INTRODUCTION: Waterborne diseases are caused by pathogenic microorganisms that most commonly

are transmitted in contaminated fresh water. Infection commonly results during bathing, washing, drinking, in the preparation of food, or the consumption of food thus infected. Various forms of waterborne diarrheal disease probably are the most prominent examples, and affect mainly children in developing countries; according to the World Health Organization, such diseases account for an estimated 4.1% of the total DALY global burden of disease, and cause about 1.8 million human deaths annually. Following are the 10 water borne diseases discussed with their causes, symptoms, treatment and prevention.

I. What is a diarrhoea (diarrhea)?

Diarrhoea ia also called loose motions. Diarrhoea is not itself a disease, but can be a symptom of several disease. Diarrhoea means there are frequent, loose or liquid stools. There may cause abdominal pain, which may reduce after a stool is passed. Acute diarrhoea may come on suddenly for a short time. Chronic diarrhoea may affect someone for a long period of time. If you have diarrhoea for long periods of time, it may very troubling and you may feel very weak and tired. Diarrhoea causes dehydration. Children are more likely than adults to die from diarrhoea because they become dehydrated more quickly. Diarrhoea is also a major cause of child malnutrition. What are the symptoms of diarrhoea?
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Frequent, loose, watery stools. Loss of appetite. Nausea vomiting. Stomach pains. Fever. Abdominal pain. Abdominal cramps Dehydration. Pricking sensation. Sometimes bacterial or parasitic infections sometimes cause bloody stools.

What are the causes of diarrhoea? There are many causes of diarrhoea, including food poisoning, infection, malnutrition. Diarrhoea may also be caused due to a chronic problem like viral stomach flu. Diarrhoea occurs when the

lining of the small or large intestine is irritated. It leads to increased water being passed in the stools. The causes of diarrhoea are listed below:
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Bacterial Infections: Several types of bacteria which get into our body through contaminated food or water, are the main causes of diarrhea. Viral infections . Many viruses are also responsible for the cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis. Food Intolerance - Some people are not able to digest some component of food properly, such as lactose, the sugar found in milk - which ultimately leads to diarrhea. Intestinal diseases. Functional bowel disorders. Sometimes too much swimming also causes diarrhoea.

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Some Herbal Remedies for Treatment of Diarrhoea: Meadowsweet may prove to be good for gentle treatment for diarrhea as it tones the lining of the small intestine. It is especially helpful in childhood diarrhea. Other herbal products good for treating diarrhoea may include:
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Agrimony (leaves, flowers). Ladies Mantle (leaves). Cranesbill. Ribwort (leaves). The stronger astringents such as Oak Bark should only be used as a last resort, when you think that every other thing has failed.

Ayurvedic Remedies for Diarrhea

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Mixture of 1 gm each of Kutaja Churna, Gangadhara Churna and Hingavashtaka Churna may be taken daily with luke warm water. Mixture of 240 mg of Raman Churna, 240 mg of Mahagandhaka Yoga and 120 mg of Sanjivani may be taken daily with honey. Mixture of 240 mg of Piyushvalli Rasa and 500 mg of Kutaja Churna, when taken with fleaseed husk three times daily, also has proved to be good in treating diarrhea. 15 gm of Rasanjanadi Churna and 1.5 gm of Yamani Shadava can also be taken two times daily after the main meals.

II .Cholera:
It is a severe diarrheal disease that is deadly without treatment. Thanks to modern hygienic advances, such as clean sanitation systems and drinking water, the disease is rare in the US and other developed countries. Even though cholera is easily prevented and treated, it remains a huge public health problem in countries where hygienic practices and sanitation systems are not established. For example, the cholera epidemic in parts of Africa has been ongoing for more than 30 years, due to inadequate sanitation and water treatment systems. Causes: Transmission usually results from consuming water that is contaminated with feces from an infected person. Consumption of cholera can happen through drinking contaminated water or eating foods that have been washed with or made with contaminated water. This kind of water-borne transmission is common in areas with poor sewage systems and unclean drinking water. Symptoms: Within 6 hours to 5 days of exposure, symptoms range from being mild or asymptomatic to severe disease, characterized by y y y huge volumes of explosive watery diarrhea (sometimes called "rice water stools" because of the similarity of appearance to water that has been used to wash rice) vomiting and leg cramps.

