Recreational Water Illness

Recreational water illnesses (RWIs) are a group of illnesses that occur secondary to swallowing, breathing, or being exposed to contaminated water from areas where water is enjoyed, such as pools, spas, water parks, lakes, ponds, rivers, oceans, and even decorative water fountains. Depending on the causative organism, illness can affect the GI, respiratory, neurosensory, genitourinary, and integumentary systems, as well as any preexisting wounds. The most common complaint is diarrhea. Although they can affect people of all ages, RWIs are most common in children, pregnant women, and immunocompromised patients, such as those with AIDS, organ transplant recipients, or those receiving chemotherapy.

Causes

Different organisms may affect different body systems. Organisms commonly responsible for GI illness include Cryptosporidium, Giardia, Shigella, Norovirus, Enterococcus, and Escherichia coli O157:H7. Most of these organisms are killed by chlorine in less than an hour; Cryptosporidium, however, takes longer to kill and may survive in swimming pools for several days, even with adequate chlorination. Infection may also be caused by organisms that exist naturally in the water or soil.

Pseudomonas may cause skin infections, such as dermatitis, folliculitis, and athlete’s foot. It may also be responsible for outer ear and eye infections as well as adenoviruses. Respiratory and central nervous system infections may result from contamination with Legionella, Mycobacterium, and echovirus.

Pools and water parks become contaminated when people with existing GI illness submerge in water. They contaminate the water after having an “accident” or from organisms that remain in the anal area after defecation. Diapered babies who experience diarrhea while in the water are also responsible for causing RWI. Spray pools can also cause RWI because that water is simply recycled from underground collection tanks. Transmission via water can result from swallowing or breathing in contaminated water or through breaks in the skin. Illness can result from even a small amount of swallowed water.

Hot tubs more frequently cause “hot tub rash” and respiratory illness. Chlorine evaporates faster in a hot tub, thereby decreasing the disinfectant levels faster. In addition, hot tubs often are not maintained as diligently as swimming pools.

Decorative water fountains are not routinely maintained with chlorine or disinfectant; therefore, they may become contaminated easily if children or diapered babies are permitted to play in them.

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