[Infections related to recreational waters]

Recreational waters are a source of infection by several microorganisms causing acute gastrointestinal, cutaneous and respiratory illnesses. Cryptosporidium, noroviruses and enteropathogenic Escherichia coli strains are the most important causes of diarrhea, while Pseudomonas and Staphylococcus aureus are the main causes of cutaneous infections, and Legionella is the major cause of acute lower respiratory disease. Approximately 90% of outbreaks occur in treated recreational waters (swimming pools, spas and recreational parks), while the remaining 10% arise from natural waters used for leisure (bathing in rivers, beaches, etc). In spas, most infections are caused by thermophilic bacteria, such as Pseudomonas and Legionella, since overgrowth of these bacteria is facilitated by the direct effect of temperature and, indirectly, by the evaporation of the disinfectant. Outbreaks related to recreational waters usually reflect deficient control of the system: a low level of disinfectant, or the use of an inappropriate disinfectant, insufficient maintenance and cleaning of the installation, higher than recommended usage, and failure of the disinfectant dosage system. The correct design, maintenance and use of these facilities drastically lower the risk of infections from recreational waters. Thus, other key actions to minimize this risk are the existence of, and compliance with, regulatory rules, as well as educational campaigns on good hygiene practices directed at users. Rapid etiologic diagnosis of affected patients, together with an epidemiological survey and detection of the pathogen implicated in water samples are the keys to outbreak control.