Due to rapid loss of fluids (up to 20 liters daily), severe dehydration and shock can occur in these individuals. Signs of dehydration include loss of skin plasticity, sunken eyes, fast heart beat, low blood pressure, and rapid weight loss. Shock occurs as a result of collapse of the circulatory system. Treatment: Because death from cholera is a consequence of dehydration, the disease is treated using oral rehydration therapy (ORT), which consists of large volumes of water mixed with a blend of sugar and salts. Prepackaged mixtures are commercially available, but wide distribution in developing countries is limited by cost. Therefore, homemade ORT recipes using common household ingredients and materials have been developed. Severe cases of cholera require intravenous fluid replacement. Antibiotics can shorten illness, but ORT is still necessary even when antibiotics are used. Do not use anti-diarrheal medicines, since they prevent flushing of the bacteria out of the body. Prevention: The CDC recommends to Boil it, cook it, peel it, or forget it. Individuals living or traveling to places where cholera is found should drink boiled or chlorine- or iodine-treated water or bottled beverage. Foods should be thoroughly cooked, and individuals should peel their

own fruits. Also, avoid ice, raw foods, and ice cream. Be wary of foods and beverages from street vendors. A new oral vaccine, called Dukoral is available in other countries, but is not recommended by the CDC because of incomplete protective effects.

III. TYPHOID :
Salmonella typhi is the most common species that causes Typhoid Fever. Other species, including Salmonella enteritidis or Salmonella typhimurium, can cause gastroenteritis (diarrhea) or typhoid-like diseases. Causes: Salmonella typhi can be shed from people with typhoid fever, as well as from carriers, who are individuals who have recovered from the disease but continue to carry and shed the bacteria in their feces. Infection occurs through ingestion of foods or drinks contaminated with Salmonella typhi, including water used for drinking or washing foods. Symptoms: High fever of 103 F to 104 F, abdominal pain, headache, loss of appetite. Treatment: Antibiotics (ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin) are usually prescribed. The selection of antibiotics depends on the pattern of antibiotic-resistance in the location where the infection was acquired. Prevention: Two vaccines available in the United States for typhoid fever: an oral vaccine (Vivotif Berna) and an injected vaccine (Typhim Vi). If you are traveling to a developing country where typhoid fever may be a problem, see your healthcare provider for a vaccination at least 1 week before you travel. Even if youve been vaccinated in the past, a booster may be needed. In addition, practice safe eating habits while traveling. Drink only bottled or boiled water, eat only hot, thoroughly cooked foods, and only eat raw fruits and vegetables that have been both washed and peeled. Complications: In addition to risk of death or persistent infection, other potential consequences of Salmonella typhi infection include liver damage, toxemia (bacterial toxins in blood), myocarditis (inflammation of the myocardium in the heart), and intestinal lesions may occur. is a skin infection that is characterized by itchy, scaly patches on the skin, fingernails, and scalp. Ringworm of the feet is known as athletes foot, and ringworm of the groin is known as jock itch. Interestingly, and contrary to popular belief, ringworm is not a worm but a disease caused by a fungus. It was originally named based on the belief that it was caused by a wormlike parasite

