specific activity of the inflammation. The efficiency of the treatment with corticosteroids (Prednison or Triamcinolonacetonid) depends of the phase of the inflammatory process. 12% of the registered cases died.

[Behcet's disease and the nervous system--a 10-year follow-up with pregnancy. Review of the literature]. / Beitrag zum Problem Morbus Behçet und Nervensystem 10jährige Verlaufsbeobachtung mit Schwangerschafte/Literaturübersicht.

A 23 years old woman with the typical symptoms of Behçet's disease developed the psychopathological changes of an acute encephalitis which remitted after treatment with corticosteroids. 4 years later on appeared a Wallenberg-syndrome with pleocytosis. The symptomatology vanished nearly immediately after blood transfusion. Intercurrent the woman was delivered of a healthy boy. During the pregnancy the dosis of corticosteroids could be reduced. 10 years from the beginning of the first symptoms there exist more or less intensive stomatitis, vaginitis and inflammatory processes of the eyes despite corticosteroid therapy but no symptoms of the nervous system.

[Subarachnoid hemorrhage (author's transl)]. / Subarachnoidal-blutungen.

Since the world-wide introduction of computer tomography, neurology is undergoing a radical change which also affects the care of patients with subarachnoid hemorrhage. This not rare clinical condition can now be recognized earlier and more accurately, better assessed and in some cases can therefore be treated earlier and with greater success. The following considerations are based on experience in 146 patients who were observed in the clinic during the last ten years. In 68 of these patients the source of the hemorrhage, an aneurysm, could be demonstrated by clinical means.