IV Ringworm

Causes : The fungi attach and grow on keratin-containing cells, such as those found in the skin, near the hair and fingernails. There are several ways that people can get infected with ringworm. Ringworm most commonly spreads from person-to-person through skin contact or contact with contaminated personal items. Ringworm can also be spread through pets, especially cats and dogs. Other animals, including cows, goats, pigs, and horses can also spread ringworm to people. Finally, rare cases of ringworm occur through environmental sources. These cases tend to be more frequent in gardeners or agricultural workers who come in contact with the fungi in soil. Whos at Risk? Ringworm is very common among children, but it can affect all people. Scalp ringworm more frequently affects young children and school athletes, whereas ringworm on the body has occurred in children with young pets and in outbreaks among high school wrestling teams. Symptoms: Ringworm usually begins with a small raised patch that grows into larger, scaly patches with defined edges. The center of the rash eventually clears to produce a ring. It can sometimes be itchy, but is usually not painful. Symptoms of skin infection usually appear 4 to 10 days after exposure. Ringworm of the scalp usually appears 10 to 14 days after exposure. Treatment: Keep skin clean and dry, and apply topical anti-fungal creams -- such as nystatin, terbinafine, clotrimazole, or miconazole -- once or twice every day for 14 to 21 days. If the infection does not resolve with these treatments, antifungal pills may be prescribed. Prevention: Practice good hygiene; do not share personal items, and keep common areas in gyms, locker rooms, daycares, and schools clean and dry; treat infected pets.

V. ASCARIASIS:
Causes- Ascariasis is caused by consuming food or drink contaminated with roundworm eggs. Ascariasis is the most common intestinal worm infection. It is found in association with poor personal hygiene, poor sanitation, and in places where human feces are used as fertilizer. SymptomsMost of the time, there are no symptoms. If there are symptoms, they may include:
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Bloody sputum Cough Low-grade fever Passing worms in stool Shortness of breath Skin rash Stomach pain

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Vomiting worms Wheezing Worms exiting through the nose or mouth

Treatment: Treatment includes medications that paralyze or kill intestinal parasitic worms, such as albendazole or mebendazole. These drugs should not be used for pregnant patients. Pyrantel pamoate is the preferred medication for pregnant patients. If there is a blockage of the intestine caused by a large number of worms, endoscopy to remove the worms or, rarely, surgery may be needed. Possible Complications:
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Liver secretion (biliary tract) obstruction Blockage in the intestine Hole (perforation) in the gut

Prevention: Improved sanitation and hygiene in developing countries will reduce the risk in those areas. In areas where this disorder is common, routine or preventive (prophylactic) treatment with deworming medications may be advised.

VI. LEPTOSPIROSIS:
CAUSES- Leptospirosis is caused by exposure to several types of the Leptospira bacteria, which can be found in fresh water that has been contaminated by animal urine. It occurs in warmer climates. It is not spread from person to person, except in vary rare cases when it is transmitted through breast milk or from a mother to her unborn child. Risk factors include:
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Occupational exposure -- farmers, ranchers, slaughterhouse workers, trappers, veterinarians, loggers, sewer workers, rice field workers, and military personnel Recreational activities -- fresh water swimming, canoeing, kayaking, and trail biking in warm areas Household exposure -- pet dogs, domesticated livestock, rainwater catchment systems, and infected rodents.

Symptoms: Symptoms can take 2 - 26 days (average 10 days) to develop, and may include:

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Dry cough Fever Headache Muscle pain Nausea, vomiting, and diarrhea Shaking chills

Less common symptoms include:

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Abdominal pain Abnormal lung sounds Bone pain Conjunctivitis Enlarged lymph glands Enlarged spleen or liver Joint aches Muscle rigidity Muscle tenderness Skin rash Sore throat

Treatment: Medications to treat leptospirosis include:

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Ampicillin Ceftriaxone Doxycycline Penicillin

Possible Complications:
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Jarisch-Herxheimer reaction when penicillin is given Meningitis Severe bleeding

Prevention: Avoid areas of stagnant water, especially in tropical climates. If you are exposed to a high risk area, taking doxycycline or amoxicillin may decrease your risk of developing this disease.

VII. Cyclosporiasis refers to infection by the sporeforming protozoan known as Cyclospora. Protozoa are a group of parasites that infect the human intestine. Parasites are organisms that live in another body, called the host, and get food and liquids from that host. This group of parasites infects the human intestine, and causes chronic recurrent infections in those with altered immunity or AIDS. Even in people with normal immune function, Cyclopsora can cause prolonged bouts of diarrhea and other gastrointestinal symptoms.
CAUSES: Until recently, Cyclospora was considered to be a form of algae. The parasite causes a common form of waterborne infectious diarrhea throughout the world. Just how the parasite gets into water sources is not yet clear. It is known that ingestion of small cysts in contaminated water leads to disease. SYMPTOMS: Symptoms begin after an incubation period of about a day or so following ingestion of cysts. A brief period of flu-like illness characterized by weakness and lowgrade fever is followed by watery diarrhea, nausea, loss of appetite, and muscle aches. In some patients, symptoms may wax and wane for weeks, and there are those in whom nausea and burping may predominate. It is also believed that infection can occur without any symptoms at all. In patients with abnormal immunity (immunocompromised patients), such as those with AIDS and cancer, prolonged diarrhea and severe weight loss often become a major problem. The bile ducts are also susceptible to infection in AIDS patients. Treatment : The first aim of treatment as with any severe diarrhea illness is to avoid dehydration and malnutrition. Oral Rehydration Solution (ORS) or intravenous fluids are sometimes needed. Medications used to treat diarrhea by decreasing intestinal motility, such as loperamide or diphenoxylate are also useful, but should only be used with the advice of a physician. The use of the medication, trimethoprim-sulfamethoxazole (Bactrim) for one week can be successful in treating intestinal infections and prevents relapse in those with a normal immune system. The same medicine can be prescribed to treat infections of both the intestine or bile ducts in immunocompromised individuals, but maintenance or continuous treatment is often needed. Prevention: Aside from a waterborne source as the origin of infection, little else is known about how the parasite is transmitted. Therefore, little can be done regarding prevention, except to maintain proper hand washing techniques and hygiene.

VIII. FILARIA:
Lymphatic filariasis (LF), is commonly called elephantiasis. The disease is usually acquired in childhood and can be a disfiguring and disabling. There are usually no symptoms in the early stages but the lymphatic system is damaged. Damage to the lymphatic system leads to the later

manifestations of the disease. In long term filariasis leads to physical consequences such as painful, swollen limbs (lymphedema or elephantiasis) or swelling of scrotum (hydrocele). CAUSES: Filaria is caused by the parasite known as Wuchereria bancrofti in most parts of India. The infection is common in both urban and rural areas in India. Culex mosquito is the vector that transmits the disease from one person to other. Filariasis develops usually after many mosquito bites over several months to year. The risk of infection is higher in people living for a long time in areas where filariasis is common. The risk of infection in short-term tourists to filarial endemic areas is very low. SYMPTOMS: Most people initially are not aware that they have lymphatic filariasis. Filariasis is not life threatening infection but it can cause lasting damage to the lymph system and kidneys. In the initial stages the disease causes no symptoms and the problems start after the adult worms die. Damage to the lymph system leads to fluid collection and swelling in the arms, breasts and legs. The swelling is called lymphedema. In men, the scrotum can become swollen. It is called hydrocele. The swelling in the leg, arm, or genital area can be several times its normal size. Swelling of the limb and damage to the lymphatic system increases the risk of bacterial infections of the skin and lymph system. Repeated infections lead to hardening and thickening of the skin, known as elephantiasis. Rare manifestations of filariasis include tropical pulmonary eosinophilia and chyluria. Treatment : In communities where filariasis is common it is important to eliminate microfilariae from the blood of infected individuals. This helps to interrupt transmission of infection by mosquito bites. Currently it is recommended that people infected with adult worms should be given a yearly dose of medicine (DEC) that kills the circulating microfilariae in the blood. Single dose has been shown to be as effective as formerly-recommended 12-day regimens of DEC. In endemic areas mass drug administration (DEC) is done to interrupt transmission of disease. To prevent worsening of lymphedema and secondary bacterial infection in the tissues with compromised lymphatic function practice the following measures:
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Wash the swollen area with soap and water properly daily. If there is any infection on the skin use anti-bacterial cream, this prevents progression and worsening of bacterial infections. Keep the swollen arm or leg elevated and exercise regularly to move the fluid and improve the lymph flow.

PREVENTION:

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Detection and appropriate treatment of people with microfilaria in blood (microfilaria carriers) Use Anti mosquito measures which includes use of antilarval measures at weekly intervals in urban areas and indoor residual spray in rural areas. Insecticide used to kill larva include temephos, Fenthion. Filling ditches, pits, low lying areas, deweeding also help to control mosquito breeding avoiding mosquito bites
is a mosquito-borne virus that leads to

IX. Japanese encephalitis

swelling of the brain. It can affect the central nervous system and cause severe complications, even death. Japanese encephalitis is a water related disease that is caused by

the Culex Tritaeniorhynchus and Culex Vishnui type of mosquitoes. Causes: Japanese encephalitis can occur if you are bitten by a mosquito infected with the virus. These mosquitoes favourite breeding ground is water flooded paddy fields. Therefore, Japanese encephalitis is majorly found in the agricultural regions of India. Symptoms of Japanese encephalitis usually appear 5-15 days after the bite from an infected mosquito. If you experience any of these symptoms, do not assume it is due to Japanese encephalitis. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
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Agitation Brain damage Chills Coma Confusion Convulsions (especially in infants) Fever Headache Nausea Neck stiffness Paraplegia Tiredness Tremors Vomiting

TREATMENT: Since there is no specific treatment for Japanese encephalitis, care is focused
on treating specific symptoms and complications. Prevention: There is a Japanese encephalitis vaccine. It is recommended for people who live or travel in certain rural parts of Asia and for lab workers who are at risk of exposure to the virus. Also, take the following measures to protect yourself from mosquito bites to prevent the disease: y y Remain in well-screened areas. Wear clothes that cover most of your body.

Use insect repellents that contain up to 30% NN-diethyl metatoluamide (DEET) on skin and clothing.

X. malaria
Malaria is an infectious disease caused by a parasite (plasmodium) which is transmitted from human to human by the bite of infected female Anopheles mosquitoes. Causes: Malaria or Malarial fever is spread by the Plasmodium parasite mosquito that breeds in water bodies like lakes and paddy fish. Stagnant water is another favourite breeding ground for these deadly parasites.

Malaria mostly kills children in India, as adults slowly form some sort of immunity against the parasite, over the years.
Symptoms of Malaria Malarial attacks present over 4 to 6 hours with shaking chills, high fever, and sweating, and are often associated with fatigue, headache, dizziness, nausea, vomiting, abdominal cramps, dry cough, muscle or joint pain, and back ache. The attacks may occur every other day or every third day. Cerebral malaria and death can occur, sometimes within 24 hours, if the infection is caused by plasmodium falciparum. Fever or other symptoms can develop in malaria as early as 8 days or as late as 60 days after exposure or stopping prophylaxis. For plasmodium vivax in temperate areas, the delay may be up to one year. Treatment : Drugs include chloroquine, mefloquine, primaquine, quinine, pyrimethaminesulfadoxine (Fansidar), and doxycycline. Some plasmodium have developed resistance to certain medications, and therefore, alternative medications will be prescribed for you.

Prevention: Prevention is based on:

y y y evaluating the risk of exposure to infection preventing mosquito bites by using DEET mosquito repellant, bed nets, and clothing that covers most of the body chemoprophylaxis (preventive medications)